Comparative Effectiveness and Toxicity of Oral Antibiotics for Early Lyme Disease Associated with Erythema Migrans: a Systematic Review and Network Meta-analysis
Han, Jung Min.
2017
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Abstract:
Background: Approximately two thirds of patients with early Lyme develop erythema
migrans. Though many antibiotics are available to treat early Lyme, it is difficult to
pinpoint the best treatment due to a limited number of RCTs comparing different
antibiotics head-to-head. Purpose: To compare effectiveness and toxicity of oral
antibiotics in patients with early Lyme with erythema m... read moreigrans. Data Source: MEDLINE,
EMBASE, Web of Science, Google Scholar, and the Cochrane Database from inception to
January 2017. Study Selection: Sixteen RCTs of patients with erythema migrans comparing
oral antibiotics with regard to acute treatment response, dissemination of Lyme at 6
months or beyond, or treatment-related adverse events. Data Extraction: Study data were
extracted by two independent reviewers. Data Synthesis: Network meta-analyses showed
that compared with penicillins, macrolides and tetracyclines were significantly less
effective in achieving acute treatment response (Odds ratio: 0.37 [95% Credible
interval: 0.15, 0.88] and 0.28 [0.09, 0.94], respectively). Most patients (96%)
recovered completely within 6 months. None of the treatments were significantly
different with regard to the number of patients reporting disease dissemination. More
patients experienced treatment-related adverse events from cephalosporins and
tetracyclines compared with penicillins (OR: 4.41 [1.50, 17.76] and 6.54 [2.31,24.15],
respectively). Patients taking tetracyclines were more likely to report adverse events
compared with macrolides (OR: 4.00 [1.19, 14.75]). Limitation: Most of the studies had
high risk of bias Conclusion: Penicillins demonstrated a significant benefit over
macrolides and tetracyclines with regard to acute treatment response and a more
favorable safety profile than cephalosporins and tetracyclines. All therapeutic classes
were similarly effective in preventing disease dissemination. These findings should
guide the selection of therapy for patients with erythema
migrans.
Thesis (M.S.)--Tufts University, 2017.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: Raveendhara Bannuru.
Committee: Cody Meissner, Farzad Nourbary, and Karen Freund.
Keyword: Health sciences.read less - ID:
- 5712mk514
- Component ID:
- tufts:23390
- To Cite:
- DCA Citation Guide EndNote
