A systematic review including 11 studies with a total of 1 213 subjects was abstracted in DARE. According to the review, phenoxymethylpenicillin, amoxicillin, amoxicillin/probenecid, tetracycline, doxycycline, and cefuroxime axetil are equally effective for the treatment of early Lyme disease. However, the available studies do not have sufficient power to detect small but potentially clinically relevant differences in the efficacy between the individual drugs. Clinical failures with erythromycin, roxithromycin, and azithromycin indicate that macrolides cannot be recommended as first line agents.
Comment: The quality of evidence is downgraded by potential reporting bias (limited literature search, no reported structured validity assessment of included studies).