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J Neurol. 2017 Jul;264(7):1506-1510. doi: 10.1007/s00415-017-8559-z. Epub 2017 Jul 4.

Lyme neuroborreliosis: do we treat according to guidelines?

Author information

1
Department of Neurology, Sørlandet Hospital Trust, PO Box 416, 4604, Kristiansand, Norway. aslaug.rudjord.lorentzen@sshf.no.
2
The Norwegian National Advisory Unit on Tick-Borne Diseases, Arendal, Norway. aslaug.rudjord.lorentzen@sshf.no.
3
Department of Neurology, Sørlandet Hospital Trust, PO Box 416, 4604, Kristiansand, Norway.
4
Department of Neurology, Møre and Romsdal Hospital Trust, Molde, Norway.
5
Eide legesenter as, Eide, Norway.
6
Department of Neurology, Stavanger University Hospital, Stavanger, Norway.
7
Department of Infectious Diseases, Stavanger University Hospital, Stavanger, Norway.
8
Department of Neurology, Telemark Hospital Trust, Skien, Norway.
9
Department of Neurology, Oslo University Hospital, Oslo, Norway.
10
Department of Neurology, Helse Fonna Trust, Haugesund, Norway.
11
Department of Neurology, St. Olavs University Hospital, Trondheim, Norway.
12
Department of Neurology, Østfold Hospital Trust, Kalnes, Norway.
13
Department of Neurology, Vestre Viken Trust, Drammen, Norway.
14
Department of Neurology, Haukeland University Hospital, Bergen, Norway.
15
Department of Neurology, Innlandet Hospital Trust, Lillehammer, Norway.
16
Department of Neurology, Nord-Trøndelag Trust, Namsos, Norway.
17
The Norwegian National Advisory Unit on Tick-Borne Diseases, Arendal, Norway.
18
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
19
Department of Rehabilitation, Sørlandet Hospital Trust, Kristiansand, Norway.

Abstract

Evidence-based guidelines, published in 2010, equate the efficacy of oral and intravenous antibiotics and recommend treatment duration of 2 weeks in early Lyme neuroborreliosis (LNB) without encephalitis or myelitis. Further, the Norwegian health authorities give a general advice to choose oral rather than intravenous administration when proven effective, due to lower costs, fewer risks, and reduced patient inconvenience. In this study we aimed to chart LNB treatment practice in Norway and compare it to these recommendations. Adult patients diagnosed with definite LNB between 2007 and 2013 in 11 different hospitals in the four health regions in Norway were invited to answer a questionnaire regarding duration and administration of antibiotic treatment. A total of 253 patients answered. Median age at diagnosis was 59 years (range 19-83), and 125 (49%) were women. Duration of treatment was 1 week in 7 (3%) patients, 2 weeks in 81 (32%), 3 weeks in 62 (25%), 4 weeks in 48 (19%), 5 weeks in 12 (5%), ≥6 weeks in 29 (12%), and unknown in 14 (6%). Treatment was given orally in 77 (30%) patients, intravenously in 110 (44%), both orally and intravenously in 65 (26%), and unknown in one. Treatment practices differed between the health regions (p = 0.002). During the study period, there were no significant time trend neither with respect to proportion of patients treated for only 2 weeks (OR 0.899, p = 0.109) nor with respect to proportion of patients treated exclusively with oral antibiotics (OR 1.131, p = 0.074). In conclusion, there seem to be a gap between evidence-based recommendations and treatment practice of LNB in Norway.

KEYWORDS:

Antibiotic treatment; Borrelia; Guidelines; Lyme neuroborreliosis; Tick-borne disease

PMID:
28676925
DOI:
10.1007/s00415-017-8559-z
[Indexed for MEDLINE]

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