{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T11:53:24Z","timestamp":1765886004709},"reference-count":37,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2015,6,8]],"date-time":"2015-06-08T00:00:00Z","timestamp":1433721600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"German Academy of Neurology"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2015,9]]},"abstract":"<jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>Our aim was to evaluate the available evidence for pharmacological treatment of acute Lyme neuroborreliosis as a basis for evidence\u2010based clinical recommendations in a systematic review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic literature search of Medline, <jats:styled-content style=\"fixed-case\">EMBASE<\/jats:styled-content>, the Cochrane Library and three trial registries was performed. Randomized controlled trials (<jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s) and non\u2010randomized studies (<jats:styled-content style=\"fixed-case\">NRS<\/jats:styled-content>) were evaluated. Risk of bias was assessed using the Cochrane risk of bias tools. The primary outcome was \u2018residual neurological symptoms\u2019 whilst the secondary outcomes were disability, quality of life, pain, fatigue, depression, cognition, sleep, adverse events and cerebrospinal fluid pleocytosis. The quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (<jats:styled-content style=\"fixed-case\">GRADE<\/jats:styled-content>) approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After screening 5779 records, eight <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s and eight <jats:styled-content style=\"fixed-case\">NRS<\/jats:styled-content> were included. Risk of bias was generally high. No statistically significant difference was found between doxycycline and beta\u2010lactam antibiotics in a meta\u2010analysis regarding residual neurological symptoms at 4\u201312\u00a0months [risk ratio (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>) 1.27, 95% confidence interval (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>) 0.98\u20131.63, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.07] or adverse events (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 0.82, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.54\u20131.25, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.35). Significantly fewer neurological symptoms for cefotaxime compared with penicillin were found (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 1.81, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.10\u20132.97, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.02). Adverse events were significantly fewer for penicillin (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 0.56, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.38\u20130.84, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.005).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Evidence regarding pharmacological treatment of acute Lyme neuroborreliosis is scarce and therefore insufficient to recommend preference of beta\u2010lactam antibiotics over doxycycline or vice versa. However, due to considerable imprecision, relevant differences between treatments cannot be excluded. No evidence suggesting benefits of extended antibiotic treatments could be identified. Further well\u2010designed trials are needed. Individual treatment decisions should address patients' preferences and individual conditions like prior allergic reactions.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.12744","type":"journal-article","created":{"date-parts":[[2015,6,10]],"date-time":"2015-06-10T23:36:11Z","timestamp":1433979371000},"page":"1249-1259","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":54,"title":["Efficacy and safety of pharmacological treatments for acute <scp>L<\/scp>yme neuroborreliosis \u2013 a systematic review"],"prefix":"10.1111","volume":"22","author":[{"given":"R.","family":"Dersch","sequence":"first","affiliation":[{"name":"German Cochrane Centre Medical Center \u2013 University of Freiburg Freiburg Germany"},{"name":"Department of Neurology Medical Center \u2013 University of Freiburg Freiburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. H.","family":"Freitag","sequence":"additional","affiliation":[{"name":"Division of General Practice Department of Health Services Research Carl von Ossietzky University Oldenburg Oldenburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"German Cochrane Centre Medical Center \u2013 University of Freiburg Freiburg Germany"},{"name":"UroEvidence@Deutsche Gesellschaft f\u00fcr Urologie Berlin Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"Sommer","sequence":"additional","affiliation":[{"name":"German Cochrane Centre Medical Center \u2013 University of Freiburg Freiburg Germany"},{"name":"Institute of Medical Biometry and Statistics Medical Center \u2013 University of Freiburg Freiburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Rauer","sequence":"additional","affiliation":[{"name":"Department of Neurology Medical Center \u2013 University of Freiburg Freiburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. J.","family":"Meerpohl","sequence":"additional","affiliation":[{"name":"German Cochrane Centre Medical Center \u2013 University of Freiburg Freiburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,6,8]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2009.02862.x"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s004150050214"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.46.3.619"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(11)70034-2"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1086\/508667"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000265517.66976.28"},{"issue":"1","key":"e_1_2_7_8_1","first-page":"S1","article-title":"Evidence\u2010based guidelines for the management of Lyme disease","volume":"2","author":"Cameron D","year":"2004","journal-title":"Expert Rev Anti Infect Ther"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1068"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2009.02862.x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/2046-4053-3-117"},{"key":"e_1_2_7_12_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0","author":"Higgins J","year":"2011"},{"key":"e_1_2_7_13_1","unstructured":"SterneJ HigginsJ ReevesB on behalf of the development group for ACROBAT\u2010NRSI.A Cochrane risk of bias assessment tool: for non\u2010randomized studies of interventions (ACROBAT NRSI) version 1.0.0.2014.http:\/\/www.riskofbias.info(accessed 19\/12\/2014)."},{"key":"e_1_2_7_14_1","unstructured":"WellsG SheaB O'ConnellD et\u00a0al.The Newcastle\u2212Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta\u2010analyses.2000.http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp(accessed 23\/1\/2015)."},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.07.015"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(08)70119-4"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s100960050166"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.44.7.1203"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/163.2.311"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01644175"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00328508"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1989.00520470044025"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.1988.tb31915.x"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365540510027228"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365540110080421"},{"key":"e_1_2_7_26_1","first-page":"46","article-title":"The clinical spectrum of Lyme neuroborreliosis","volume":"103","author":"Elamin M","year":"2010","journal-title":"Ir Med J"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0404.1990.tb01588.x"},{"key":"e_1_2_7_28_1","first-page":"362","article-title":"[Neurologic forms of Lyme disease. 12 cases]","volume":"145","author":"Viader F","year":"1989","journal-title":"Rev Neurol (Paris)"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.51.5.699"},{"key":"e_1_2_7_30_1","first-page":"182","article-title":"[Meningoradiculitis after a tick bite. Study of 31 cases]","volume":"143","author":"Hirsch E","year":"1987","journal-title":"Rev Neurol (Paris)"},{"key":"e_1_2_7_31_1","first-page":"63","article-title":"\u010cast\u0301y v\u00fdskyt lymesk\u00e9 neuroboreli\u00f3zy u d\u011bt\u00ed v \u010cesk\u00e9 Republice [Frequent incidence of Lyme neuroborreliosis in children in the Czech Republic]","volume":"76","author":"Lib\u00e1\u2010Vrabelov\u00e1 Z","year":"2013","journal-title":"Cesk Slov Neurol N"},{"key":"e_1_2_7_32_1","first-page":"357","article-title":"High\u2010dose penicillin therapy in meningopolyneuritis Garin\u2212Bujadoux\u2212Bannwarth. Clinical and cerebrospinal fluid data","volume":"263","author":"Kristoferitsch W","year":"1987","journal-title":"Zentralbl Bakteriol Mikrobiol Hyg A"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2009.02756.x"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2011.03563.x"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0404.2010.01482.x"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD006978"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.3109\/00365548709117207"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2010.03175.x"}],"container-title":["European Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fene.12744","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ene.12744","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T22:23:53Z","timestamp":1695507833000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ene.12744"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,6,8]]},"references-count":37,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2015,9]]}},"alternative-id":["10.1111\/ene.12744"],"URL":"https:\/\/doi.org\/10.1111\/ene.12744","archive":["Portico"],"relation":{},"ISSN":["1351-5101","1468-1331"],"issn-type":[{"value":"1351-5101","type":"print"},{"value":"1468-1331","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,6,8]]},"assertion":[{"value":"2015-02-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-04-06","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-06-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}