Department of Clinical Science, Intervention and Technology - CLINTEC, Alfred Nobels Allé 8, S-141 52, Huddinge, Sweden.
Department of Pediatric Infectious Diseases, Astrid Lindgren's Children's Hospital, Karolinska Vägen 22, S-171 64 Solna, Stockholm, Sweden.
BMC Pediatr. 2022 Jun 9;22(1):332. doi: 10.1186/s12887-022-03335-w.
Lyme neuroborreliosis (LNB) is a tick-borne infection caused by the spirochete Borrelia burgdorferi sensu lato complex with various neurological manifestations. The recommended treatment for LNB in Swedish children has been intravenous ceftriaxone 50-100 mg/kg × 1 (< 8 years of age) or oral doxycycline 4 mg/kg × 1 (≥ 8 years of age) for 10-14 days. Studies on adult LNB patients have shown equal efficacy for ceftriaxone and doxycycline, but no such studies have been conducted on pediatric LNB patients. The aim of this study is to retrospectively evaluate clinical outcome in children with LNB who have received intravenous ceftriaxone or oral doxycycline.
Clinical and laboratory data from three previously conducted prospective studies on children with LNB (1998-2014) were retrospectively analyzed. A total of 321 children (1-19 years of age), who received antibiotic treatment for definite LNB or possible LNB, were included. Clinical outcome at the 2-month follow-up (recovery/non-recovery) was evaluated using Chi test and logistic multivariate regression analysis. Out of 321 LNB patients, 194 children (60%) had received ceftriaxone and 127 children (40%) had received doxycycline. When comparing clinical outcome between treatment groups, no difference was found (p = 0,217). Results did not change when incorporating relevant clinical and laboratory data into the logistic multivariate regression analysis.
In this large retrospective study, no difference in clinical outcome was found, independent of age, when comparing children who received ceftriaxone with those who received doxycycline, supporting an equal effectiveness for treatment of LNB pediatric patients. However, future randomized comparative treatment studies are warranted for evaluation of efficacy of antibiotic treatment in pediatric LNB patients.
莱姆神经Borreliosis（LNB）是一种由疏螺旋体 Borrelia burgdorferi sensu lato 复合物引起的蜱传感染，具有各种神经表现。瑞典儿童 LNB 的推荐治疗方法是静脉注射头孢曲松 50-100mg/kg×1（<8 岁）或口服多西环素 4mg/kg×1（≥8 岁），持续 10-14 天。成人 LNB 患者的研究表明头孢曲松和多西环素的疗效相同，但尚未对儿科 LNB 患者进行此类研究。本研究旨在回顾性评估接受头孢曲松静脉注射或多西环素口服治疗的 LNB 儿童的临床结局。
对三项先前进行的儿童 LNB 前瞻性研究（1998-2014 年）的临床和实验室数据进行了回顾性分析。共纳入 321 名（1-19 岁）接受抗生素治疗的明确 LNB 或可能 LNB 儿童。使用 Chi 检验和逻辑多元回归分析评估 2 个月随访时的临床结局（恢复/未恢复）。321 例 LNB 患者中，194 例（60%）接受头孢曲松治疗，127 例（40%）接受多西环素治疗。比较两组治疗的临床结局时，无差异（p=0.217）。将相关临床和实验室数据纳入逻辑多元回归分析后，结果无变化。
在这项大型回顾性研究中，比较头孢曲松组和多西环素组的临床结局时，发现年龄与疗效无关，支持对儿科 LNB 患者进行等效治疗。然而，需要进一步开展随机对照治疗研究来评估儿科 LNB 患者的抗生素治疗效果。
