Oral antibiotic therapy for pediatric Lyme meningitis safe, effective

Patients who received oral antibiotic therapy for pediatric Lyme meningitis had no serious adverse events and achieved symptom resolution, according to study results published in the Journal of the Pediatric Infectious Diseases Society.

“Although well-established diagnostic criteria for Lyme meningitis exists, the optimal management of pediatric Lyme meningitis is controversial,” Santiago M.C. Lopez, MD, of the division of pediatric infectious diseases at UPMC Children’s Hospital of Pittsburgh, and colleagues wrote. “No American studies have specifically evaluated outcomes of oral therapy for pediatric Lyme meningitis. In this study, we reviewed the clinical response and final outcome in pediatric patients after oral therapy for Lyme meningitis.”

Efficacy of oral antibiotics

Lopez and colleagues used a case series chart review to identify 38 patients (median age, 9.4 years; 62.5% male) who were diagnosed and treated for Lyme meningitis between January 2012 and May 2017 at UPMC Children’s Hospital of Pittsburgh. They compared the efficacy of oral vs. parenteral antibiotic therapy.

Santiago M.C. Lopez

During their hospital stay, 34 children were administered at least one dose of parenteral antibiotic therapy with ceftriaxone — including 21 who received parenteral therapy only and 13 who also received one or more doses of oral therapy of doxycycline. Four patients received only oral therapy of doxycycline during their hospital stay.

Upon discharge, 32 patients received oral therapy with doxycycline and amoxycillin. Five others received a combination of oral doxycycline and parenteral therapy of ceftriaxone, and one patient received IV ceftriaxone. The researchers reported no serious adverse events related to amoxicillin and that two patients developed potential adverse events related to doxycycline.

An infectious disease specialist, child neurologist or another health care provider conducted follow-up appointments. Patients who had been treated with oral antibiotic therapy had resolution of symptoms at follow-up.

“Our report highlights the efficacy of oral management for pediatric Lyme meningitis,” Lopez told Infectious Diseases in Children. “Advantages of this route included decreased days of hospitalization, limitation of potential peripherally inserted central catheter line complications and decreased cost of care. Echoing this work, the 2018 AAP Red Book recommendation now recommends oral doxycycline or ceftriaxone for Lyme meningitis therapy.”

Antibiotics resolve Lyme disease symptoms within weeks

Another study — also published in the Journal of the Pediatric Infectious Diseases Society — found that antibiotic treatment promptly resolved the symptoms of most pediatric patients with early-disseminated or late-stage Lyme disease within 3 to 18 days.

Mattia E. Chason, MD, a third-year resident at Children’s National Health System, and colleagues conducted a retrospective study of children who required hospitalization for early-disseminated and late-stage Lyme disease at a pediatric hospital in a region where Lyme disease is endemic. Their analysis included patients aged up to 18 years who were admitted between 2008 and 2015.

Of the 78 children (mean age at time of admission, 9.8 years; 55% white) in the study, 46% presented with symptoms consistent with early-disseminated Lyme disease and 54% presented with symptoms consistent with late-stage disease. Most patients had a diagnosis of Lyme disease, the researcher said.

Sixty-eight patients (87%) had received no therapy before presenting symptoms at the hospital. The researchers also noted that among patients who had undergone previous therapy, only one in 10 had received the correct dose of the appropriate antibiotics.

The patients were treated with doxycycline, cefotaxime or ceftriaxone and were transitioned to an outpatient antibiotic regimen, with a median duration of 4.5 days of hospitalization and one outpatient follow-up visit.

Meningitis was the most common presentation of early-disseminated disease (83%). In 25 patients with meningitis who experienced headache, median duration of headache was 10 days, with 85% experiencing headache resolution in less than 7 days. The median duration of headache resolution was 3 days (range, 1-67 days). The researchers noted that the duration of headache before admission was similar to prior study results describing characteristics of pediatric patients with Lyme neuroborreliosis and Lyme meningitis.

Most patients with late-stage disease had isolated arthritis, including monoarthritis of the knee, except for one patient who had arthritis with concomitant multiple erythema migrans rash. The 29 patients with arthritis experienced a median time to arthritis resolution of 18 days (range, 3-204 days), the researchers said.

“Full recovery occurred for most patients regardless of the duration of symptoms before their diagnosis, although recovery time was longer in patients with a prolonged duration of joint symptoms before treatment,” the researchers concluded. “Future prospective longitudinal studies in the pediatric population are needed to characterize more precisely the expected time course of recovery from all presentations of Lyme disease. This information is critical for guiding and informing practitioners’ and families’ expectations and to prevent complications associated with unproven therapies.” – by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.

