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Incidence and Patterns of Extended-Course Antibiotic Therapy in Patients Evaluated for Lyme Disease
Yi-Ju Tseng1, Aurel Cami2, Donald A Goldmann3
1Computational Health Informatics Program, Boston Children's Hospital.
Background:
Most patients with Lyme disease (LD) can be treated effectively with 2-4 weeks of antibiotics. The Infectious Disease Society of America guidelines do not currently recommend extended treatment even in patients with persistent symptoms.
Methods:
To estimate the incidence of extended use of antibiotics in patients evaluated for LD, we retrospectively analyzed claims from a nationwide US health insurance plan in 14 high-prevalence states over 2 periods: 2004-2006 and 2010-2012.
Results:
As measured by payer claims, the incidence of extended antibiotic therapy among patients evaluated for LD was higher in 2010-2012 (14.72 per 100 000 person-years; n = 684) than in 2004-2006 (9.94 per 100 000 person-years; n = 394) (P < .001). Among these patients, 48.8% were treated with ≥2 antibiotics in 2010-2012 and 29.9% in 2004-2006 (P < .001). In each study period, a distinct small group of providers (roughly 3%-4%) made the diagnosis in >20% of the patients who were evaluated for LD and prescribed extended antibiotic treatment.
Conclusions:
Insurance claims data suggest that the use of extended courses of antibiotics and multiple antibiotics in the treatment of LD has increased in recent years.
Insights
The use of extended antibiotic treatment for Lyme disease (LD) has increased, with more patients receiving multiple antibiotics. This trend was observed in insurance claims data from 2004-2012.
Area of Science:
- Infectious Diseases
- Public Health
- Health Services Research
Background:
- Standard Lyme disease (LD) treatment involves 2-4 weeks of antibiotics.
- Current Infectious Disease Society of America guidelines do not endorse extended antibiotic therapy for persistent LD symptoms.
Purpose of the Study:
- To assess the incidence of extended antibiotic use in patients evaluated for LD.
- To analyze trends in antibiotic prescribing for LD over two distinct time periods.
Main Methods:
- Retrospective analysis of nationwide US health insurance claims.
- Data collected from 14 high-prevalence states across two periods: 2004-2006 and 2010-2012.
Main Results:
- Extended antibiotic therapy for LD increased from 9.94 to 14.72 per 100,000 person-years between the study periods.
- The use of multiple antibiotics (≥2) rose significantly, from 29.9% to 48.8% of patients.
- A small percentage of providers (3-4%) accounted for over 20% of LD diagnoses with extended antibiotic treatment.
Conclusions:
- Insurance claims indicate a rise in extended and multiple antibiotic courses for Lyme disease treatment.
- These findings suggest a growing trend in antibiotic use beyond standard recommendations for LD.
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