Efficacy and Safety of Antibiotic Therapy in Early Cutaneous Lyme Borreliosis: A Network Meta-analysis.

Torbahn G, et al. JAMA Dermatol. 2018.


Importance: Controversies about the choice of antibiotic agent and treatment modality exist in the management of erythema migrans in early cutaneous Lyme borreliosis (LB).

Objective: To conduct a network meta-analysis (NMA) of all randomized clinical trials on various antibiotic agents and treatment modalities in early cutaneous LB.

Data Sources: Electronic searches in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were conducted from inception until July 2017. The reference lists of the included studies were hand searched, authors were contacted, and ongoing trials were searched at

Study Selection: One reviewer screened the titles and abstracts of the 9975 reports identified by the electronic searches. Full-text copies of 161 potentially relevant articles were obtained, and 2 reviewers independently assessed those articles for inclusion. Adults with a physician-confirmed early localized skin infection who were treated with antibiotics of any dose or duration were included.

Data Extraction and Synthesis: Two reviewers independently extracted data on study, patient, and intervention characteristics. Network meta-analyses on treatment effects and adverse outcomes were calculated with a frequentist approach using the R package netmeta. The Grading of Recommendations Assessment, Development and Evaluation guidance for NMA was used to assess the certainty of evidence.

Main Outcomes and Measures: Treatment effects for response to treatment (resolution of symptoms) and treatment-related adverse events.

Results: Overall, 19 studies (2532 patients) were included. The mean patient age ranged between 37 and 56 years, and the percentage of female patients ranged from 36% to 60%. The antibiotics investigated were doxycycline, cefuroxime axetil, ceftriaxone, amoxicillin, azithromycin, penicillin V, and minocycline. Pooled effect sizes from NMAs did not suggest any significant differences in treatment response by antibiotic agent (eg, amoxicillin vs doxycycline odds ratio, 1.26; 95% CI, 0.41-3.87), dose, or duration (eg, doxycycline, 200 mg/d for 3 weeks, vs doxycycline, 200 mg/d for 2 weeks, odds ratio, 1.28; 95% CI, 0.49-3.34). Treatment failures were rare at both 2 months (4%; 95% CI, 2%-5%) and 12 months (2%, 95% CI, 1%-3%) after treatment initiation. There were also no differences in the effect sizes among antibiotic agents and treatment modalities for treatment-related adverse outcomes, which were generally mild to moderate.

Certainty of evidence was categorized as low and very low mostly because of imprecision, indirectness, and study limitations (high risk of bias) of the included studies.

Conclusions and Relevance: This NMA suggests that neither the antibiotic agent nor treatment modality contributed to comparative effectiveness or drug-related adverse outcomes. This finding is relevant for physicians treating patients with LB and for patient decision making.



This meta-analysis demonstrates that early detection and treatment for LD is IMPERATIVE.

Also, it needs to be emphasized that current CDC two-tiered testing:

  • Misses up to 60% of acute cases (Rosenfeld , Wang, Schwartz, Wormser, 2005)
  • Can not differentiate between active infection and previous exposure
  • Does not detect other Borrelia species including B. miyamotoi, which causes Lyme-like symptoms
  • Requires subjective interpretation of results, leading to significant variability across and even within laboratories
So there’s a problem Houston even getting through the initial gate.  Many, many people are not even making the criteria to be diagnosed in the first place.

Then, the “management of erythema migrans in early cutaneous Lyme borreliosis (LB),” is a poor marker of effective treatment, particularly since many never remember a tick bite or see the bullseye rash.  This informative article shows pictures of varying rashes as well as the fact while the CDC states 70% may exhibit the erythema migrans, it can vary by region. A 2010 study showed that in the state of Maine only 43% of Lyme patients exhibited this particular type of rash.

So….far less than half in Maine had this rash at all…..  This article states a range of 27-80% seeing the rash, and yet that is the main marker of “effective treatment” for this meta analysis.

This is a great example of garbage in, garbage out.  This article shows us very little due to its parameters.  This, right here, has been the trouble from the get-go.  The Cabal has set parameters that just aren’t accurate.

And, everyone under the sun recognizes acute cases are fairly straight forward.  We don’t need MORE research showing this.  What we need is research on the thousands if not millions of us who struggle with chronic/persistent symptoms.


Oh, and then there’s this gem:

Certainty of evidence was categorized as low and very low mostly because of imprecision, indirectness, and study limitations (high risk of bias) of the included studies.

I rest my case.