Repeated doxycycline treatment among patients with neuroborreliosis: a nationwide, population-based, registry-based, matched cohort study
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Repeated doxycycline treatment among patients with neuroborreliosis : a nationwide, population-based, registry-based, matched cohort study. / Tetens, Malte M.; Omland, Lars Haukali; Dessau, Ram B.; Ellermann-Eriksen, Svend; Andersen, Nanna S.; Jørgensen, Charlotte Sværke; Pedersen, Michael; Bodilsen, Jacob; Søgaard, Kirstine K.; Bangsborg, Jette; Nielsen, Alex Christian Yde; Møller, Jens Kjølseth; Obel, Niels; Lebech, Anne Mette.
I: Infectious Diseases, 2024.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Repeated doxycycline treatment among patients with neuroborreliosis
T2 - a nationwide, population-based, registry-based, matched cohort study
AU - Tetens, Malte M.
AU - Omland, Lars Haukali
AU - Dessau, Ram B.
AU - Ellermann-Eriksen, Svend
AU - Andersen, Nanna S.
AU - Jørgensen, Charlotte Sværke
AU - Pedersen, Michael
AU - Bodilsen, Jacob
AU - Søgaard, Kirstine K.
AU - Bangsborg, Jette
AU - Nielsen, Alex Christian Yde
AU - Møller, Jens Kjølseth
AU - Obel, Niels
AU - Lebech, Anne Mette
N1 - Publisher Copyright: © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2024
Y1 - 2024
N2 - Objectives: To investigate receipt of antibiotics among patients with neuroborreliosis after initial antibiotic treatment, likely attributable to posttreatment symptoms. Methods: We performed a nationwide, matched, population-based cohort study in Denmark (2009-2021). We included all Danish patients with neuroborreliosis, i.e. a positive Borrelia burgdorferi intrathecal antibody index test and a cerebrospinal fluid leukocyte count ≥10 × 106/l, and initially treated with doxycycline. To form a comparison cohort, we randomly extracted individuals from the general population matched 1:10 to patients with neuroborreliosis on date of birth and sex. The main outcome was receipt of doxycycline, and the secondary outcome was receipt of phenoxymethylpenicillin. We calculated short-term (<1 year) and long-term (≥1 year) hazard ratios (HR) with 95% confidence intervals (95%CI). Results: We included 463 patients with neuroborreliosis and 2,315 comparison cohort members. Compared with the comparison cohort members, patients with neuroborreliosis initially treated with doxycycline had increased receipt of additional doxycycline within 1 year (HR: 38.6, 95%CI: 17.5–85.0) and ≥1 years (HR: 3.5, 95%CI: 1.9–6.3). Compared with comparison cohort members, patients with neuroborreliosis had no increased receipt of phenoxymethylpenicillin (<1 year HR 1.0, 95%CI: 0.7–1.3; ≥1 years HR 1.2, 95%CI: 0.9–1.5). Conclusions: After initial antibiotic treatment, patients with neuroborreliosis have increased receipt of doxycycline particularly within one year after initial antibiotic therapy but also subsequently. The lack of increased receipt of phenoxymethylpenicillin suggests that the receipt of doxycycline was not merely due to differences in healthcare-seeking behaviour, increased risk of early Lyme borreliosis due to exposure, or differences in antibacterial usage in general.
AB - Objectives: To investigate receipt of antibiotics among patients with neuroborreliosis after initial antibiotic treatment, likely attributable to posttreatment symptoms. Methods: We performed a nationwide, matched, population-based cohort study in Denmark (2009-2021). We included all Danish patients with neuroborreliosis, i.e. a positive Borrelia burgdorferi intrathecal antibody index test and a cerebrospinal fluid leukocyte count ≥10 × 106/l, and initially treated with doxycycline. To form a comparison cohort, we randomly extracted individuals from the general population matched 1:10 to patients with neuroborreliosis on date of birth and sex. The main outcome was receipt of doxycycline, and the secondary outcome was receipt of phenoxymethylpenicillin. We calculated short-term (<1 year) and long-term (≥1 year) hazard ratios (HR) with 95% confidence intervals (95%CI). Results: We included 463 patients with neuroborreliosis and 2,315 comparison cohort members. Compared with the comparison cohort members, patients with neuroborreliosis initially treated with doxycycline had increased receipt of additional doxycycline within 1 year (HR: 38.6, 95%CI: 17.5–85.0) and ≥1 years (HR: 3.5, 95%CI: 1.9–6.3). Compared with comparison cohort members, patients with neuroborreliosis had no increased receipt of phenoxymethylpenicillin (<1 year HR 1.0, 95%CI: 0.7–1.3; ≥1 years HR 1.2, 95%CI: 0.9–1.5). Conclusions: After initial antibiotic treatment, patients with neuroborreliosis have increased receipt of doxycycline particularly within one year after initial antibiotic therapy but also subsequently. The lack of increased receipt of phenoxymethylpenicillin suggests that the receipt of doxycycline was not merely due to differences in healthcare-seeking behaviour, increased risk of early Lyme borreliosis due to exposure, or differences in antibacterial usage in general.
KW - antimicrobial stewardship
KW - cohort studies
KW - doxycycline
KW - Lyme neuroborreliosis
U2 - 10.1080/23744235.2024.2366526
DO - 10.1080/23744235.2024.2366526
M3 - Journal article
C2 - 38950593
AN - SCOPUS:85197648175
JO - Infectious Diseases
JF - Infectious Diseases
SN - 2374-4235
ER -
ID: 400743230