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To guide treatment recommendations, a systematic review was performed of the available literature on specific treatment for PTLDs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic literature search of MEDLINE and CENTRAL was performed. No restrictions on case definitions, study types or specific interventions were applied to enable a comprehensive overview of the available literature. Risk of bias was assessed using the Cochrane risk of bias tools for randomized controlled trials. Certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. Outcomes of interest were quality of life, fatigue, depression and cognition as well as adverse events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After screening 1274 records, eight eligible randomized controlled trials were included. Heterogeneity was observed regarding inclusion criteria, intervention, length of treatment and outcome measures. For efficacy outcomes, results are presented narratively due to heterogeneity. Eligible studies show no statistically significant difference between antibiotics and placebo regarding quality of life, cognition and depression. Results for fatigue were inconsistent whilst studies with low risk of bias showed no statistically significant difference between antibiotics and placebo. Meta\u2010analysis of safety outcomes showed statistically significantly more adverse events for antibiotics compared to placebo.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Available literature on treatment of PTLDs is heterogeneous, but overall shows evidence of no effect of antibiotics regarding quality of life, depression, cognition and fatigue whilst showing more adverse events. Patients with suspected PTLDs should not be treated with antibiotics.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.16293","type":"journal-article","created":{"date-parts":[[2024,4,12]],"date-time":"2024-04-12T09:58:45Z","timestamp":1712915925000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Treatment of post\u2010treatment Lyme disease symptoms\u2014a systematic review"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7366-4401","authenticated-orcid":false,"given":"Rick","family":"Dersch","sequence":"first","affiliation":[{"name":"Clinic of Neurology and Neurophysiology Medical Center\u2014University of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1463-3119","authenticated-orcid":false,"given":"Gabriel","family":"Torbahn","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Paracelsus Medical University Klinikum N\u00fcrnberg Universit\u00e4tsklinik der Paracelsus Medizinischen Privatuniversit\u00e4t N\u00fcrnberg Nuremberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Rauer","sequence":"additional","affiliation":[{"name":"Clinic of Neurology and Neurophysiology Medical Center\u2014University of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,4,12]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-015-7923-0"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ277"},{"issue":"3","key":"e_1_2_10_4_1","first-page":"454","article-title":"Lyme disease: an infectious and postinfectious syndrome","volume":"21","author":"Asch ES","year":"1994","journal-title":"J Rheumatol"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1086\/508667"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2022.04.004"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0225012"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2021.100142"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2023.104825"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2906.221685"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-36709-w"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2014.09.022"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1086\/318082"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-015-7891-4"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/brb3.2608"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awac206"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.15721"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1586\/14787210.2014.940900"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2021.05.011"},{"issue":"10","key":"e_1_2_10_20_1","doi-asserted-by":"crossref","first-page":"1568","DOI":"10.1093\/cid\/ciy329","article-title":"Adverse events associated with antibiotics and intravenous therapies for post\u2010Lyme disease syndrome in a commercially insured sample","volume":"67","author":"Goodlet KJ","year":"2018","journal-title":"Clin Infect Dis"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6623a3"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/2046-4053-3-117"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d5928"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.12744"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.16034"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1186"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.07.015"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1505425"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare10071314"},{"issue":"5","key":"e_1_2_10_30_1","first-page":"489","article-title":"Severity of Lyme disease with persistent symptoms. 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