Elderly Lyme disease patients more likely to have unfavorable treatment outcome

There have been limited studies investigating the impact of age on the clinical course and treatment outcome for Lyme disease. Now, a European study by Borsic and colleagues examines whether age is associated with treatment response.

The authors reviewed the records of 1,220 young, middle-aged and elderly patients, comparing disease course and long-term outcomes for each group.

The patients had been treated at an outpatient clinic at the University Medical Center Ljubljana in Slovenia. The study included 224 elderly patients, with 173 between 65-74 years old, 48 between 75-84 years old and 3 patients who were 85 years or older.

Patients with an erythema migrans (EM) rash were treated up to 14 days with doxycycline, amoxicillin, or cefuroxime. Individuals with multiple EM rashes were prescribed a 14-day course of intravenous ceftriaxone or doxycycline.

The outcomes for elderly patients were compared to those for middle-aged (ages 45-66) and young subjects (ages 18-44).

The authors found that “older patients had slower resolution of EM and higher odds for an unfavorable outcome of treatment.”

At the 12-month follow-up visit, 7.8% of elderly patients had an incomplete treatment response, compared to 6.6% for middle-aged patients (n=627) and 3.7% (n=369) for younger patients.

“Up until now, information on the impact of age on the clinical course and outcome of early [Lyme borreliosis] was limited to one report from the U.S.,” the authors state.

This study found that the odds for an incomplete response was not only higher for older patients but also for women, patients with multiple EM, and for those who presented with [Lyme borreliosis]-associated constitutional symptoms, they say.

None of the elderly subjects with post-Lyme borreliosis symptoms met the criteria for “post-Lyme disease syndrome” because their reported symptoms did not necessitate a reduction of their previous activity levels.

In other words, the elderly subjects with “post-Lyme disease” were ill but could still function.