CDC Shares Risks Associated with Long-Term Antibiotic Therapy for Chronic Lyme Disease

Chronic Lyme disease is a relatively new diagnosis, often made without supportive data from laboratory tests, that has become a sort of “catch-all” for otherwise unexplained fatigue, pain, and neurologic symptoms.

Although treatment for chronic Lyme through prolonged immunoglobulin therapy or long-term IV antibiotic use has provided some patients with relief of their symptoms, it may also expose them to complications related to the prescribed modalities. Researchers affiliated with the Centers for Disease Control and Prevention (CDC) highlighted some of these risks in a case presentation published June 16, 2017 in the agency’s Morbidity and Mortality Weekly Report (MMWR). According to the CDC, the exact numbers of Americans who receive treatment for chronic Lyme disease remains unknown.

“[Several] studies have shown that prolonged treatments for Lyme disease are increasing—according to Tseng et al, ‘the incidence of extended antibiotic therapy among patients evaluated for Lyme disease in 2010-2012 was higher than in 2004-2006,’ Moreover, among these patients, nearly half were treated with more than two antibiotics in 2010-2012, which is not recommended,” a spokesperson for the CDC told Contagion^®. “Long-term antibiotics or other alternative treatments for Lyme disease can be dangerous and have not been shown to lead to substantial long-term improvement in patient outcomes.”

In fact, the case presentation in MMWR follows up on the findings linking the treatment of chronic Lyme disease to poor outcomes, and some of the studies date back to the early 2000s. More recently, clinicians in a case published by JAMA Internal Medicine in December 2016 described a woman who developed drug reaction with eosinophilia and systemic symptoms (DRESS) following months of antibiotic treatment (with multiple agents) for unconfirmed Lyme disease, this despite the fact a New England Journal of Medicine study published earlier in 2016 found that long-term antibiotic therapy in this setting does not provide “additional beneficial effects on health-related quality of life.”

To reinforce these findings, the CDC team presented 5 cases of poor outcomes following therapy for chronic Lyme disease, including 2 cases of septic shock (1 of them fatal) attributed to long-term antibiotic use and 1 case of Clostridium difficile colitis, also related to prolonged antibiotic therapy.

The authors of the presentation write that they hope to make clinicians aware of the “severity and scope of adverse effects that can be caused by the use of unproven treatments for chronic Lyme disease, [including]… injuries related to unnecessary procedures, bacteremia and resulting metastatic infection, venous thromboses, and missed opportunities to diagnose and treat the actual underlying cause of the patient’s symptoms.” They add that, “Systematic investigation into the scope and effects of these complications, including the rate and extent of infections and the pathogens associated with these infections, would be helpful to inform clinical practice and fully characterize the risks…”

A CDC spokesman also noted, “The case-based presentation was used to illustrate the risks of these treatments. As is typical for case reports/case series published in peer-reviewed scientific literature, the intent was to highlight an important medical or public health finding. We wanted to raise awareness about the risks of these treatments to help health care providers and patients make informed decisions about their care. This report underscores the importance for patients and health care providers to be aware of the risks of long-term and alternative treatments offered to patients given a diagnosis of chronic Lyme disease.”

More discussion on Lyme disease and why the medical community remains at odds over chronic Lyme disease, coming soon in an upcoming Peer Exchange which will be posted on the Contagion^® website in July 2017.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.