TY - JOUR
T1 - Towards shortening the duration of antibiotic therapy for Lyme borreliosis
T2 - a systematic review and meta-analysis
AU - Raffetin, Alice
AU - Henningsson, Anna J.
AU - Ornstein, Katharina
AU - Arias, Pauline
AU - Fingerle, Volker
AU - Patrat-Delon, Solene
AU - Bremell, Daniel
AU - Lindgren, Per Eric
AU - Rupprecht, Tobias A
AU - Jaulhac, Benoît
AU - Hunfeld, Klaus-Peter
AU - Cazorla, Céline
AU - Markowicz, Mateusz
AU - Lienhard, Reto
AU - van Dam, Alje P
AU - Baux, Elisabeth
AU - Mavin, Sally
AU - Hovius, Joppe W
AU - Baarsma, M E
AU - Berg, Kristine Karlsrud
AU - Eikeland, Randi
AU - Dessau, Ram B
AU - ESGBOR the ESCMID study group for Tick-Borne Diseases
N1 - © 2025. Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2025/6
Y1 - 2025/6
N2 - 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.
AB - 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.
KW - Lyme borreliosis
KW - Systematic review
KW - Treatment duration
KW - Outcomes
KW - Meta-analysis
KW - Humans
KW - Lyme Disease/drug therapy
KW - Treatment Outcome
KW - Anti-Bacterial Agents/therapeutic use
KW - Duration of Therapy
KW - Randomized Controlled Trials as Topic
U2 - 10.1007/s15010-025-02501-3
DO - 10.1007/s15010-025-02501-3
M3 - Review
C2 - 40246800
SN - 0300-8126
VL - 53
SP - 809
EP - 830
JO - Infection
JF - Infection
ER -