http://www.timesunion.com/news/article/Report-on-dangers-of-antibiotic-treatments-for-11231166.php

Report on dangers of antibiotic use for Lyme disease sparks controversy

 

ALBANY — Dangerous bacterial infections have resulted from long-term antibiotic treatments prescribed for chronic Lyme disease, a new report states.

The report, published last week by the U.S. Centers for Disease Control and Prevention, includes accounts of five patients whose complications from the unproven treatments included septic shock, colitis, spinal disc infection, abscess and death.

A Capital Region advocate for further research and improved treatment for chronic Lyme disease, however, believes medical politics are behind the study’s publication.  

Holly Ahern, a microbiologist at SUNY Adirondack in Queensbury, said some of the report’s authors are also engaged in updating Lyme disease treatment guidelines for the Infectious Disease Society of America, or IDSA. The influential doctors’ group does not acknowledge chronic Lyme disease as a legitimate diagnosis.  

The authors looked for patients whose cases would confirm what they already believed, Ahern said.

“They are simply trying to prop up the 30-year-old studies by rewriting it and publishing is as a ‘new study,’ so that it can then be cited as ‘evidence’ in their ‘evidence-based’ treatment guidelines,” she said.

The CDC estimates there are 300,000 cases of Lyme disease each year, most in the Northeast and Midwest where the ticks that carry the disease are most plentiful.

It is no surprise that a report on chronic Lyme disease is creating controversy. A battle has raged for decades over whether it even exists and, if it does, how it should be treated.

Chronic Lyme disease is a term used for a constellation of symptoms that can occur after an acute case of Lyme disease, which is caused by bacteria transmitted from a tick bite. Chronic Lyme is the exception rather than the rule: In most cases, Lyme disease that is caught early can be treated effectively with antibiotics.

But in 10 percent to 20 percent of patients, symptoms like headaches, joint and nerve pain, dizziness and fatigue can endure for months and even years. That’s undisputed.

It’s the cause of those persistent symptoms that’s at the heart of the debate.

IDSA sees these lingering symptoms as an aftereffect of infection. But doctors who diagnose patients with chronic Lyme disease believe the bacteria that causes the infection remains in the body, though it is not detected by standard tests. These doctors therefore use antibiotics, which combat bacteria, to fight it, usually by infusing the drugs through intravenous lines over extended periods.

The risk, however, is that antibiotics attack not only the bacteria that makes people sick, but also the bacteria that helps fight infection, explained Timothy Sellati, a former Albany-based immunologist who is now chair of the Department of Infectious Diseases at Southern Research in Alabama. Infections can also form at the site of the IV lines if they are not kept sterile.

For both those reasons, extended use of IV antibiotics should usually be avoided, Sellati said.

Doctors, public health officials and patients have contacted CDC with reports of serious bacterial infections resulting from such unproven treatment, according to the CDC report. The five stories in last week’s report highlighted these.

One patient was treated with two four-week courses of antibiotics after tests determined that she had Lyme disease. But two years later, with continued fatigue and trouble thinking, she was diagnosed with chronic Lyme and received a year’s worth of IV antibiotic treatments. A year after that, another month’s worth of antibiotics was delivered through a catheter.

She was admitted to a hospital after developing back pain and shortness of breath. Doctors found that her spine was infected by bacteria found at the catheter tip.

“That is a whole long time on antibiotics,” Sellati said of the case. “I would ask that physician: What were you expecting to happen? Where do you think this bacteria is hiding from this assault?”

Ahern, on the other hand, questioned the CDC’s use of five extreme examples amid thousands of people treated with IV antibiotics for chronic Lyme disease. Lymedisease.org, a California-based group that advocates for patients with chronic Lyme disease, filed an ethics complaint three years ago against the research that led to the report.

One of the report’s authors, a CDC epidemiologist, allegedly solicited IDSA doctors for evidence of harm from IV antibiotic treatments, offering co-authorship of the report if anecdotes were used, according to a blog post by Lymedisease.org’s vice president. No such solicitation was made for IV treatment success stories, according to the advocacy group.

Ahern sees that as a prime example of bias in the study, published in the CDC’s Morbidity and Mortality Weekly Report.

“If you search the MMWR archives, there are no other examples of this sort of bias for ANY OTHER infectious disease requiring IV treatments,” Ahern wrote in an email. “None.”