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One Dose of Doxycycline for the Prevention of Lyme Disease: A Review of Clinical Effectiveness and Guidelines

Last updated: May 21, 2019
Project Number: RC1121-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of one dose of doxycycline for the prevention of Lyme disease in patients with tick attachment?
  2. Are the evidence-based guidelines associated with the use of one dose of doxycycline for the prevention of Lyme disease in patients with tick attachment?

Key Message

Based primarily on a very-low quality randomized controlled trial, one dose of doxycycline appears to be clinically effective for the prevention of Lyme disease in patients with tick attachment. The very-low quality of this evidence decreases confidence in these findings.Evidence-based guidelines offer conflicting recommendations based on the same low-quality randomized controlled trial. Two guidelines recommend one dose of doxycycline for the prevention of Lyme disease in patients with tick attachment and two guidelines recommend against one dose of doxycycline for the prevention of Lyme disease in patients with tick attachment, citing high risk of bias in the randomized controlled trial, low infection rates, and proven clinical effectiveness of treatment for Lyme disease once signs and symptoms manifest.Further high-quality studies are needed to confirm the results of this randomized controlled trial with appropriate enrollment and follow-up of a validated outcome in a generalizable setting. Ideally this research would be conducted in Canada to inform Canadian clinical decision-making and policy making.