Shore doctors' Lyme disease procedures faulted

January 21, 1998|By Jonathan Bor | Jonathan Bor,SUN STAFF

Many physicians on Maryland's Eastern Shore are needlessly prescribing antibiotics and ordering blood tests for patients who have been bitten by ticks but have no symptoms of Lyme disease, according to a study published today.

Researchers warned that the overuse of antibiotics, besides driving up health care costs, could spur the growth of new bacterial strains that resist standard drugs. Antibiotics are not 00 warranted unless patients have developed symptoms characteristic of Lyme disease, they said.

"They're using some pretty powerful and potentially harmful antibiotics with little indication," said Kent County Health Officer John Grant, one of the study's authors. The study, which appears in today's Journal of the American Medical Association, was directed by researchers with the University of Maryland Medical Center.

Researchers identified 142 patients in four Eastern Shore counties who went to primary care doctors complaining of tick bites but no symptoms of Lyme disease.

In 95 of the cases, 67 percent, doctors prescribed antibiotics rather than waiting for clinical signs of illness.

None of the treated or untreated patients developed Lyme disease.

"The general recommendation is not to treat with antibiotic therapy but to wait for signs of disease to develop," said Dr. Alan D. Fix, a University of Maryland epidemiologist. "If signs develop, then treat. The disease is generally very responsive to therapy."

Lyme disease is caused by corkscrew-shaped bacteria transmitted from wild mice to humans by the bite of the tiny deer tick. It usually produces a red, bull's-eye-shaped rash and flulike symptoms. Untreated, it can damage the heart and cause lifelong joint pain.

The Eastern Shore has the highest incidence of Lyme disease in Maryland. Statewide, there were 481 cases in 1997.

According to the study, physicians ordered blood tests for 55 percent of the symptom-free patients. Researchers said the tests are of little value and that a positive result could indicate an exposure from long ago. A negative finding must be followed by another test a month later. By then, doctors tend to prescribe drugs anyway.

Dr. Helen Noble, a primary-care doctor in Chestertown, said she was surprised by the findings. She said she usually waits to see a rash or a fever before prescribing antibiotics, and sometimes orders a blood test to confirm a diagnosis she has made based on symptoms.

The researchers called for better education for doctors and consumers. In an editorial accompanying the article, Dr. Alan G. Barbour of the University of California at Irvine said: "We can applaud the greater participating of patients and their families in decisions about their medical care, but physicians may be too quick to accede to patients' demands in some instances."

Pub Date: 1/21/98

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