The Institute for Tropical Medicine, School of Basic Medical Sciences, Kunming Medical University, Kunming, 650500, China.
Yunnan Province Key Laboratory for Tropical Infectious Diseases in Universities, Kunming Medical University, Kunming, 650500, China.
BMC Infect Dis. 2021 Nov 8;21(1):1141. doi: 10.1186/s12879-021-06837-7.
In areas where Lyme disease is endemic, bites from ticks are common, but no vaccine is currently available against Lyme disease for humans. Therefore, the feasibility of using antibiotic prophylaxis to prevent Lyme disease after a tick bite is worth further exploration. Previous meta-analyses lack sufficient power to demonstrate the efficacy of about antibiotic prophylaxis for the prevention of Lyme disease following a tick bite. In this study, we explored more precise evidence and attempted to identify and update optimum treatment strategies.
We searched PubMed, Embase, and the Cochrane Library for studies until March 23, 2021. We included studies if the enrolled patients were randomly allocated to a treatment or control group within 72 h following a tick bite and had no clinical evidence of Lyme disease at enrolment. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed for data abstraction. Two authors (GZZ and XX) independently reviewed the abstracts and identified articles for detailed assessment. We used a random-effects model to calculate the pooled results and reported the 95% confidence interval (CI). Study quality was assessed using a modified Jadad scale, and publication bias was assessed using Egger's test. We calculated the risk ratio (RR) for the rates of unfavorable events in patients who received intervention versus the control group. This study is registered with PROSPERO, number CRD42021245002.
Six studies (3,766 individuals) were included. The pooled rate of unfavorable events in persons receiving treatment and the control group were 0.4% (95%CI: 0.1-1.1%) and 2.2% (95%CI: 1.6-3.0%), respectively. The pooled RR was 0.38 (95%CI: 0.22-0.66). Subgroup analysis revealed that the pooled RR was 0.29 (95%CI: 0.14-0.60) in the single-use 200-mg doxycycline group; 0.28 (95%CI: 0.05-1.67) in a 10-day course group (Amoxicillin, Penicillin or tetracycline); and 0.73 (95%CI: 0.25-2.08) in a topical antibiotic treatment group (Azithromycin).
The available evidence supports the use of antibiotics for the prevention of Lyme disease, and reveals advantages of using single-dose; however, further confirmation is needed.
在莱姆病流行的地区，蜱虫叮咬很常见，但目前尚无针对人类莱姆病的疫苗。因此，探索使用抗生素预防来预防蜱虫叮咬后的莱姆病的可行性是值得进一步探索的。之前的荟萃分析缺乏足够的效力来证明大约抗生素预防对蜱虫叮咬后预防莱姆病的疗效。在这项研究中，我们探索了更精确的证据，并试图确定和更新最佳治疗策略。
我们在 2021 年 3 月 23 日之前，在 PubMed、Embase 和 Cochrane 图书馆中搜索了研究。如果在蜱虫叮咬后 72 小时内将入组患者随机分配到治疗组或对照组，并且在入组时没有莱姆病的临床证据，则我们将研究纳入。我们遵循系统评价和荟萃分析的首选报告项目（PRISMA）报告准则进行数据提取。两位作者（GZZ 和 XX）独立审查了摘要并确定了详细评估的文章。我们使用随机效应模型计算合并结果并报告 95%置信区间（CI）。使用改良 Jadad 量表评估研究质量，并使用 Egger 检验评估发表偏倚。我们计算了接受干预的患者与对照组相比不良事件发生率的风险比（RR）。这项研究在 PROSPERO 注册，编号 CRD42021245002。
纳入了 6 项研究（3766 人）。接受治疗的人和对照组的不良事件发生率分别为 0.4%（95%CI：0.1-1.1%）和 2.2%（95%CI：1.6-3.0%）。合并 RR 为 0.38（95%CI：0.22-0.66）。亚组分析显示，在单次使用 200mg 强力霉素组中，合并 RR 为 0.29（95%CI：0.14-0.60）；在 10 天疗程组（阿莫西林、青霉素或四环素）中，合并 RR 为 0.28（95%CI：0.05-1.67）；在局部抗生素治疗组（阿奇霉素）中，合并 RR 为 0.73（95%CI：0.25-2.08）。
现有证据支持使用抗生素预防莱姆病，并且表明单次使用的优势，但是还需要进一步的证实。
