Torbahn G, et al. - In this network meta-analysis (NMA), researchers assessed the safety and effectiveness of antibiotic therapy in patients with early cutaneous Lyme borreliosis (LB). They found that, in early cutaneous LB, neither the antibiotic agent nor treatment modality contributed to comparative effectiveness or drug-related adverse outcomes. The authors indicated the importance of this finding for practitioners treating patients with LB and also with respect to patient decision-making.

Methods

• From inception until July 2017, the authors searched the MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials databases for relevant reports.
• The reference lists of included studies were hand-searched, and the authors were contacted; the investigators searched ongoing trials at ClinicalTrials.gov.
• One reviewer screened the titles and abstracts of the 9,975 identified reports.
• The investigators obtained full-text copies of 161 potentially relevant articles, and 2 reviewers independently evaluated those articles for inclusion.
• Study participants included adults with a physician-confirmed early localized skin infection who were treated with antibiotics of any dose or duration.
• Two reviewers in this analysis independently extracted data on study, patient, and intervention characteristics.
• Using the R package netmeta, NMAs on treatment effects and adverse outcomes were calculated with a frequentist approach.
• To assess the certainty of evidence, the Grading of Recommendations Assessment, Development and Evaluation guidance for NMA was used.

Results

• A total of 19 studies representing 2,532 patients were included.
• Researchers found that the mean patient age ranged between 37 and 56 years, and the percentage of female patients ranged from 36% to 60%.
• Doxycycline, cefuroxime axetil, ceftriaxone, amoxicillin, azithromycin, penicillin V, and minocycline were the investigated antibiotics.
• Data reported that pooled effect sizes from NMAs did not suggest any significant 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/day for 3 weeks vs doxycycline, 200 mg/day for 2 weeks; odds ratio, 1.28; 95% CI, 0.49-3.34).
• After treatment initiation, treatment failures were rare at both 2 months (4%; 95% CI, 2% to 5%) and 12 months (2%; 95% CI, 1% to 3%).
• No differences were found in the effect sizes among antibiotic agents and treatment modalities for treatment-related adverse outcomes, which were generally mild to moderate in severity.
• They categorized certainty of evidence as low and very low mostly due to imprecision, indirectness, and study limitations (high risk of bias) of the included studies.