Erythema migrans: Lyme disease does not need prolonged therapy

Antibiotic therapy duration is a major public health issue worldwide. Shortening antibiotic treatment is a way to limit the use of antibiotics and to limit adverse effects, costs, and the risks related to the emergence of antibiotic resistance. The consensus is to treat patients with the shortest possible duration of the antibiotic treatment without compromising the effectiveness of said treatment. However, observation shows that there is still progress to be made for the correct prescription of antibiotics in Europe. 1 European Centre for Disease Prevention and ControlLess and more appropriate antibiotic use needed to reduce antibiotic resistance. https://www.ecdc.europa.eu/en/news-events/less-and-more-appropriate-antibiotic-use-needed-reduce-antibiotic-resistanceDate: 2021 Date accessed: August 6, 2022 Google Scholar In The Lancet Infectious Diseases, Stupica and colleagues 2 Stupica D Collinet-Adler S Blagus R et al. Treatment of erythema migrans with doxycycline for 7 days versus 14 days in Slovenia: a randomised open-label non-inferiority trial. Lancet Infect Dis. 2022; (published online Oct 6.)https://doi.org/10.1016/S1473-3099(22)00528-X Summary Full Text Full Text PDF Scopus (4) Google Scholar report the non-inferiority of a 7-day-course regimen of doxycycline versus 14 days in the treatment of erythema migrans in a randomised, open-label non-inferiority trial enrolling 300 patients in Slovenia. This study is of major interest by advocating for a reduced duration of antibiotic treatment in early Lyme disease. This study is published 10 years after a previous study from the same team showed the non-inferiority of reducing the duration of erythema migrans treatment from 14 days to 10 days, which contributed to the current international guidelines. 3 Stupica D Lusa L Ruzić-Sabljić E Cerar T Strle F Treatment of erythema migrans with doxycycline for 10 days versus 15 days. Clin Infect Dis. 2012; 55: 343-350 Crossref PubMed Scopus (66) Google Scholar , 4 Auwaerter PG Kobayashi T Wormser GP Guidelines for Lyme disease are updated. Am J Med. 2021; 134: 1314-1316 Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar Treatment of erythema migrans with doxycycline for 7 days versus 14 days in Slovenia: a randomised open-label non-inferiority trialOur data support 7 days of oral doxycycline for adult European patients with solitary erythema migrans, permitting less antibiotic exposure than current guideline-driven therapy. Full-Text PDF