Efficacy and safety of pharmacological treatments for Lyme neuroborreliosis in children: a systematic review.
BACKGROUND
Many aspects of pharmacological treatment of Lyme neuroborreliosis in children, such as choice of drug, dosage, and duration are subject to intense debates, leading to uncertainties in patients' parents and healthcare providers alike. To assess the available evidence for pharmacological treatment for children with Lyme neuroborreliosis we conducted a systematic review.


METHODS
The comprehensive systematic literature search included randomized-controlled trials (RCTs) and non-randomized studies (NRS) on treatment of Lyme neuroborreliosis in children (age <18 years). Our primary outcome was neurological symptoms after treatment. Risk of bias was assessed with the Cochrane risk of bias tools for RCTs and NRS. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.


RESULTS
Two RCTs and four NRS were eligible for inclusion. Risk of bias in RCTs and NRS was generally high. Reporting of studies was generally poor. Regarding the primary outcome neurological symptoms at 1-3 months, no statistically significant difference could be found in cohort studies between doxycycline and beta-lactam antibiotics. In two RCTs comparing penicillin G and ceftriaxone, no patient experienced residual neurological symptoms at the last reported time points. Quality of evidence according to GRADE was judged very low.


CONCLUSIONS
Data is scarce and with limited quality. Several issues could not be addressed due to scarcity of information. No eligible study compared different treatment durations. According to the available evidence, there seems to be no difference between different antibiotic agents for the treatment of Lyme neuroborreliosis in children regarding neurological symptoms. We found no evidence that supports extended antibiotic regimes.


BACKGROUND
Systematic review registration: CRD42014008839 .
Cochrane Germany, Medical Center-University of Freiburg, Berliner Allee 29, D-79110, Freiburg im Breisgau, Germany. rick.dersch@uniklinik-freiburg.de.|Department of Neurology, Medical Center-University of Freiburg, Breisacher Str. 64, D-79106, Freiburg, Germany. rick.dersch@uniklinik-freiburg.de.
Rick
R
Dersch
Department of Neurology, Medical Center-University of Freiburg, Breisacher Str. 64, D-79106, Freiburg, Germany.
Tilman
T
Hottenrott
Cochrane Germany, Medical Center-University of Freiburg, Berliner Allee 29, D-79110, Freiburg im Breisgau, Germany.|UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany.
Stefanie
S
Schmidt
Institute of Medical Biometry and Statistics, Medical Center-University of Freiburg, Stefan-Meier-Str- 26, D-79104, Freiburg, Germany.
Harriet
H
Sommer
Prof.-Hess-Kinderklinik, Klinikum Bremen-Mitte, Sankt-Jürgen-Str. 1, D-28177, Bremen, Germany.
Hans-Iko
HI
Huppertz
Department of Neurology, Medical Center-University of Freiburg, Breisacher Str. 64, D-79106, Freiburg, Germany.
Sebastian
S
Rauer
Cochrane Germany, Medical Center-University of Freiburg, Berliner Allee 29, D-79110, Freiburg im Breisgau, Germany.|Centre de Recherche Épidémiologie et Statistique INSERM Sorbonne Paris, Cochrane France, Hôpital Hôtel-Dieu, 1 place du Parvis Notre Dame, 75181, Paris Cedex 04, France.
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