Treatment of Early Lyme Disease
Authors: Raphael B. Stricker, Andrea Gaito, Nick S. Harris, Joseph J. Burrascano
Journal: Annals of Internal Medicine (2004)

Letters6 April 2004Treatment of Early Lyme DiseaseRaphael B. Stricker, MD, Andrea Gaito, MD, Nick S. Harris, PhD, and Joseph J. Burrascano, MDRaphael B. Stricker, MDFrom California Pacific Medical Center, San Francisco, CA 94108; Morristown Memorial Hospital, Morristown, NJ 07962; IGeneX Laboratory, Palo Alto, CA 94303; and East End Medical Associates, East Hampton, NY 11937.Search for more papers by this author, Andrea Gaito, MDFrom California Pacific Medical Center, San Francisco, CA 94108; Morristown Memorial Hospital, Morristown, NJ 07962; IGeneX Laboratory, Palo Alto, CA 94303; and East End Medical Associates, East Hampton, NY 11937.Search for more papers by this author, Nick S. Harris, PhDFrom California Pacific Medical Center, San Francisco, CA 94108; Morristown Memorial Hospital, Morristown, NJ 07962; IGeneX Laboratory, Palo Alto, CA 94303; and East End Medical Associates, East Hampton, NY 11937.Search for more papers by this author, and Joseph J. Burrascano, MDFrom California Pacific Medical Center, San Francisco, CA 94108; Morristown Memorial Hospital, Morristown, NJ 07962; IGeneX Laboratory, Palo Alto, CA 94303; and East End Medical Associates, East Hampton, NY 11937.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-7-200404060-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Wormser and colleagues (1) reported the results of very short-term (10-day) versus short-term (20-day) antibiotic treatment for patients with early Lyme disease who presented with an erythema migrans rash. Using an on-study analysis, the authors claimed that 84% to 90% of patients had a complete response to one or the other treatment after 30 months of follow-up. These results represent “creative mismanagement” of the study data (2).Although the study enrolled 180 patients in 3 treatment groups, only 99 patients were evaluable after 30 months of observation, yielding a dropout-plus-exclusion rate of 45% (25% of patients were ...References1. Wormser GP, Ramanathan R, Nowakowski J, McKenna D, Holmgren D, Visintainer P, et al . Duration of antibiotic therapy for early Lyme disease. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2003;138:697-704. [PMID: 12729423] LinkGoogle Scholar2. Schulz KF, Grimes DA. Sample size slippages in randomised trials: exclusions and the lost and wayward. Lancet. 2002;359:781-5. [PMID: 11888606] CrossrefMedlineGoogle Scholar3. Liegner KB, Shapiro JR, Ramsay D, Halperin AJ, Hogrefe W, Kong L. Recurrent erythema migrans despite extended antibiotic treatment with minocycline in a patient with persisting Borrelia burgdorferi infection. J Am Acad Dermatol. 1993;28:312-4. [PMID: 8436647] CrossrefMedlineGoogle Scholar4. Stricker RB, Lautin A. The Lyme Wars: time to listen. Expert Opin Investig Drugs. 2003;12:1609-14. [PMID: 14519082] CrossrefMedlineGoogle Scholar5. Phillips S, Bransfield R, Sherr V, Brand S, Smith H, Dickson K, et al. Evaluation of antibiotic treatment in patients with persistent symptoms of Lyme disease: an ILADS position paper. Accessed at www.ilads.org/position2.htm on 9 May 2003. Google Scholar6. Stricker RB, Phillips SE. Lyme disease without erythema migrans: cause for concern? [Letter]. Am J Med. 2003;115:72-3. [PMID: 12867241] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From California Pacific Medical Center, San Francisco, CA 94108; Morristown Memorial Hospital, Morristown, NJ 07962; IGeneX Laboratory, Palo Alto, CA 94303; and East End Medical Associates, East Hampton, NY 11937. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDuration of Antibiotic Therapy for Early Lyme Disease Gary P. Wormser , Roshan Ramanathan , John Nowakowski , Donna McKenna , Diane Holmgren , Paul Visintainer , Rhea Dornbush , Brij Singh , and Robert B. Nadelman Treatment of Early Lyme Disease Gary P. Wormser , John Nowakowski , and Robert B. Nadelman Metrics Cited byIn vitro evaluation of antibacterial activity of phytochemicals and micronutrients against Borrelia burgdorferi and Borrelia gariniiLyme Disease: The Quest for Magic BulletsLyme disease: point/counterpoint 6 April 2004Volume 140, Issue 7Page: 577KeywordsAntibioticsErythemaInfectious diseasesIntent to treat analysisLyme diseaseRashes ePublished: 6 April 2004 Issue Published: 6 April 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...