Prophylaxis with Single-Dose Doxycycline for the Prevention of Lyme Disease after an Ixodes scapularis Tick Bite
This large trial shows the efficacy of a single, prophylactic dose of doxycycline to prevent Lyme disease. Lyme disease is transmitted by the bite of an Ixodes scapularis tick and is the most common vector-borne disease in the United States. 1 This infection may be prevented by vaccination. 2 , 3 Ho...
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| Published in | The New England journal of medicine Vol. 345; no. 2; pp. 79 - 84 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article Conference Proceeding |
| Language | English |
| Published |
Boston, MA
Massachusetts Medical Society
12.07.2001
|
| Subjects | |
| Online Access | Get full text |
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| Abstract | This large trial shows the efficacy of a single, prophylactic dose of doxycycline to prevent Lyme disease.
Lyme disease is transmitted by the bite of an
Ixodes scapularis
tick and is the most common vector-borne disease in the United States.
1
This infection may be prevented by vaccination.
2
,
3
However, the vaccine's general acceptance is likely to be limited by its cost (a cost to the pharmacist of $61.25 per dose) and the need for multiple doses to achieve and maintain protection.
2
,
3
In addition, the vaccine is less than 100 percent effective and is currently approved only for persons 15 to 70 years of age.
3
Antimicrobial prophylaxis for persons with
I. scapularis
tick bites may be a . . . |
|---|---|
| AbstractList | It is unclear whether antimicrobial treatment after an Ixodes scapularis tick bite will prevent Lyme disease. In an area of New York where Lyme disease is hyperendemic, we conducted a randomized, double-blind, placebo-controlled trial of treatment with a single 200-mg dose of doxycycline in 482 subjects who had removed attached I. scapularis ticks from their bodies within the previous 72 hours. At base line, three weeks, and six weeks, subjects were interviewed and examined, and serum antibody tests were performed, along with blood cultures for Borrelia burgdorferi. Erythema migrans developed at the site of the tick bite in a significantly smaller proportion of the subjects in the doxycycline group than of those in the placebo group (1 of 235 subjects [0.4 percent] vs. 8 of 247 subjects [3.2 percent], P<0.04). The efficacy of treatment was 87 percent (95 percent confidence interval, 25 to 98 percent). Objective extracutaneous signs of Lyme disease did not develop in any subject, and there were no asymptomatic serocon-versions. Treatment with doxycycline was associated with more frequent adverse effects (in 30.1 percent of subjects, as compared with 11.1 percent of those assigned to placebo; P<0.001), primarily nausea (15.4 percent vs. 2.6 percent) and vomiting (5.8 percent vs. 1.3 percent). Erythema migrans developed more frequently after untreated bites from nymphal ticks than after bites from adult female ticks (8 of 142 bites [5.6 percent] vs. 0 of 97 bites [0 percent], P=0.02). A single 200-mg dose of doxycycline given within 72 hours after an I. scapularis tick bite can prevent the development of Lyme disease. Background It is unclear whether antimicrobial treatment after an Ixodes scapularis tick bite will prevent Lyme disease. Methods In an area of New York where Lyme disease is hyperendemic, we conducted a randomized, double-blind, placebo-controlled trial of treatment with a single 200-mg dose of doxycycline in 482 subjects who had removed attached I. scapularis ticks from their bodies within the previous 72 hours. At base line, three weeks, and six weeks, subjects were interviewed and examined, and serum antibody tests were performed, along with blood cultures for Borrelia burgdorferi . Results Erythema migrans developed at the site of the tick bite in a significantly smaller proportion of the subjects in the doxycycline group than of those in the placebo group (1 of 235 subjects [0.4 percent] vs. 8 of 247 subjects [3.2 percent], P<0.04). The efficacy of treatment was 87 percent (95 percent confidence interval, 25 to 98 percent). Objective extracutaneous signs of Lyme disease did not develop in any subject, and there were no asymptomatic seroconversions. Treatment with doxycycline was associated with more frequent adverse effects (in 30.1 percent of subjects, as compared with 11.1 percent of those assigned to placebo; P<0.001), primarily nausea (15.4 percent vs. 2.6 percent) and vomiting (5.8 percent vs. 1.3 percent). Erythema migrans developed more frequently after untreated bites from nymphal ticks than after bites from adult female ticks (8 of 142 bites [5.6 percent] vs. 0 of 97 bites [0 percent], P=0.02). Conclusions A single 200-mg dose of doxycycline given within 72 hours after an I. scapularis tick bite can prevent the development of Lyme disease. It is unclear whether antimicrobial treatment after an Ixodes scapularis tick bite will prevent Lyme disease. In an area of New York where Lyme disease is hyperendemic we conducted a randomized, double-blind, placebo-controlled trial of treatment with a single 200-mg dose of doxycycline in 482 subjects who had removed attached