The Lyme Disease Network
|Title:||Intramuscular Bicillin For Persistent Pediatric Lyme Disease|
|Authors:||Corsaro L; Montemayer M; Fallon B|
|Conference:||9th Annual International Scientific Conference on Lyme Disease & Other Tick-Borne Disorders, Westin Copley Plaza Hotel, Boston, MA, April 19-20, 1996|
|Presenter:||Louis Corsaro, M.D.|
Northern Westchester Hospital
Columbia University, New York City
Steere et al ('85) reported that 3 weeks of IM benzathine penicillin led to a complete resolution of Lyme arthritis in 35% of patients. Cimmino and Accardo ('92) reported two cases of adult patients with chronic Lyme arthritis resistant to the recommended antibiotic regimens who were cured by 2-6 months of treatment with benzathine penicillin. Based solely on these reports, the use of IM Penicillin among patients with persistent Lyme disease has become common. As a preliminary study of efficacy, we conducted a chart review and follow-up of all patients with seropositive Lyme disease treated with IM Bicillin in a private pediatric out-patient office in a Lyme endemic area between 1993 and 1995.
Methods: The diagnosis of Lyme disease was based on at least one seropositive test and typical articular or neurological symptoms. Treatment consisted of either Bicillin LA or CR 1.2-2.4 million units administered weekly. Relapse was defined as the return of any symptoms which required greater than two weeks of Abx treatment. To assess efficacy, the longest period without symptoms prior to IM Bicillin was compared to the symptom free interval after bicillin.
Results: 61 charts were reviewed of which 25 met study criteria for seropositive Lyme disease. Mean age at time of chart review 11.9 +/- 4.4 years. Mean age at time of Lyme disease onset was 9.4 +/- 4.3 years. Mean duration of symptoms prior to the administration of antibiotics was 16 +/- 32 weeks. All patients failed to sustain improvement after courses of oral antibiotics ranging from 4 to 22 weeks (mean 25.9 +/- 29 wks; median 14 wks). Five children received IV antibiotics and all failed to sustain improvement despite having received 4-27 weeks of IV treatment (mean 9.6 +?- 9.8 wks; median 6 weeks). The longest period free of clinically significant Lyme disease since symptom onset and prior to receiving IM Bicillin ranged from 0-76 wks (mean 60.2 +/- 84.2 wks.; median 8 wks). Of the twenty-five patients given IM PCN, the mean duration of IM treatment was 4-38 weeks (mean 14.5 +/- 8.9 wks; median 10.5 wks). One was still receiving treatment at the time of follow-up and another was symptom free having just completed treatment. Of the 23 children available to assess relapse after treatment, 19 were symptom free, 3 had mild symptoms that did not require treatment, and 1 relapsed and was being retreated. Among the 22 relapse free children, the follow-up period ranged from 2 to 62 week (mean 27 +/- 15.5 wks; median 22 wks). Seventeen of the 22 children had exceeded their longest relapse free interval prior to IM Bicillin, 14 of whom had been relapse free by more than twice the duration of their pre-Bicillin relapse free interval.
Conclusion: A chart review and follow-up studies suggest that intramuscular Bicillin may be a particularly effective treatment for children with antibiotic refractory persistent Lyme disease whether previously treated orally or with
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