Efficacy of antibiotic prophylaxis for prevention of Lyme disease.
OBJECTIVE
To determine if antibiotic prophylaxis following a dear tick bite is effective in reducing the risk of developing Lyme disease.


METHODS
Meta-analysis of published trials.


METHODS
Clinical trials were identified by a computerised literature search of MEDLINE and by an assessment of the bibliographies of published studies.


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


METHODS
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
Among the 600 patients with Ixodes 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, was 0.0 (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.
Warshafsky
S
S
Department of Medicine, New York Medical College, Valhalia 10595, USA.
Nowakowski
J
J
Nadelman
R B
RB
Kamer
R S
RS
Peterson
S J
SJ
Wormser
G P
GP
D000658:Amoxicillin / Q000627:therapeutic use; D000818:Animals; D019072:Antibiotic Prophylaxis; D001733:Bites and Stings; D006801:Humans; D018884:Ixodes; D008193:Lyme Disease / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D010406:Penicillins / Q000627:therapeutic use; D012307:Risk Factors; D013752:Tetracycline / Q000627:therapeutic use
D010406:Penicillins; D000658:Amoxicillin; D013752:Tetracycline