I. scapularis ticks from their bodies within the previous 72 hours. At base line, three weeks, and six weeks, subjects were interviewed and examined, and serum antibody tests were performed, along with blood cultures for Borrelia burgdorferi. Entomologists confirmed the species of the ticks and classified them according to sex, stage, and degree of engorgement. Erythema migrans developed at the site of the tick bite in a significantly smaller proportion of the subjects in the doxycycline group than of those in the placebo group (1 of 235 subjects [0.4 percent] vs. 8 of 247 subjects [3.2 percent], P<0.04). The efficacy of treatment was 87 percent (95 percent confidence interval, 25 to 98 percent). Objective extracutaneous signs of Lyme disease did not develop in any subject, and there were no asymptomatic seroconversions. Treatment with doxycycline was associated with more frequent adverse effects (in 30.1 percent of subjects, as compared with 11.1 percent of those assigned to placebo; P<0.001), primarily nausea (15.4 percent vs. 2.6 percent) and vomiting (5.8 percent vs. 1.3 percent). Erythema migrans developed more frequently after untreated bites from nymphal ticks than after bites from adult female ticks (8 of 142 bites [5.6 percent] vs. 0 of 97 bites [0 percent], P=0.02) and particularly after bites from nymphal ticks that were at least partially engorged with blood (8 of 81 bites [9.9 percent], as compared with 0 of 59 bites from unfed, or flat, nymphal ticks [0 percent]; P=0.02). A single 200-mg dose of doxycycline given within 72 hours after an I. scapularis tick bite can prevent the development of Lyme disease. This large trial shows the efficacy of a single, prophylactic dose of doxycycline to prevent Lyme disease. Lyme disease is transmitted by the bite of an Ixodes scapularis tick and is the most common vector-borne disease in the United States. 1 This infection may be prevented by vaccination. 2 , 3 However, the vaccine's general acceptance is likely to be limited by its cost (a cost to the pharmacist of $61.25 per dose) and the need for multiple doses to achieve and maintain protection. 2 , 3 In addition, the vaccine is less than 100 percent effective and is currently approved only for persons 15 to 70 years of age. 3 Antimicrobial prophylaxis for persons with I. scapularis tick bites may be a . . . It is unclear whether antimicrobial treatment after an Ixodes scapularis tick bite will prevent Lyme disease.BACKGROUNDIt is unclear whether antimicrobial treatment after an Ixodes scapularis tick bite will prevent Lyme disease.In an area of New York where Lyme disease is hyperendemic we conducted a randomized, double-blind, placebo-controlled trial of treatment with a single 200-mg dose of doxycycline in 482 subjects who had removed attached I. scapularis ticks from their bodies within the previous 72 hours. At base line, three weeks, and six weeks, subjects were interviewed and examined, and serum antibody tests were performed, along with blood cultures for Borrelia burgdorferi. Entomologists confirmed the species of the ticks and classified them according to sex, stage, and degree of engorgement.METHODSIn an area of New York where Lyme disease is hyperendemic we conducted a randomized, double-blind, placebo-controlled trial of treatment with a single 200-mg dose of doxycycline in 482 subjects who had removed attached I. scapularis ticks from their bodies within the previous 72 hours. At base line, three weeks, and six weeks, subjects were interviewed and examined, and serum antibody tests were performed, along with blood cultures for Borrelia burgdorferi. Entomologists confirmed the species of the ticks and classified them according to sex, stage, and degree of engorgement.Erythema migrans developed at the site of the tick bite in a significantly smaller proportion of the subjects in the doxycycline group than of those in the placebo group (1 of 235 subjects [0.4 percent] vs. 8 of 247 subjects [3.2 percent], P<0.04). The efficacy of treatment was 87 percent (95 percent confidence interval, 25 to 98 percent). Objective extracutaneous signs of Lyme disease did not develop in any subject, and there were no asymptomatic seroconversions. Treatment with doxycycline was associated with more frequent adverse effects (in 30.1 percent of subjects, as compared with 11.1 percent of those assigned to placebo; P<0.001), primarily nausea (15.4 percent vs. 2.6 percent) and vomiting (5.8 percent vs. 1.3 percent). Erythema migrans developed more frequently after untreated bites from nymphal ticks than after bites from adult female ticks (8 of 142 bites [5.6 percent] vs. 0 of 97 bites [0 percent], P=0.02) and particularly after bites from nymphal ticks that were at least partially engorged with blood (8 of 81 bites [9.9 percent], as compared with 0 of 59 bites from unfed, or flat, nymphal ticks [0 percent]; P=0.02).RESULTSErythema migrans developed at the site of the tick bite in a significantly smaller proportion of the subjects in the doxycycline group than of those in the placebo group (1 of 235 subjects [0.4 percent] vs. 8 of 247 subjects [3.2 percent], P<0.04). The efficacy of treatment was 87 percent (95 percent confidence interval, 25 to 98 