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Better pediatric Lyme meningitis treatments needed
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Current Lyme meningitis treatment regimens have substantial associated morbidity, according to study results from researchers at the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del.
Amy D. Thompson, MD, and colleagues from the division of emergency conducted a retrospective cohort study of 149 children with a median age of 10 years who presented with Lyme meningitis in one of three EDs in the Lyme-endemic areas of Pennsylvania and Massachusetts between 1997 and 2010. Children were treated with parenteral antibiotics, most commonly ceftriaxone, received through a peripherally inserted central catheter (PICC).
The researchers said children often have complications related to either the PICC or the prescribed antibiotic. According to Thompson and colleagues, 26% of the 149 study participants with follow-up records had one or more complications. Adverse drug reactions occurred in 10% of patients.
They said of the 144 children who had a PICC placed, 17% had at least one PICC-associated complication; 10% had a mechanical problem; 8% had an infectious complication; and 1% had a venous thromboembolism.
“Given the high complication rates, aseptic infusion techniques, stabilization devices, and patient education should be optimized,” the researchers concluded. “Further investigation into alternate treatment regimens including a randomized clinical trial comparing oral doxycycline to parental ceftriaxone is needed.”
Disclosure: Dr. Thompson reports no relevant financial disclosures.
Perspective
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Eugene Shapiro, MD
This article makes some important points about high rates of complications associated with treatment of Lyme meningitis with intravenous ceftriaxone. The authors also make the good point that studies in adults from Europe found that orally administered doxycycline was as effective as ceftriaxone for treating Lyme meningitis and might be a good alternative. I also think that being especially careful that the diagnosis of Lyme meningitis is accurate before starting treatment is an important way to reduce the number of complications of treatment.
We are not told what proportion of the patients with Lyme meningitis were diagnosed based on a positive IgM antibody result alone (one of the criteria that were used to make the diagnosis). However, it is well recognized that false-positive IgM results are especially common (Seriburi V. Clin Microbiol Infect. 2012;doi:10.1111/j.1469-0691.2011.03749.x). Use of now widely available modern diagnostic techniques, such as polymerase chain reaction of cerebrospinal fluid for enteroviral infection, may help improve the accuracy of the diagnosis and reduce unnecessary complications of treatment.
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Thompson AD. Pediatr Infect Dis J. 2012;doi:10.1097/INF.0b013e31825eb3c7.
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