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

Alice Raffetin; Ram B Dessau; ESGBOR the ESCMID study group for Tick-Borne Diseases

doi:10.1007/s15010-025-02501-3

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

Alice Raffetin^*
, Ram B Dessau^*
, ESGBOR the ESCMID study group for Tick-Borne Diseases

^*Corresponding author for this work

Clinical Microbiology

Research output: Contribution to journal › Review › Research › peer-review

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.

Original language	English
Pages (from-to)	809-830
Number of pages	22
Journal	Infection
Volume	53
Early online date	17 Apr 2025
DOIs	https://doi.org/10.1007/s15010-025-02501-3
Publication status	Published - Jun 2025

Funding

We thank Jarmo Oksi and Anne Marit Solheim for sharing their collected data used in previous publications. We thank Yoann Madec for his advice for statistical analysis. We thank the French Infectious Diseases Society (SPILF) for the support to organise the workshop in February 2024.

Funders
French Infectious Diseases Society

Keywords

Lyme borreliosis
Systematic review
Treatment duration
Outcomes
Meta-analysis
Humans
Lyme Disease/drug therapy
Treatment Outcome
Anti-Bacterial Agents/therapeutic use
Duration of Therapy
Randomized Controlled Trials as Topic

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10.1007/s15010-025-02501-3

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@article{a03201b649b945fd9b4c3ecc80df5dcb,

title = "Towards shortening the duration of antibiotic therapy for Lyme borreliosis: a systematic review and meta-analysis",

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.",

keywords = "Lyme borreliosis, Systematic review, Treatment duration, Outcomes, Meta-analysis, Humans, Lyme Disease/drug therapy, Treatment Outcome, Anti-Bacterial Agents/therapeutic use, Duration of Therapy, Randomized Controlled Trials as Topic",

author = "Alice Raffetin and Henningsson, \{Anna J.\} and Katharina Ornstein and Pauline Arias and Volker Fingerle and Solene Patrat-Delon and Daniel Bremell and Lindgren, \{Per Eric\} and Rupprecht, \{Tobias A\} and Beno{\^i}t Jaulhac and Klaus-Peter Hunfeld and C{\'e}line Cazorla and Mateusz Markowicz and Reto Lienhard and \{van Dam\}, \{Alje P\} and Elisabeth Baux and Sally Mavin and Hovius, \{Joppe W\} and Baarsma, \{M E\} and Berg, \{Kristine Karlsrud\} and Randi Eikeland and Dessau, \{Ram B\} and \{ESGBOR the ESCMID study group for Tick-Borne Diseases\}",

note = "{\textcopyright} 2025. Springer-Verlag GmbH Germany, part of Springer Nature.",

year = "2025",

month = jun,

doi = "10.1007/s15010-025-02501-3",

language = "English",

volume = "53",

pages = "809--830",

journal = "Infection",

issn = "0300-8126",

publisher = "Springer Science and Business Media Deutschland GmbH",

}

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

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 -

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

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