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 mi... read moregrans. 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
