Safety of IV antibiotic therapy of neurologic Lyme disease

Topics with information and discussion about published studies related to Lyme disease and other tick-borne diseases.
Martian
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Safety of IV antibiotic therapy of neurologic Lyme disease

Post by Martian » Thu 18 Mar 2010 3:29

Oh geez, this sucks...

Johnson L. as one of the authors? Are you kidding me, I thought she was a lawyer!? But Stricker RB and Savely VR are actually even worse; a.o. they both jumped on the Morgellons bandwagon and associate it with Lyme disease and allegedly treat patients for that with long-term IV antibiotic treatment.

And what is the point of this study? Excuse excessive IV treatment even though there is no evidence that it's better than oral intake of antibiotics? How can one trust a study that supports their own practices?

I also don't agree with the positive conclusion, because "two patients (1.0%) had gallbladder toxicity. IVD complications occurred in 15 patients (7.5%)" doesn't sound like such a good results to me when the mean length of intravenous antibiotic treatment was only 118 days. There are many alleged Lyme patients who have much longer IV treatments, longer than a year is not an exception, maybe over two years is.

And then this: "None of the IVD complications were fatal." LOL yeah, that would be the last straw!
Minerva Med. 2010 Feb;101(1):1-7.

Safety of intravenous antibiotic therapy in patients referred for treatment of neurologic Lyme disease.

Stricker RB, Green CL, Savely VR, Chamallas SN, Johnson L.

Union Square Medical Associates, San Francisco, CA, USA - rstricker@usmamed.com.

AIM: Although intravenous antibiotic therapy is recommended for neurologic Lyme disease, safety concerns have been raised about treatment beyond 30 days in patients with persistent neurologic symptoms. The goal of our study was to evaluate the safety of extended intravenous antibiotic therapy in patients referred for treatment of neurologic Lyme disease.

METHODS: We enrolled 200 consecutive patients with significant neurologic symptoms and positive testing for Borrelia burgdorferi. Patients were treated with intravenous antibiotics using various intravascular devices (IVDs). Standard IVD care was administered to all patients, and monitoring for medication reactions and IVD complications was performed on a weekly basis.

RESULTS: The mean length of intravenous antibiotic treatment was 118 days (range, 7-750 days) representing 23,654 IVD-days. Seven patients (3.5%) experienced allergic reactions to the antibiotic medication, and two patients (1.0%) had gallbladder toxicity. IVD complications occurred in 15 patients (7.5%) representing an incidence of 0.63 per 1,000 IVD-days. The IVD problems occurred an average of 81 days after initiation of treatment (range, 7-240 days). There were six suspected line infections for an incidence of 0.25 per 1,000 IVD-days. Only one of the IVD infections was confirmed, and no resistant organisms were cultured from any patient. None of the IVD complications were fatal.

CONCLUSION: Prolonged intravenous antibiotic therapy is associated with low morbidity and no IVD-related mortality in patients referred for treatment of neurologic Lyme disease. With proper IVD care, the risk of extended antibiotic therapy in these patients appears to be low.

PMID: 20228716 [PubMed - in process]

edit: added journal data: Minerva Med. 2010 Feb;101(1):1-7. For some reason or my error this was missing.
Last edited by Martian on Thu 3 Nov 2011 0:17, edited 1 time in total.

Cobwebby
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Re: Safety of IV antibiotic therapy of neurologic Lyme disea

Post by Cobwebby » Thu 18 Mar 2010 5:31

"None of the IVD complications were fatal."

I think the safety or risks of IV antibiotic therapy are the same for whatever the disease.There's a risk of death whenever it is used regardless.

I risked death and lived to tell about it. Now whether it was REALLY necessary, I don't know for sure. I only had two years of disability-would oral antibiotics have crossed the brain barrier as efficiently?
The greater part of our happiness or misery
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Spanky
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Re: Safety of IV antibiotic therapy of neurologic Lyme disea

Post by Spanky » Thu 18 Mar 2010 16:55

Cobwebby:

-would oral antibiotics have crossed the brain barrier as efficiently?
Right. Exactly. I wanna know, too.

What's the supposed 'LLMD' rationale for extended iv therapy? What's the justification?

As I understand it, ivs are used to get the antribiotic level, "load" up quickly in patients where there is reason to fear permanent or severe complications. (Cardio, neuro).

If those complications, symptoms are not present...then are the ivs for the patient's benefit...or the "LLMD"s?

Martian
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Re: Safety of IV antibiotic therapy of neurologic Lyme disea

Post by Martian » Thu 18 Mar 2010 16:59

Cobwebby wrote:would oral antibiotics have crossed the brain barrier as efficiently?
That depends on the properties of the antibiotic, and it seems to me that the route (IV or oral) in principle doesn't make a difference to that. Of course some antibiotics are only suitable for oral or IV.

What does make a difference though is the dosage and timing. Since antibiotics can be time- or concentration-dependent, it could make a difference in some cases that higher peak levels can be reached with IV administration. That can be both positive and negative depending on the type of antibiotic.

But even if it would indeed be mandatory to use IV to cross the blood brain barrier efficiently, where is the evidence that this needs to be done over an extended period of time, let's say over 6 months?