Patients who received oral antibiotic therapy for pediatric Lyme meningitis had no serious adverse events and achieved symptom resolution, according to study results published in the Journal of the Pediatric Infectious Diseases Society.

“Although well-established diagnostic criteria for Lyme meningitis exists, the optimal management of pediatric Lyme meningitis is controversial,” Santiago M.C. Lopez, MD, of the division of pediatric infectious diseases at UPMC Children’s Hospital of Pittsburgh, and colleagues wrote. “No American studies have specifically evaluated outcomes of oral therapy for pediatric Lyme meningitis. In this study, we reviewed the clinical response and final outcome in pediatric patients after oral therapy for Lyme meningitis.”

Efficacy of oral antibiotics

Lopez and colleagues used a case series chart review to identify 38 patients (median age, 9.4 years; 62.5% male) who were diagnosed and treated for Lyme meningitis between January 2012 and May 2017 at UPMC Children’s Hospital of Pittsburgh. They compared the efficacy of oral vs. parenteral antibiotic therapy.

Santiago M.C. Lopez

During their hospital stay, 34 children were administered at least one dose of parenteral antibiotic therapy with ceftriaxone — including 21 who received parenteral therapy only and 13 who also received one or more doses of oral therapy of doxycycline. Four patients received only oral therapy of doxycycline during their hospital stay.

Upon discharge, 32 patients received oral therapy with doxycycline and amoxycillin. Five others received a combination of oral doxycycline and parenteral therapy of ceftriaxone, and one patient received IV ceftriaxone. The researchers reported no serious adverse events related to amoxicillin and that two patients developed potential adverse events related to doxycycline.

An infectious disease specialist, child neurologist or another health care provider conducted follow-up appointments. Patients who had been treated with oral antibiotic therapy had resolution of symptoms at follow-up.

“Our report highlights the efficacy of oral management for pediatric Lyme meningitis,” Lopez told Infectious Diseases in Children. “Advantages of this route included decreased days of hospitalization, limitation of potential peripherally inserted central catheter line complications and decreased cost of care. Echoing this work, the 2018 AAP Red Book recommendation now recommends oral doxycycline or ceftriaxone for Lyme meningitis therapy.”

Antibiotics resolve Lyme disease symptoms within weeks

Another study — also published in the Journal of the Pediatric Infectious Diseases Society — found that antibiotic treatment promptly resolved the symptoms of most pediatric patients with early-disseminated or late-stage Lyme disease within 3 to 18 days.

Mattia E. Chason, MD, a third-year resident at Children’s National Health System, and colleagues conducted a retrospective study of children who required hospitalization for early-disseminated and late-stage Lyme disease at a pediatric hospital in a region where Lyme disease is endemic. Their analysis included patients aged up to 18 years who were admitted between 2008 and 2015.

Of the 78 children (mean age at time of admission, 9.8 years; 55% white) in the study, 46% presented with symptoms consistent with early-disseminated Lyme disease and 54% presented with symptoms consistent with late-stage disease. Most patients had a diagnosis of Lyme disease, the researcher said.

Sixty-eight patients (87%) had received no therapy before presenting symptoms at the hospital. The researchers also noted that among patients who had undergone previous therapy, only one in 10 had received the correct dose of the appropriate antibiotics.

The patients were treated with doxycycline, cefotaxime or ceftriaxone and were transitioned to an outpatient antibiotic regimen, with a median duration of 4.5 days of hospitalization and one outpatient follow-up visit.

Meningitis was the most common presentation of early-disseminated disease (83%). In 25 patients with meningitis who experienced headache, median duration of headache was 10 days, with 85% experiencing headache resolution in less than 7 days. The median duration of headache resolution was 3 days (range, 1-67 days). The researchers noted that the duration of headache before admission was similar to prior study results describing characteristics of pediatric patients with Lyme neuroborreliosis and Lyme meningitis.

Most patients with late-stage disease had isolated arthritis, including monoarthritis of the knee, except for one patient who had arthritis with concomitant multiple erythema migrans rash. The 29 patients with arthritis experienced a median time to arthritis resolution of 18 days (range, 3-204 days), the researchers said.

“Full recovery occurred for most patients regardless of the duration of symptoms before their diagnosis, although recovery time was longer in patients with a prolonged duration of joint symptoms before treatment,” the researchers concluded. “Future prospective longitudinal studies in the pediatric population are needed to characterize more precisely the expected time course of recovery from all presentations of Lyme disease. This information is critical for guiding and informing practitioners’ and families’ expectations and to prevent complications associated with unproven therapies.” – by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.