PP121 How To Involve Patients In Decisions About Antibiotic Prophylaxis After Tick Bite

2019 ◽  
Vol 35 (S1) ◽  
pp. 59-59
Author(s):  
Sylvie Bouchard ◽  
Gaelle Gernigon ◽  
Fatiha Karam ◽  
Jean-Marc Daigle ◽  
Genevieve Morrow ◽  
...  
Keyword(s):  
Single Dose ◽  
Lyme Disease ◽  
Antibiotic Prophylaxis ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Tick Bite ◽  
Knowledge Mobilization ◽  
Level Of Evidence ◽  
The Real ◽  
Real Risk

IntroductionAntibiotic prophylaxis with a single dose of doxycycline after a tick bite is one of the tools for preventing Lyme disease, which is becoming increasingly prevalent in Quebec. The aim of this work was to revisit this practice in adults and children younger than 8 years of age.MethodsTo assess the safety and absolute risk reduction (ARR) of doxycycline for preventing Lyme disease in contraindicated populations, two systematic reviews were conducted with a re-analysis of the original efficacy data. A knowledge mobilization framework was used to consider the scientific, contextual, and experiential evidence, taking into account information on patients’ and clinicians’ experiences.ResultsA single dose of doxycycline prescribed within 72 hours of being bitten by a tick (Ixodes scapularis) could prevent cutaneous manifestation of Lyme disease (ARR -2.8%, 95% confidence interval: -11.7–6.1; p = 0.06), without serious side effects, provided that the bite occurred in a geographical region where at least 25 percent of nymph and 50 percent of adult ticks are infected with the disease. However, the level of evidence was low and its generalizability to other contexts was doubtful. The decision to prescribe antibiotic prophylaxis may be based more on the fear of Lyme disease, rather than on effectiveness data and the real risk of contracting Lyme disease.ConclusionsIt may be challenging for clinicians to discuss Lyme disease prophylaxis with patients and their families in contexts where people are fearful of the disease, and the risk of contracting it from a tick bite is uncertain. Decision aids that provide scientific evidence on the real risk of developing Lyme disease after a tick bite, particularly in Quebec, can promote informed decisions based on patient preferences and values by supporting discussion between clinicians and patients.

scholarly journals Antibiotic prophylaxis for prevention against Lyme disease following tick bite: an updated systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Guozhong Zhou ◽  
Xin Xu ◽  
Yu Zhang ◽  
Peng Yue ◽  
Shiqi Luo ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Antibiotic Prophylaxis ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Tick Bite ◽  
Cochrane Library ◽  
Control Group ◽  
Sufficient Power ◽  
Detailed Assessment ◽  
Meta Analyses

Abstract Background In areas where Lyme disease is endemic, bites from ticks are common, but no vaccine is currently available against Lyme disease for humans. Therefore, the feasibility of using antibiotic prophylaxis to prevent Lyme disease after a tick bite is worth further exploration. Previous meta-analyses lack sufficient power to demonstrate the efficacy of about antibiotic prophylaxis for the prevention of Lyme disease following a tick bite. In this study, we explored more precise evidence and attempted to identify and update optimum treatment strategies. Methods We searched PubMed, Embase, and the Cochrane Library for studies until March 23, 2021. We included studies if the enrolled patients were randomly allocated to a treatment or control group within 72 h following a tick bite and had no clinical evidence of Lyme disease at enrolment. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed for data abstraction. Two authors (GZZ and XX) independently reviewed the abstracts and identified articles for detailed assessment. We used a random-effects model to calculate the pooled results and reported the 95% confidence interval (CI). Study quality was assessed using a modified Jadad scale, and publication bias was assessed using Egger’s test. We calculated the risk ratio (RR) for the rates of unfavorable events in patients who received intervention versus the control group. This study is registered with PROSPERO, number CRD42021245002. Results Six studies (3,766 individuals) were included. The pooled rate of unfavorable events in persons receiving treatment and the control group were 0.4% (95%CI: 0.1–1.1%) and 2.2% (95%CI: 1.6–3.0%), respectively. The pooled RR was 0.38 (95%CI: 0.22–0.66). Subgroup analysis revealed that the pooled RR was 0.29 (95%CI: 0.14–0.60) in the single-use 200-mg doxycycline group; 0.28 (95%CI: 0.05–1.67) in a 10-day course group (Amoxicillin, Penicillin or tetracycline); and 0.73 (95%CI: 0.25–2.08) in a topical antibiotic treatment group (Azithromycin). Conclusions The available evidence supports the use of antibiotics for the prevention of Lyme disease, and reveals advantages of using single-dose; however, further confirmation is needed.