LymeH
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Re: Safety of IV antibiotic therapy of neurologic Lyme disea

Post by LymeH » Sun 21 Mar 2010 5:33

Martian wrote:Stricker RB, Green CL, Savely VR, Chamallas SN, Johnson L.
We enrolled 200 consecutive patients with significant neurologic symptoms and positive testing for Borrelia burgdorferi. Patients were treated with intravenous antibiotics using various intravascular devices (IVDs). Standard IVD care was administered to all patients, and monitoring for medication reactions and IVD complications was performed on a weekly basis.

....With proper IVD care, the risk of extended antibiotic therapy in these patients appears to be low.

PMID: 20228716 [PubMed - in process]
My understanding is that most LLMDs are not administering the IV antibiotics or assisting the patient with maintaining their port. They are sending the patients home and expecting them to maintain their IV port and self-infuse by themselves. They are endangering the patient. In the cases of 'significant neurological symptoms' it is reckless to expect such an extremely ill patient to be capable of mixing IV medications, accessing ports/PICCs, and maintaining sterile conditions.

With so much emphasis on the profound neuropsych complications of Lyme disease, how can a physician reasonably expect that a patient in this condition is capable of safe infusion techniques?

(edited for clarity)
Last edited by LymeH on Fri 23 Sep 2011 18:24, edited 1 time in total.

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Yvonne
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Re: Safety of IV antibiotic therapy of neurologic Lyme disea

Post by Yvonne » Sun 21 Mar 2010 10:16

LymeHystorian wrote :
They are sending the patients home and expecting them to care for the IV's themself. They are endangering the patient. In the cases of 'significant neurological symtoms' it is reckless


I think that's really not good.

It should at least be done by a nurse

But I really think that it must be done under medical supervision
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Martian
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Re: Safety of IV antibiotic therapy of neurologic Lyme disea

Post by Martian » Sun 21 Mar 2010 15:29

LymeHystorian wrote:My understanding this that most LLMD's are not administering the IV antibiotics. They are sending the patients home and expecting them to care for the IV's themself. They are endangering the patient. In the cases of 'significant neurological symtoms' it is reckless to expect a patient to be capable of mixing IV meds, accessing ports/PICCs, and maintaining sterile conditions.

With so much emphasis on the profound neuropsych complications of Lyme disease, how can a physician reasonaly expect that a patient in this condition is capable of safe infusion techniques?
Good points! This makes the conclusions of this "study" even more dubious.

Cobwebby
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Re: Safety of IV antibiotic therapy of neurologic Lyme disea

Post by Cobwebby » Sun 21 Mar 2010 21:40

The study stated that: Standard IVD care was administered to all patients, and monitoring for medication reactions and IVD complications was performed on a weekly basis.

In my case-and I think for most Lymies, the PICC line was inserted in a hospital and an infusion nurse followed up the next day to administer the first dose. Then she returned once a week to change bandage and look for complications.

BUT I was told that with concerns of any kind, big or small, they were available 24/7-and it turns out they were. I was also instructed to take my temp several times a day-which I didn't always do-otherwise I followed instructions to the letter.

I had the same IV the whole time(8 months)-but I have heard of Lymies who have needed to have their line changed several times.

This is a situation where it is very important that the patient be their own advocate -or in the case of severe neurological problems have an attendent-spouse/family member/ live-in/significant other who can oversee the care.
Using IV's outside of hospital settings has saved the insurance companies quite a bit of money. As a patient, I also preferred this outside of hospital setting, too. If my insurance company had not authorized it, I would have continued on orals.

Too bad no two Lymies are exactly alike so they could run parallel studies.
The greater part of our happiness or misery
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and not on our circumstances.
Martha Washington

LymeH
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Re: Safety of IV antibiotic therapy of neurologic Lyme disea

Post by LymeH » Mon 22 Mar 2010 1:16

I wonder how they define 'standard IVD care'?

Exactly what criteria do they use to monitor for medication interactions - what do they even consider as an interaction?

Unfortunately, sometimes people don't have an advocate and have to rely on the physician's judgment. Sometimes patients are thrown to the wind - expected to do their own IVs and the physician won't arrange for home nursing care and won't allow their nurses to mix up IV solutions or provide any other on-going IV support. Surely, there are many in Lymeland with a similar experience - or are they happy with this quality of care? Perhaps they feel like they will do/endure anything just to get that IV, else the Lyme disease will kill them? They blindly trust their LLMD, which some describe as having faith in your doctor and giving them a fair chance to help you...
Last edited by LymeH on Fri 23 Sep 2011 18:26, edited 1 time in total.

Cobwebby
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Re: Safety of IV antibiotic therapy of neurologic Lyme disea

Post by Cobwebby » Mon 22 Mar 2010 4:37

"They blindly trust their LLMD, which some describe as having faith in your doctor and giving them a fair chance to help you..."

I'm guilty of this. It all felt like a crap shoot, too. But I must say-even with all the fumbling around with various antibiotics I eventually got better.
The greater part of our happiness or misery
depends on our dispositions,
and not on our circumstances.
Martha Washington

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