TY - JOUR
T1 - A single dose of doxycycline after an Ixodes ricinus tick bite to prevent Lyme borreliosis: an open-label randomized controlled trial
AU - Harms, M. G.
AU - Hofhuis, A.
AU - Sprong, H.
AU - Bennema, S. C.
AU - Ferreira, J. A.
AU - Fonville, M.
AU - Docters van Leeuwen, A.
AU - Assendelft, W. J. J.
AU - van Weert, H. C. P. M.
AU - van Pelt, W.
AU - van den Wijngaard, C. C.
N1 - Funding Information: This work was funded by The Netherlands Organisation for Health Research and Development (ZonMw). We are very grateful to Alienke Wijmenga en Renee van Boxtel for monitoring the trial. Funding Information: This work was funded by The Netherlands Organisation for Health Research and Development ( ZonMw ). We are very grateful to Alienke Wijmenga en Renee van Boxtel for monitoring the trial. Publisher Copyright: © 2020 The British Infection Association Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - OBJECTIVES: A single dose of doxycycline after a tick bite can prevent the development of Lyme borreliosis in North America, but extrapolation to Europe is hampered by differences in Borrelia burgdorferi sensu lato genospecies and tick species. We assessed the efficacy of prophylaxis after a tick bite in Europe. METHODS: We conducted an open-label randomized controlled trial, administering a single dose of 200 mg doxycycline within 72 hours after removing an attached tick from the skin, compared to no treatment. Potential participants ≥ 8 years of age who reported a recent tick bite online were invited for the study. After informed consent, they were randomly assigned to either the prophylaxis or the no-treatment group. Participants in the prophylaxis group were asked to visit their general practitioner to administer the antibiotics. All participants were followed up by online questionnaires. Our primary outcome was the development of physician-confirmed Lyme borreliosis in a modified-intention-to-treat analysis. This study is registered in the Netherlands Trial Register (NTR3953) and is closed. RESULTS: Between April 11, 2013, and June 10, 2015, 3538 potential participants were randomized, of whom 1689 were included in the modified-intention-to-treat analysis. 10 cases of Lyme borreliosis were reported out of 1041 participants (0•96 %) in the prophylaxis group, and 19 cases out of 648 no-treatment participants (2•9 %), resulting in a relative risk reduction of 67% (95% CI 31 - 84%), and a number-needed-to-treat of 51 (95% CI 29 - 180). No serious adverse events were reported. CONCLUSIONS: This primary care-based trial provides evidence that a single dose of doxycycline can prevent the development of Lyme borreliosis after an Ixodes ricinus tick bite.
AB - OBJECTIVES: A single dose of doxycycline after a tick bite can prevent the development of Lyme borreliosis in North America, but extrapolation to Europe is hampered by differences in Borrelia burgdorferi sensu lato genospecies and tick species. We assessed the efficacy of prophylaxis after a tick bite in Europe. METHODS: We conducted an open-label randomized controlled trial, administering a single dose of 200 mg doxycycline within 72 hours after removing an attached tick from the skin, compared to no treatment. Potential participants ≥ 8 years of age who reported a recent tick bite online were invited for the study. After informed consent, they were randomly assigned to either the prophylaxis or the no-treatment group. Participants in the prophylaxis group were asked to visit their general practitioner to administer the antibiotics. All participants were followed up by online questionnaires. Our primary outcome was the development of physician-confirmed Lyme borreliosis in a modified-intention-to-treat analysis. This study is registered in the Netherlands Trial Register (NTR3953) and is closed. RESULTS: Between April 11, 2013, and June 10, 2015, 3538 potential participants were randomized, of whom 1689 were included in the modified-intention-to-treat analysis. 10 cases of Lyme borreliosis were reported out of 1041 participants (0•96 %) in the prophylaxis group, and 19 cases out of 648 no-treatment participants (2•9 %), resulting in a relative risk reduction of 67% (95% CI 31 - 84%), and a number-needed-to-treat of 51 (95% CI 29 - 180). No serious adverse events were reported. CONCLUSIONS: This primary care-based trial provides evidence that a single dose of doxycycline can prevent the development of Lyme borreliosis after an Ixodes ricinus tick bite.
KW - Antibiotic prophylaxis
KW - Citizen science
KW - Erythema migrans
KW - Ixodes ricinus
KW - Lyme borreliosis
KW - Tick bite
UR - http://www.scopus.com/inward/record.url?scp=85089063713&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jinf.2020.06.032
DO - https://doi.org/10.1016/j.jinf.2020.06.032
M3 - Article
C2 - 32565073
SN - 0163-4453
VL - 82
SP - 98
EP - 104
JO - Journal of Infection
JF - Journal of Infection
IS - 1
ER -