7 days of Doxycycline therapy for early Lyme disease as effective as therapy for 14 days

SLOVENIA: According to a study published in The Lancet Infectious Diseases, erythema migrans, the most common symptom of early Lyme borreliosis, can be effectively treated with a shorter oral doxycycline course while also lowering the need for hazardous antibiotics.

The most common vector-borne illness in North America and Europe is Lyme borreliosis. The major treatment guideline for erythema migrans is doxycycline for 10 days.

The authors sought to determine whether oral doxycycline for 7 days is non-inferior to 14 days in treating people with solitary erythema migrans in order to decrease possibly harmful antibiotic misuse by identifying shorter effective therapies.

At the University Medical Center in Ljubljana, Slovenia, the researchers enrolled individuals with a single erythema for this randomised open-label non-inferiority trial. Patients were excluded if they exhibited other Lyme borreliosis symptoms, were pregnant or nursing, immunosuppressed, allergic to doxycycline, or had recently taken medications with anti-borrelial action. Adults received oral doxycycline 100 mg twice daily for 7 or 14 days, according to a 1:1 random distribution. In a per-protocol analysis, the difference in the proportion of patients who experienced treatment failure, as indicated by persistent erythema, new objective Lyme borreliosis symptoms, or borrelial isolation on skin re-biopsy at 2 months, served as the primary efficacy endpoint. Six percentage points made up the non-inferiority margin. All patients who were randomized to the study and were subject to evaluation at the 14-day visit had their safety assessed.

Key highlights:

• 295 patients finished their prescribed course of antibiotics, and 294 (98%) of them were still evaluable two months after enrollment.
• Treatment failure manifested as persistent erythema in five (3%) of 147 patients from the 7-day group and three (2%) of 147 patients from the 14-day group (one patient did not attend the 2-month visit and could not be reached by phone). (Difference 1.4 percentage points; upper limit of one-sided 95% CI 5.2 percentage points; p=0.64)
• Neither patients nor repeat skin biopsies resulted in positive Lyme borreliosis objective symptoms during follow-up.
• Adverse events led to the discontinuation of therapy in two (1%) of the 150 patients in the 7-day group and one (1%) of the 150 patients in the 14-day group.

"Our findings justify the use of oral doxycycline for 7 days in adult European patients with isolated erythema migrans, allowing for less antibiotic exposure than is currently recommended," concluded the authors.

REFERENCE

Daša Stupica,et al,. Treatment of erythema migrans with doxycycline for 7 days versus 14 days in Slovenia: a randomised open-label non-inferiority trial. Published:October 06, 2022,DOI: https://doi.org/10.1016/S1473-3099(22)00528-X