scholarly journals Risk of Lyme disease development after a tick bite

2010 ◽  
Vol 67 (5) ◽  
pp. 369-374 ◽  
Author(s):  
Jovan Mladenovic ◽  
Radovan Cekanac ◽  
Novica Stajkovic ◽  
Milena Krstic
Keyword(s):  
Lyme Disease ◽  
Absolute Risk ◽  
Clinical Manifestations ◽  
Infectious Agent ◽  
Epidemiological Data ◽  
Relevant Information ◽  
Tick Bite ◽  
Healthcare Personnel ◽  
Tick Attachment ◽  
The Way

Background/Aim. Despite numerous research of Lyme disease (LD), there are still many concerns about environmental of infectious agent of LD, as well as its prophylaxis, diagnosis and treatment. The aim of this work was to determine the risk of LD in relation to the way of removing ticks and duration of tick attachment. Methods. In the period from 2000 to 2007 a prospective study was conducted including persons with tick bite referred to the Institute of Epidemiology, Military Medical Academy, and followed for the occurrence of early Lyme disease up to six months after a tick bite. Epidemiological questionnaire was used to collect relevant information about the place and time of tick bites, the way of a removing tick, duration of tick attachment, remnants of a tick left in the skin (parts of the mouth device) and the signs of clinical manifestations of LD. Duration of tick attachment was determined on the basis of size of engorged tick and epidemiological data. Removed ticks were determined by the key of Pomerancev. Professional removing of attached tick was considered to be removing of tick with mechanical means by healthcare personnel. Fisher's exact test, Chi squares test and calculation of the relative risk (RR) were used for data analysis. Results. Of 3 126 patients with tick bite, clinical manifestations of LD were demonstrated in 19 (0.61%). In the group of subjects (n = 829) in which a tick was not removed professionally there were 17 (2.05%) cases with LD, while in the group of respondents (n=2 297) in who a tick was removed professionally there were 2 (0.09%) cases with LD after tick bite (RR, 23.55; p < 0.0001). The disease was most frequent in the group of respondents with incompletely and unprofessionally removed ticks (2.46%). In the groups of patients with unprofessionally but completely removed ticks LD occurred in 0.89%, while in the group of subjects with a tick removed by an expert, but incompletely in 0.78% cases. The disease occurred rarely in the group with a tick removed completely and professionally (0.05%). There was no case of LD in the group of patients with a tick removed within 24 hours. The longer time of exposure after 24 hours, the higher absolute risk of disease was reported. Conclusion. In prevention of Lyme disease it is important to urgent remove a tick, to use a correct procedure of removing and to remove the whole tick without any remnants.

scholarly journals Prediction of Residual Stroke Risk in Anticoagulated Patients with Atrial Fibrillation: mCARS

2021 ◽  
Vol 10 (15) ◽  
pp. 3357
Author(s):  
Wern Yew Ding ◽  
José Miguel Rivera-Caravaca ◽  
Francisco Marin ◽  
Christian Torp-Pedersen ◽  
Vanessa Roldán ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trial ◽  
Real World ◽  
Stroke Risk ◽  
Risk Estimation ◽  
Absolute Risk ◽  
Oral Anticoagulants ◽  
Absolute Risk Reduction ◽  
The Real ◽  
Anticoagulated Patients

