Forty Years of Evidence on the Efficacy and Safety of Oral and Injectable Antibiotics for Treating Lyme Disease of Adults and Children: A Network Meta-Analysis.
Forty Years of Evidence on the Efficacy and Safety of Oral and Injectable Antibiotics for Treating Lyme Disease of Adults and Children: A Network Meta-Analysis.
复制标题
口服和注射抗生素治疗成人和儿童莱姆病的功效和安全性四十年的证据：网络荟萃分析。
DOI：
10.1128/spectrum.00761-21
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发表时间：
2021-12-22
影响因子：
3.7
通讯作者：
Bao F
中科院分区：
文献类型：
--
作者：
Yang J;Wen S;Kong J;Yue P;Cao W;Xu X;Zhang Y;Chen J;Liu M;Fan Y;Luo L;Chen T;Li L;Li B;Dong Y;Luo S;Zhou G;Liu A;Bao F
莱姆病（LD）是一种严重的公共卫生负担。LD最常见的表现包括游走性红斑（EM）、莱姆病神经疏螺旋体病（LNB）和莱姆病关节炎（LA）。抗生素治疗LD的有效性和安全性仍存在争议。因此，我们进行了网络荟萃分析（NMA），以获得更多的数据，并试图解决这个问题。我们在Embase和PubMed数据库中检索了自其建立之日起至2021年4月22日的研究。比值比（OR）用于评估二分结局。共纳入31项随机对照试验（RCT），涉及2，748例患者和11种抗生素。口服阿莫西林（1.5 g/天）、口服阿奇霉素（0.5 g/天）、注射用头孢曲松和注射用头孢噻肟治疗LD有效（OR范围为1.02 - 1，610.43）。头孢呋辛和青霉素治疗LD是安全的（OR范围为0.027 ~ 0.98）。阿莫西林治疗EM有效（OR范围为1.18至25.66）。根据结果，我们认为口服阿莫西林（1.5 g/d）、口服阿奇霉素（0.5 g/d）、注射用头孢曲松和注射用头孢噻肟治疗LD有效。头孢呋辛和青霉素治疗LD安全。阿莫西林治疗EM有效。我们没有观察到证据证明强力霉素在治疗儿童或成人LD、LA、LNB和EM的有效性和安全性方面的优势。我们没有足够的数据证明治疗成人LA和LNB与儿童LD的疗效存在显著差异，治疗LD的口服药物安全性存在显著差异，治疗EM的药物安全性存在显著差异。一些先前的研究调查了抗生素治疗莱姆病（LD）的有效性和安全性。然而，由于技术上的限制，关于药物给药途径和药物剂量的一些问题仍然不清楚，这可能会给临床医生带来问题。因此，我们进行了网络荟萃分析（NMA），以定量分析在过去40年中发表的临床数据。在这里，我们展示了关于常用于治疗成人和儿童LD的抗生素的有效性和安全性的证据。我们发现阿莫西林、阿奇霉素、头孢曲松和头孢噻肟治疗LD有效，但我们没有观察到强力霉素治疗LD的显著疗效和安全性。
Lyme disease (LD) is a heavy public health burden. The most common manifestations of LD include erythema migrans (EM), Lyme neuroborreliosis (LNB), and Lyme arthritis (LA). The efficacy and safety of antibiotics for treating LD is still controversial. Thus, we performed a network meta-analysis (NMA) to obtain more data and tried to solve this problem. We searched studies in the databases of Embase and PubMed from the date of their establishments until 22 April 2021. Odds ratios (ORs) were used to assess dichotomous outcomes. A total of 31 randomized controlled trials (RCTs) involving 2,748 patients and 11 antibiotics were included. Oral amoxicillin (1.5 g/day), oral azithromycin (0.5 g/day), injectable ceftriaxone, and injectable cefotaxime were effective for treating LD (range of ORs, 1.02 to 1,610.43). Cefuroxime and penicillin were safe for treating LD (range of ORs, 0.027 to 0.98). Amoxicillin was effective for treating EM (range of ORs, 1.18 to 25.66). Based on the results, we thought oral amoxicillin (1.5 g/day), oral azithromycin (0.5 g/day), injectable ceftriaxone, and injectable cefotaxime were effective for treating LD. Cefuroxime and penicillin were safe for treating LD. Amoxicillin was effective for treating EM. We did not observe evidence proving the advantage of doxycycline in efficacy and safety for treating LD, LA, LNB, and EM of children or adults. We did not have sufficient data to prove the significant difference of efficacy for treating LA and LNB in adults and LD in children, the significant difference of safety of oral drugs for treating LD, and the significant difference of safety of drugs for treating EM. IMPORTANCE Some previous studies investigated the efficacy and safety of antibiotics for treating Lyme disease (LD). However, due to technical limitations, several questions regarding the routes of drug administration and the dosages of drug are still unclear, which might be causing problems for clinicians. Hence, we performed network meta-analysis (NMA) to quantitatively analyze the clinical data published during the last 40 years. Here, we demonstrate the evidence regarding the efficacy and safety of antibiotics commonly used for treating LD in adults and children. We found that amoxicillin, azithromycin, ceftriaxone, and cefotaxime were effective for treating LD, but we did not observe significant efficacy and safety of doxycycline for treating LD.