Zur Sicherheit einer intravenösen Langzeitantibiose bei Neuroborreliose
Zur Sicherheit einer intravenösen Langzeitantibiose im fortgeschrittenen Stadium einer Borreliose
Die Arbeitsgruppe im Stricker et al. kommt in ihrer jüngst erschienen Studie an 200 Patienten, die im Median etwa 3.8 Monate intravenös mit Antibiotika behandelt worden waren zu dem Schluss, dass das Risiko für Komplikationen bei sachgerechter intravenöser Langzeittherapie in der untersuchten Studienpopulation gering ist. Eine englische Kurzzusammenfassung können sie im folgenden lesen:
Safety of intravenous antibiotic therapy in patients referred for treatment of neurologic Lyme disease.
Author: Stricker RB , Green CL , Savely VR , Chamallas SN , Johnson L
Source: Minerva Med, 101(1): 1-7 2010
Abstract: AIM: Although intravenous antibiotic therapy is recommended for neurologic Lyme disease, safety concerns have been raised about treatment beyond 30 days in patients with persistent neurologic symptoms. The goal of our study was to evaluate the safety of extended intravenous antibiotic therapy in patients referred for treatment of neurologic Lyme disease. METHODS: We enrolled 200 consecutive patients with significant neurologic symptoms and positive testing for Borrelia burgdorferi. Patients were treated with intravenous antibiotics using various intravascular devices (IVDs). Standard IVD care was administered to all patients, and monitoring for medication reactions and IVD complications was performed on a weekly basis.
RESULTS: The mean length of intravenous antibiotic treatment was 118 days (range, 7-750 days) representing 23,654 IVD-days. Seven patients (3.5%) experienced allergic reactions to the antibiotic medication, and two patients (1.0%) had gallbladder toxicity. IVD complications occurred in 15 patients (7.5%) representing an incidence of 0.63 per 1,000 IVD-days. The IVD problems occurred an average of 81 days after initiation of treatment (range, 7-240 days). There were six suspected line infections for an incidence of 0.25 per 1,000 IVD-days. Only one of the IVD infections was confirmed, and no resistant organisms were cultured from any patient. None of the IVD complications were fatal.
CONCLUSION: Prolonged intravenous antibiotic therapy is associated with low morbidity and no IVD-related mortality in patients referred for treatment of neurologic Lyme disease. With proper IVD care, the risk of extended antibiotic therapy in these patients appears to be low.