Our ability to evaluate residual stroke risk despite anticoagulation in atrial fibrillation (AF) is currently lacking. The Calculator of Absolute Stroke Risk (CARS) has been proposed to predict 1-year absolute stroke risk in non-anticoagulated patients. We aimed to determine whether a modified CARS (mCARS) may be used to assess the residual stroke risk in anticoagulated AF patients from ‘real-world’ and ‘clinical trial’ cohorts. We studied patient-level data of anticoagulated AF patients from the real-world Murcia AF Project and AMADEUS clinical trial. Individual mCARS were estimated for each patient. None of the patients were treated with non-vitamin K antagonist oral anticoagulants. The predicted residual stroke risk was compared to actual stroke risk. 3503 patients were included (2205 [62.9%] clinical trial and 1298 [37.1%] real-world). There was wide variation of CARS for each category of CHA2DS2-VASc score in both cohorts. Average predicted residual stroke risk by mCARS (1.8 ± 1.8%) was identical to actual stroke risk (1.8% [95% CI, 1.3–2.4]) in the clinical trial, and broadly similar in the real-world (2.1 ± 1.9% vs. 2.4% [95% CI, 1.6–3.4]). AUCs of mCARS for prediction of stroke events in the clinical trial and real-world were 0.678 (95% CI, 0.598–0.758) and 0.712 [95% CI, 0.618–0.805], respectively. mCARS was able to refine stroke risk estimation for each point of the CHA2DS2-VASc score in both cohorts. Personalised residual 1-year absolute stroke risk in anticoagulated AF patients may be estimated using mCARS, thereby allowing an assessment of the absolute risk reduction of treatment and facilitating a patient-centred approach in the management of AF. Such identification of patients with high residual stroke risk could help target more aggressive interventions and follow-up.

scholarly journals Antibiotic Prophylaxis for Prevention against Lyme Disease Following Tick Bite: An Updated Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Guozhong Zhou ◽  
Xin Xu ◽  
Yu Zhang ◽  
Peng Yue ◽  
Shiqi Luo ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Antibiotic Prophylaxis ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Tick Bite ◽  
Cochrane Library ◽  
Control Group ◽  
Sufficient Power ◽  
Detailed Assessment ◽  
Meta Analyses

Abstract Background: In areas where Lyme disease is endemic, bites from ticks are common, but no vaccine is currently available against Lyme disease for humans. Therefore, the feasibility of using antibiotic prophylaxis to prevent Lyme disease after a tick bite is worth further exploration. Previous meta-analyses lack sufficient power to demonstrate the efficacy of about antibiotic prophylaxis for the prevention of Lyme disease following a tick bite. In this study, we explored more precise evidence and attempted to identify and update optimum treatment strategies.Methods: We searched PubMed, Embase, and the Cochrane Library for studies until March 23, 2021. We included studies if the enrolled patients were randomly allocated to a treatment or control group within 72 h following a tick bite and had no clinical evidence of Lyme disease at enrolment. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed for data abstraction. Two authors (GZZ and XX) independently reviewed the abstracts and identified articles for detailed assessment. We used a random-effects model to calculate the pooled results and reported the 95% confidence interval (CI). Study quality was assessed using a modified Jadad scale, and publication bias was assessed using Egger’s test.We calculated the risk ratio (RR) for the rates of unfavorable events in patients who received intervention versus the control group. This study is registered with PROSPERO, number CRD42021245002Results: Six studies (3,766 individuals) were included. The pooled rate of unfavorable events in persons receiving treatment and the control group were 0.4% (95%CI: 0.1–1.1%) and 2.2% (95%CI: 1.6–3.0%), respectively. The pooled RR was 0.38 (95%CI: 0.22–0.66). Subgroup analysis revealed that the pooled RR was 0.29 (95%CI: 0.14–0.60) in the single-use 200-mg doxycycline group; 0.28 (95%CI: 0.05–1.67) in a 10-day course group (Amoxicillin, Penicillin or tetracycline); and 0.73 (95%CI: 0.25–2.08) in a topical antibiotic treatment group (Azithromycin).Conclusions: The available evidence supports the use of antibiotics for the prevention of Lyme disease, and reveals advantages of using single-dose; however, further confirmation is needed.

The place of corticosteroids in migraine attack management: A 65-year systematic review with pooled analysis and critical appraisal

Cephalalgia ◽  
2015 ◽  
Vol 35 (11) ◽  
pp. 996-1024 ◽  
Author(s):  
YW Woldeamanuel ◽  
AM Rapoport ◽  
RP Cowan
Keyword(s):  
Single Dose ◽  
Systematic Reviews ◽  
Absolute Risk ◽  
Previous History ◽  
Absolute Risk Reduction ◽  
Corticosteroid Treatment ◽  
Pooled Analysis ◽  
Cochrane Library ◽  
Meta Analyses ◽  
Headache Recurrence

