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Oral therapy for pediatric Lyme meningitis safe, effective
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Patients who received oral antimicrobial therapy for pediatric Lyme meningitis had no serious adverse events and achieved symptom resolution, according to a 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.”
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 antimicrobial therapy.
During their hospital stay, 34 children were administered at least one dose of parenteral antimicrobial therapy of 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 antimicrobial 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.” – by Bruce Thiel
Disclosures: The authors report no relevant financial disclosures.
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