percent). Objective extracutaneous signs of Lyme disease did not develop in any subject, and there were no asymptomatic seroconversions. Treatment with doxycycline was associated with more frequent adverse effects (in 30.1 percent of subjects, as compared with 11.1 percent of those assigned to placebo; P<0.001), primarily nausea (15.4 percent vs. 2.6 percent) and vomiting (5.8 percent vs. 1.3 percent). Erythema migrans developed more frequently after untreated bites from nymphal ticks than after bites from adult female ticks (8 of 142 bites [5.6 percent] vs. 0 of 97 bites [0 percent], P=0.02) and particularly after bites from nymphal ticks that were at least partially engorged with blood (8 of 81 bites [9.9 percent], as compared with 0 of 59 bites from unfed, or flat, nymphal ticks [0 percent]; P=0.02).A single 200-mg dose of doxycycline given within 72 hours after an I. scapularis tick bite can prevent the development of Lyme disease.CONCLUSIONSA single 200-mg dose of doxycycline given within 72 hours after an I. scapularis tick bite can prevent the development of Lyme disease. |
| Author | Marcus, Robert Fish, Durland Falco, Richard C Wormser, Gary P Dennis, David T Nadelman, Robert B Agüero-Rosenfeld, Maria E Nowakowski, John Freeman, Katherine McKenna, Donna Welch, Peter |
| Author_xml | – sequence: 1 givenname: Robert B surname: Nadelman fullname: Nadelman, Robert B – sequence: 2 givenname: John surname: Nowakowski fullname: Nowakowski, John – sequence: 3 givenname: Durland surname: Fish fullname: Fish, Durland – sequence: 4 givenname: Richard C surname: Falco fullname: Falco, Richard C – sequence: 5 givenname: Katherine surname: Freeman fullname: Freeman, Katherine – sequence: 6 givenname: Donna surname: McKenna fullname: McKenna, Donna – sequence: 7 givenname: Peter surname: Welch fullname: Welch, Peter – sequence: 8 givenname: Robert surname: Marcus fullname: Marcus, Robert – sequence: 9 givenname: Maria E surname: Agüero-Rosenfeld fullname: Agüero-Rosenfeld, Maria E – sequence: 10 givenname: David T surname: Dennis fullname: Dennis, David T – sequence: 11 givenname: Gary P surname: Wormser fullname: Wormser, Gary P |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1080119$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/11450675$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1056/NEJM199208203270806 10.1093/infdis/159.1.136 10.1093/oxfordjournals.aje.a009886 10.1056/NEJM199807233390401 10.1086/514009 10.1007/BF02600042 10.1093/oxfordjournals.aje.a008728 10.1086/318818 10.1128/jcm.8.1.102-104.1978 10.1086/314053 10.1001/jama.218.5.711 10.2307/2530245 10.1016/S0002-9343(95)99915-9 10.1001/jama.280.7.602-a 10.1056/NEJM199212173272501 10.1056/NEJM198402233100805 10.1016/0002-9343(90)90122-T |
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| Keywords | Lyme disease Chemoprophylaxis Spirochaetaceae Toxicity Ixodes scapularis Prevention Acari Bacteria Adult Ixodidae Spirachaetosis Human Parasitiformes Borrelia burgdorferi Spirochaetales Treatment efficiency Tetracycline derivatives Borrelia infection Single dose Infection Arachnida Chemotherapy Treatment Ixodida Arthropoda Doxycycline Bacteriosis Double blind study Invertebrata |
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| Snippet | This large trial shows the efficacy of a single, prophylactic dose of doxycycline to prevent Lyme disease.
Lyme disease is transmitted by the bite of an
Ixodes... It is unclear whether antimicrobial treatment after an Ixodes scapularis tick bite will prevent Lyme disease. In an area of New York where Lyme disease is... Background It is unclear whether antimicrobial treatment after an Ixodes scapularis tick bite will prevent Lyme disease. Methods In an area of New York where... It is unclear whether antimicrobial treatment after an Ixodes scapularis tick bite will prevent Lyme disease. In an area of New York where Lyme disease is... It is unclear whether antimicrobial treatment after an Ixodes scapularis tick bite will prevent Lyme disease.BACKGROUNDIt is unclear whether antimicrobial... |
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| SubjectTerms | Adolescent Adult Aged Aged, 80 and over Animals Anti-Bacterial Agents - administration & dosage Anti-Bacterial Agents - adverse effects Antibacterial agents Antibiotic Prophylaxis Antibiotics Antibiotics. Antiinfectious agents. Antiparasitic agents Bacterial diseases Biological and medical sciences Bites and Stings Borrelia burgdorferi Borrelia burgdorferi Group - isolation & purification Borrelia infections Child Clinical trials Double-Blind Method doxycycline Doxycycline - administration & dosage Doxycycline - adverse effects Drug therapy Erythema Chronicum Migrans - prevention & control Female Human bacterial diseases Humans Infectious diseases Ixodes - growth & development Ixodes scapularis Ixodidae Lyme disease Lyme Disease - prevention & control Lyme Disease - transmission Male Medical sciences Middle Aged Nymph Pharmacology. Drug treatments Preventive medicine Tropical bacterial diseases USA, New York |
| Title | Prophylaxis with Single-Dose Doxycycline for the Prevention of Lyme Disease after an Ixodes scapularis Tick Bite |
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