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Efficacy of antibiotic prophylaxis for prevention of lyme disease

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Abstract

OBJECTIVE: To determine if antibiotic prophylaxis following a deer tick bite is effective in reducing the risk of developing Lyme disease.

DESIGN: Meta-analysis of published trials.

DATA IDENTIFICATION: Clinical trials were identified by a computerized literature search of MEDLINE and by an assessment of the bibliographies of published studies.

STUDY SELECTION: Trials were included in the analysis if their patients were randomly allocated to a treatment or control group, enrolled within 72 hours following anIxodes tick bite, and had no clinical evidence of Lyme disease at enrollment. Three trials were selected for review after inclusion criteria were applied.

DATA EXTRACTION: Data were extracted for details of study design, patient characteristics, interventions, duration of therapy, and number of adverse events in each arm of therapy.

RESULTS OF DATA SYNTHESIS: Among the 600 patients withIxodes tick bites, the rate of infection in the placebo group was 1.4%. In contrast, patients who received antibiotic prophylaxis had a 0% infection rate. The pooled odds ratio, comparing prophylaxis to placebo, was0.0 (95% confidence interval 0.0, 1.5) (p=.12).

CONCLUSIONS: The available evidence to date suggests that the routine use of antibiotic prophylaxis for the prevention of Lyme disease remains uncertain. Meta-analysis of the controlled trials failed to establish definitive treatment efficacy owing to the small sample size of the combined trials and the low rates of infection following a deer tick bite. A larger randomized trial is needed to demonstrate definitively that prophylaxis is more effective than placebo in reducing the risk of early Lyme disease in endemic areas.

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Authors and Affiliations

  1. the Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla

    John Nowokowski MD, Robert B. Nadelman MD & Gary P. Wormser MD

  2. Section of General Internal Medicine, Department of Medicine, New York Medical College, 10595, Valhalla, NY

    Stephen Warshafsky MD, Russell S. Kamer MD & Stephen J. Peterson MD

Authors
  1. Stephen Warshafsky MD
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  2. John Nowokowski MD
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  3. Robert B. Nadelman MD
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  4. Russell S. Kamer MD
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  5. Stephen J. Peterson MD
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  6. Gary P. Wormser MD
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Additional information

This study was supported in part by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (RO1-AR41508 and RO1-AR43135), the Centers for Disease Control and Prevention (Cooperative Agreements U50/CCU 21280 and U50/CCU 210286), and from the new York State Department of health, Tick-Borne Disease Institute (C-011001). The contents of this report are solely the responsibility of the authors and do not necessarily represent the official views of any of the above agencies.

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Warshafsky, S., Nowokowski, J., Nadelman, R.B. et al. Efficacy of antibiotic prophylaxis for prevention of lyme disease. J Gen Intern Med 11, 329–333 (1996). https://doi.org/10.1007/BF02600042

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