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Intramuscular Bicillin For Persistent Pediatric Lyme Disease - Louis Corsaro, M.D.
FROM THE ABSTRACT: * We conducted a chart review and follow-up of all patients with seropositive Lyme disease treated with IM Bicillin in a private pediatric out-patient office in a Lyme endemic area between 1993 and 1995. * Methods: The diagnosis of Lyme disease was based on at least one seropositive test and typical articular or neurological symptoms. Treatment consisted of either Bicillin LA or CR 1.2-2.4 million units administered weekly. Relapse was defined as the return of any symptoms which required greater than two weeks of Abx treatment. To assess efficacy, the longest period without symptoms prior to IM Bicillin was compared to the symptom free interval after bicillin. * 61 charts were reviewed of which 25 met study criteria for seropositive Lyme disease. Mean age at time of chart review 11.9 +/- 4.4 years. Mean age at time of Lyme disease onset was 9.4 +/- 4.3 years. Mean duration of symptoms prior to the administration of antibiotics was 16 +/- 32 weeks. * All patients failed to sustain improvement after courses of oral antibiotics. Five children received IV antibiotics and all failed to sustain improvement. Of the twenty-five patients given IM PCN (Intramuscular Penicillin), the mean duration of IM treatment was 4-38 weeks (mean 14.5 +/- 8.9 wks; median 10.5 wks). * Of the 23 children available to assess relapse after treatment, 19 were symptom free, 3 had mild symptoms that did not require treatment, and 1 relapsed and was being retreated. * Conclusion: A chart review and follow-up studies suggest that intramuscular Bicillin may be a particularly effective treatment for children with antibiotic refractory persistent Lyme disease whether previously treated orally or with intravenous antibiotics.
FROM THE NOTES: * If the patient was going to relapse it generally occurred the second week following cessation of treatment. * If relapse occurred treatment was reinstituted for another 4 weeks before trying to stop again. This cycle continued until the patient was symptom free for two weeks beyond ending of therapy.
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