Background and objectives Headaches recur in up to 87% of migraine patients visiting the emergency department (ED), making ED recidivism a management challenge. We aimed herein to determine the role of corticosteroids in the acute management of migraine in the ED and outpatient care. Methods Advanced search strategies employing PubMed/MEDLINE, Web of Science, and Cochrane Library databases inclusive of a relevant gray literature search was employed for Clinical Studies and Systematic Reviews by combining the terms “migraine” and “corticosteroids” spanning all previous years since the production of synthetic corticosteroids ca. 1950 until August 30, 2014. Methods were in accordance with MOOSE guidelines. Results Twenty-five studies ( n = 3989, median age 37.5 years, interquartile range or IQR 35–41 years; median male:female ratio 1:4.23, IQR 1:2.1–6.14; 52% ED-based, 56% randomized-controlled) and four systematic reviews were included. International Classification of Headache Disorders criteria were applied in 64%. Nineteen studies (76%) indicated observed outcome differences favoring benefits of corticosteroids, while six (24%) studies indicated non-inferior outcomes for corticosteroids. Median absolute risk reduction was 30% (range 6%–48.2%), and 11% (6%–48.6%) for 24-, and 72-hour headache recurrence, respectively. Parenteral dexamethasone was the most commonly (56%) administered steroid, at a median single dose of 10 mg (range 4–24 mg). All meta-analyses revealed efficacy of adjuvant corticosteroids to various abortive medications—indicating generalizability. Adverse effects were tolerable. Higher disability, status migrainosus, incomplete pain relief, and previous history of headache recurrence predicted outcome favorability. Conclusions Our literature review suggests that with corticosteroid treatment, recurrent headaches become milder than pretreated headaches and later respond to nonsteroidal therapy. Single-dose intravenous dexamethasone is a reasonable option for managing resistant, severe, or prolonged migraine attacks.

scholarly journals 153. Utilization of Post-Exposure Prophylaxis to Prevent Lyme Disease in a Large US Healthcare Database

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S188-S188
Author(s):  
Grace E Marx ◽  
Candace C Fuller ◽  
Nicole Haug ◽  
Dave Martin ◽  
Catherine Corey ◽  
...  
Keyword(s):  
Single Dose ◽  
Lyme Disease ◽  
Disease Incidence ◽  
The United States ◽  
Emergency Department Visits ◽  
Tick Bite ◽  
Post Exposure Prophylaxis ◽  
Tick Bites ◽  
Post Exposure ◽  
Exposure Prophylaxis

Abstract Background In the United States, at least 50,000 emergency department visits for tick bite and an estimated 476,000 Lyme disease diagnoses occur annually, with incidence of both high among children. The majority of these healthcare visits occur in the northeastern and midwestern states having high Lyme disease incidence and during the summer and fall months, corresponding to peak opportunities for exposure to blacklegged ticks. Post-exposure prophylaxis (PEP) with a single dose of doxycycline can effectively prevent Lyme disease after a tick bite that is high risk for transmission of Lyme disease. We describe characteristics of patients with dispensings of single-dose doxycycline in a large US-based system that includes patients enrolled in private and public health insurance plans. Methods Single-dose doxycycline (≤200 mg) dispensings during January 2009 – February 2020 were identified for patients enrolled in seven Data Partners that contributed electronic healthcare data to the Food and Drug Administration Sentinel Distributed Database, including large national insurers, an integrated delivery care network, a state Medicaid, and the 100% Medicare fee-for-service plan. We examined patient and PEP dispensing characteristics by patient age, state of residence, and month of dispensing. Results We identified 408,897 patients with PEP (n=474,414 total dispensings) with a mean age of 60 years at first dispensing. Overall, there were 21 patients per 10,000 eligible members with PEP dispensings. Dispensings were less common in children (&lt; 1 and 4 patients per 10,000 eligible members aged &lt; 8 and 8-18 years, respectively). Most dispensings (72%) occurred in states with high incidence of Lyme disease. Seasonality of dispensings was bimodal, with most occurring during April – July and October – November (71 – 83%, by year). Conclusion Lyme disease PEP was relatively common and mirrored geographic and seasonal trends observed for ED visits for tick bites and Lyme disease diagnoses. However, we observed more PEP among older adults, and few dispensings among children. Despite healthcare visits for tick bites and Lyme disease occurring disproportionately among pediatric age groups, PEP appears to be underutilized in children. Disclosures All Authors: No reported disclosures

A Single Dose Antibiotic Prophylaxis in Clean Surgery:-Our Experience

2011 ◽  
Vol 2 (2) ◽  
pp. 122-123
Author(s):  
Dr.Chakane Milind ◽  
◽  
Dr.Snehal Purandare
Keyword(s):  
Single Dose ◽  
Antibiotic Prophylaxis
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