Torbahn G, et al. - Researchers performed this network meta-analysis (NMA) that included 2532 patients to determine the most effective and safest antibiotic treatments of early cutaneous Lyme borreliosis. Antibiotics investigated in this work comprised doxycycline, cefuroxime axetil, ceftriaxone, amoxicillin, azithromycin, penicillin V, and minocycline. Outcomes suggest that antibiotic agent, dose, or duration did not significantly influence treatment response. Also, antibiotic agents and treatment modalities displayed no differences in the effect sizes in treatment-related adverse outcomes, which were generally mild to moderate; treatment failures were rare.

Methods

• In MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, researchers performed electronic searches from inception until July 2017.
• They hand searched the reference lists of the included studies, contacted the authors, and searched ongoing trials at ClinicalTrials.gov.
• The electronic searches yielded 9975 reports; one reviewer screened the titles and abstracts of these reports.
• They obtained full-text copies of 161 potentially relevant articles; articles for inclusion were assessed by 2 reviewers independently.
• Included were the adults with a physician-confirmed early localized skin infection who were treated with antibiotics of any dose or duration.
• Data extraction regarding study, patient, and intervention characteristics was performed by 2 reviewers independently.
• They applied a frequentist approach using the R package netmeta to calculate network meta-analyses on treatment effects and adverse outcomes.
• The certainty of evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation guidance for NMA.
• Main outcomes assessed were treatment effects for response to treatment (resolution of symptoms) and treatment-related adverse events.

Results

• Researchers included 19 studies (2532 patients).
• Patients' had mean age ranging from 37 to 56 years; the percentage of female patients ranged from 36% to 60%.
• Doxycycline, cefuroxime axetil, ceftriaxone, amoxicillin, azithromycin, penicillin V, and minocycline were the antibiotics investigated.
• Pooled effect sizes from NMAs indicates no marked differences in treatment response by antibiotic agent (eg, amoxicillin vs doxycycline odds ratio, 1.26; 95% CI, 0.41-3.87), dose, or duration (eg, doxycycline, 200 mg/d for 3 weeks, vs doxycycline, 200 mg/d for 2 weeks, odds ratio, 1.28; 95% CI, 0.49-3.34).
• They rarely noted treatment failures at both 2 months (4%; 95% CI, 2%-5%) and 12 months (2%, 95% CI, 1%-3%) after treatment initiation.
• Antibiotic agents and treatment modalities displayed no differences in the effect sizes for treatment-related adverse outcomes, which were generally mild to moderate.
• Because of imprecision, indirectness, and study limitations (high risk of bias) of the included studies, certainty of evidence was categorized as low and very low.