Effectiveness of antibiotic treatment in children with Lyme neuroborreliosis - a retrospective study

Abstract

Background Lyme neuroborreliosis (LNB) is a tick-borne infection caused by the spirochete Borrelia burgdorferi sensu lato complex with various neurological manifestations. The recommended treatment for LNB in Swedish children has been intravenous ceftriaxone 50–100 mg/kg × 1 (< 8 years of age) or oral doxycycline 4 mg/kg × 1 (≥ 8 years of age) for 10–14 days. Studies on adult LNB patients have shown equal efficacy for ceftriaxone and doxycycline, but no such studies have been conducted on pediatric LNB patients. The aim of this study is to retrospectively evaluate clinical outcome in children with LNB who have received intravenous ceftriaxone or oral doxycycline. Results Clinical and laboratory data from three previously conducted prospective studies on children with LNB (1998–2014) were retrospectively analyzed. A total of 321 children (1–19 years of age), who received antibiotic treatment for definite LNB or possible LNB, were included. Clinical outcome at the 2-month follow-up (recovery/non-recovery) was evaluated using Chi2 test and logistic multivariate regression analysis. Out of 321 LNB patients, 194 children (60%) had received ceftriaxone and 127 children (40%) had received doxycycline. When comparing clinical outcome between treatment groups, no difference was found (p = 0,217). Results did not change when incorporating relevant clinical and laboratory data into the logistic multivariate regression analysis. Conclusion In this large retrospective study, no difference in clinical outcome was found, independent of age, when comparing children who received ceftriaxone with those who received doxycycline, supporting an equal effectiveness for treatment of LNB pediatric patients. However, future randomized comparative treatment studies are warranted for evaluation of efficacy of antibiotic treatment in pediatric LNB patients.

Efficacy and safety of pharmacological treatments for Lyme neuroborreliosis: An updated systematic review

“…Additionally, qualitative synthesis of two RCTs also showed similar effects of beta-lactam antibiotics and doxycycline on CSF pleocytosis [13,20]. These results are further corroborated by data from two additional NRS [14,17]. These new studies add to the certainty of previous analysis and corroborate current guideline recommendations [6].…”

“…Characteristics of included studies are shown in Table 1. Two studies were RCTs [12,13] five were NRS [14][15][16][17][18]. Data from one RCT regarding choice of antibiotic treatment could be integrated in a meta-analysis of previous studies.…”

“…One additional NRS focused on LNB in children and also reported no statistically significant difference regarding the primary outcome of residual neurological symptoms 2 months after treatment for the comparison of ceftriaxone and doxycycline. This study had an overall critical risk of bias for issues with confounding, classification of interventions and measurement of outcomes [14].…”

Increased usage of doxycycline for young children with Lyme disease

“…With its high oral availability and known activity against Borrelia burgdorferi, doxycycline provides an attractive treatment alternative (Saivin and Houin, 1988;Wormser and Halperin, 2008). Several European clinical trials in adults (Borg et al, 2005;Ljøstad et al, 2008;Kortela et al, 2021;Arnason and Skogman, 2022) and a retrospective study in children (Lopez et al, 2019) reported good outcomes for patients with Lyme meningitis treated with doxycycline. In 2020, the Infectious Disease Society of America, American Academy of Neurology, and American College of Rheumatology recommended either oral doxycycline or parenteral ceftriaxone as a first-line treatment for Lyme meningitis (Lantos et al, 2021).…”

Tick-borne diseases and the central nervous system : clinical and immunological aspects

“…Since ceftriaxone is administered once daily, it is the more commonly used intravenous antibiotic, especially for patients not in hospital care. The efficiency of oral versus intravenous treatment in patients with LNB has been studied in several studies, both in adults and children with equal outcomes and therefore oral doxycycline is the drug of choice according to Swedish guidelines (Appendix 1 and 2) [49][50][51][52][53]. In LNB patients with CNS symptoms, such as myelitis or encephalitis, ceftriaxone is recommended, according to the EFNS guidelines.…”