Gary P. Wormser, MD; John Nowakowski, MD; Robert B. Nadelman, MD
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Wormser G., Nowakowski J., Nadelman R.; Treatment of Early Lyme Disease. Ann Intern Med. 2004;140:577-578. doi: 10.7326/0003-4819-140-7-200404060-00023
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Published: Ann Intern Med. 2004;140(7):577-578.
Stricker and colleagues have “creatively” misread our study, in which 10 days and 20 days of doxycycline treatment were demonstrated to have similar efficacy in patients with erythema migrans. Efficacy was evaluated at 4 different, specific time points (20 days, 3 months, 12 months, and 30 months), as well as at the time of the last visit with the patient, in both an on-study and an intention-to-treat analysis. The sample size estimates were based, as explicitly stated in the manuscript, on the 12-month time point, and were met.
At last patient contact in our intention-to-treat analysis, the complete response rates for the 10-day and 20-day doxycycline groups were nearly identical (83.3% and 86.2%, respectively). The patients who were classified as partial responders had usually mild subjective symptoms, such as intermittent fatigue or arthralgias. “Healthy” control groups of adults without a history of Lyme disease have been found to have similar symptoms at comparable frequencies (1), suggesting that Lyme disease is one of a number of triggers of such symptoms or that our patients' symptoms were unrelated to their episode of Lyme disease. In either case, the take-home message is that symptoms in early Lyme disease sometimes resolve slowly but will do so at the same rate regardless of whether antibiotic therapy is extended beyond 10 days.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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