Abstract
BackgroundDoxycycline is one of the recommended antibiotics for treating erythema migrans (EM). Since EM predominantly occurs during summer, the potential of doxycycline to induce photosensitivity is of concern. In studies on the efficacy of doxycycline for treating relatively small numbers of patients with EM, the reported frequency of photosensitivity has varied from none to 15%. The aim of this study was to elucidate the frequency and clinical symptoms of doxycycline-induced photosensitivity in a large cohort of patients with EM treated in a single medical centre.MethodsProspectively collected data on adverse events were analysed in adult patients with EM treated with doxycycline 100 mg twice daily for 10–15 days.ResultsPhotosensitivity reactions ranging from itching and burning sensations to transient mild erythema of sun-exposed skin were documented in 16/858 (1.9, 95% CI 1.1–3.0%) patients and appeared from June to October with highest frequency in July. These adverse events were more frequent in patients treated for 14 or 15 days (16/750 [2.1%]; 95% CI 1.2–3.4%) than in those treated for 10 days (0/108 [0%]; 95% CI 0.0–3.4%); however, the difference was not significant (P = 0.24). Women were more often affected than men (13/475 [2.7%], 95% CI 1.5–4.6% versus 3/383 [0.8%], 95% CI 0.2–2.3%; P = 0.04). Of the 16 patients who developed photosensitivity, 13 did not adhere to the recommendation to avoid sun exposure. None of the patients had any long-term sequelae of photosensitivity.ConclusionsPhotosensitivity reactions in adult patients with EM treated with doxycycline 100 mg twice daily for 10–15 days occurred rarely, were not severe, and had no long-term sequelae.Trial registrationRegistered at http://clinicaltrials.gov, Identifiers NCT00910715, May 28th 2009, NCT01163994, July 13th 2010 and NCT03584919, June 19th 2018 retrospectively registered.
Highlights
Doxycycline is one of the recommended antibiotics for treating erythema migrans (EM)
Doxycycline has the advantage of its efficacy against Anaplasma phagocytophilum, the possible coinfecting bacterium in patients with early Lyme borreliosis [2], but its major drawback is potential photosensitization [3, 4], which is of particular concern because EM
16/858 (1.9, 95% confidence intervals (CI) 1.1–3.0%) patients reported photosensitivity reactions: 0/108 (0, 95% CI 0– 3.4%), 8/488 (1.6, 95% CI 0.7–3.2%), and 8/262 (3.1, 95% CI 1.3–5.9%) of those who received doxycycline for 10, 14 or 15 days, respectively
Summary
Doxycycline is one of the recommended antibiotics for treating erythema migrans (EM). In studies on the efficacy of doxycycline for treating relatively small numbers of patients with EM, the reported frequency of photosensitivity has varied from none to 15%. The aim of this study was to elucidate the frequency and clinical symptoms of doxycycline-induced photosensitivity in a large cohort of patients with EM treated in a single medical centre. The relatively small numbers of patients evaluated in individual trials probably contributes to such pronounced disparities. In these studies, clinical symptoms of photosensitivity were not Velušček et al BMC Infectious Diseases (2018) 18:365
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