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Evidence summaries

Treatment of Early Lyme Disease

Oral beta-lactam antibiotics and oral tetracyclines appear to be effective against early Lyme disease. Oral macrolides are probably not effective. Level of evidence: "B"

A systematic review 1 including 11 studies with a total of 1 213 subjects was abstracted in DARE. According to the review, phenoxymethylpenicillin, amoxicillin, amoxicillin/probenecid, tetracycline, doxycycline, and cefuroxime axetil are equally effective for the treatment of early Lyme disease. However, the available studies do not have sufficient power to detect small but potentially clinically relevant differences in the efficacy between the individual drugs. Clinical failures with erythromycin, roxithromycin, and azithromycin indicate that macrolides cannot be recommended as first line agents.

Comment: The quality of evidence is downgraded by potential reporting bias (limited literature search, no reported structured validity assessment of included studies).

References

  • Loewen PS, Marra CA, Marra F. Systematic review of the treatment of early Lyme disease. Drugs 1999 Feb;57(2):157-73. [PubMed][DARE]

Primary/Secondary Keywords