https://www.ncbi.nlm.nih.gov/pubmed/30796143

Neurology. 2019 Feb 22. pii: 10.1212/WNL.0000000000007186. doi: 10.1212/WNL.0000000000007186. [Epub ahead of print]

Effect of prolonged antibiotic treatment on cognition in patients with Lyme borreliosis.

Berende A1, Ter Hofstede HJM2, Vos FJ2, Vogelaar ML2, van Middendorp H2, Evers AWM2, Kessels RPC2, Kullberg BJ2.

Author information

Abstract

OBJECTIVE:

To investigate whether longer-term antibiotic treatment improves cognitive performance in patients with persistent symptoms attributed to Lyme borreliosis.

METHODS:

Data were collected during the Persistent Lyme Empiric Antibiotic Study Europe (PLEASE) trial, a randomized, placebo-controlled study. Study participants passed performance-validity testing (measure for detecting suboptimal effort) and had persistent symptoms attributed to Lyme borreliosis. All patients received a 2-week open-label regimen of intravenous ceftriaxone before the 12-week blinded oral regimen (doxycycline, clarithromycin/hydroxychloroquine, or placebo). Cognitive performance was assessed at baseline and after 14, 26, and 40 weeks with neuropsychological tests covering the cognitive domains of episodic memory, attention/working memory, verbal fluency, speed of information processing, and executive function.

RESULTS:

Baseline characteristics of patients enrolled (n = 239) were comparable in all treatment groups. After 14 weeks, performance on none of the cognitive domains differed significantly between the treatment arms (p = 0.49-0.82). At follow-up, no additional treatment effect (p= 0.35-0.98) or difference between groups (p = 0.37-0.93) was found at any time point. Patients performed significantly better in several cognitive domains at weeks 14, 26, and 40 compared to baseline, but this was not specific to a treatment group.

CONCLUSIONS:

A 2-week treatment with ceftriaxone followed by a 12-week regimen of doxycycline or clarithromycin/hydroxychloroquine did not lead to better cognitive performance compared to a 2-week regimen of ceftriaxone in patients with Lyme disease-attributed persistent symptoms.

CLINICALTRIALSGOV IDENTIFIER:

NCT01207739.

CLASSIFICATION OF EVIDENCE:

This study provides Class II evidence that longer-term antibiotics in patients with borreliosis-attributed persistent symptoms does not increase cognitive performance compared to shorter-term antibiotics.

Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

PMID:

  

30796143

  

DOI:

  

10.1212/WNL.0000000000007186