Towards shortening the duration of antibiotic therapy for Lyme borreliosis: a systematic review and meta-analysis.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2025-06-01 Epub Date: 2025-04-17 DOI:10.1007/s15010-025-02501-3

Alice Raffetin, Anna J Henningsson, Katharina Ornstein, Pauline Arias, Volker Fingerle, Solene Patrat-Delon, Daniel Bremell, Per Eric Lindgren, Tobias A Rupprecht, Benoît Jaulhac, Klaus-Peter Hunfeld, Céline Cazorla, Mateusz Markowicz, Reto Lienhard, Alje P van Dam, Elisabeth Baux, Sally Mavin, Joppe W Hovius, M E Baarsma, Kristine Karlsrud Berg, Randi Eikeland, Ram B Dessau

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引用次数: 0

Abstract

Objectives: Systematic review and meta-analysis on shortening antibiotic therapy for Lyme borreliosis (LB) patients.

Methods: Data sources: Medline, Google, and Google Scholar (queried from January 2022-February 2024), following the PRISMA method and the Cochrane Handbook.

Eligibility criteria: Randomized clinical trials, comparative studies; clear definitions of LB, duration of antibiotics and outcome; follow-up ≥ 6-12 months. Meta-analysis included studies that examined three outcomes: treatment failure; residual symptoms; adverse events.

Intervention: Short vs. extended antibiotic therapy for erythema migrans (≤ 10 days vs. > 10 days) and disseminated LB (≤ 21 days vs. > 21 days). Assessment of risk of bias. Independently, using the Cochrane Tools.

Methods: of data synthesis. Estimation of treatment effects based on a fixed-effect model (Mantel-Haenszel or Peto method), with odds ratio (OR) and 95% confidence intervals (CI).

Results: Thirty-eight full-text articles were examined (850 patients): 29 were included in the qualitative analysis; six in the meta-analysis. Heterogeneity was low (I² = 0%). At 12 months, short-term treatment did not differ from long-term treatment in terms of failures (OR1.50, 95%CI[0.43-5.22]) and residual symptoms (OR0.95, 95%CI[0.66-1.37]), albeit with small samples.

Conclusion: This meta-analysis was underpowered to prove non-inferiority of shorter treatment, but suggests its safety for EM. Studies focusing on antibiotics duration, with sufficient sample sizes and clear outcomes, are warranted.

查看原文本刊更多论文

缩短莱姆病抗生素治疗持续时间：一项系统回顾和荟萃分析。

目的：对莱姆病（Lyme borreliosis， LB）患者缩短抗生素治疗时间进行系统评价和荟萃分析。方法：数据来源：Medline、谷歌和谷歌Scholar（查询时间为2022年1月- 2024年2月），采用PRISMA方法和Cochrane Handbook。入选标准：随机临床试验、比较研究；明确LB的定义、抗生素持续时间和结局；随访≥6-12个月。荟萃分析包括检查三种结果的研究：治疗失败；残余症状;不良事件。干预措施：对移行性红斑（≤10天vs. >0天）和弥散性LB（≤21天vs. > 21天）进行短期与延长抗生素治疗。偏倚风险评估。独立使用Cochrane工具。数据综合方法。基于固定效应模型（Mantel-Haenszel或Peto方法）的治疗效果估计，具有优势比（or）和95%置信区间（CI）。结果：共检查全文38篇（850例患者），其中29篇纳入定性分析；在荟萃分析中有6个。异质性低（I2 = 0%）。在12个月时，短期治疗与长期治疗在失败（OR1.50, 95%CI[0.43-5.22]）和残留症状（OR0.95, 95%CI[0.66-1.37]）方面没有差异，尽管样本量较小。结论：该荟萃分析不足以证明较短治疗的非劣效性，但表明其对EM的安全性。关注抗生素持续时间的研究，有足够的样本量和明确的结果是有必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.