EMERGENCY ANTIBIOTIC PROPHYLAXIS OF LYME BORRELIOSIS IN PREGNANT WOMEN
DOI:
https://doi.org/10.11603/1681-2727.2025.4.15760Keywords:
Lyme borreliosis, emergency antibiotic prophylaxis, pregnant womenAbstract
SUMMARY. Despite the current order of the Ministry of Health of Ukraine (No. 218 of May 16, 2005, “On strengthening measures for the diagnosis and prevention of ixodid tick-borne borrelioses in Ukraine”), as well as relevant detailed guidelines (“Standard of medical care: Lyme disease” – Order of the Ministry of Health No. 1623 of September 21, 2024, and “Lyme disease: Evidence-based clinical guideline”), post-exposure prophylaxis (PEP) of Lyme borreliosis (LB) after a tick bite has not been developed for pregnant and breastfeeding women. According to the authors, such prophylaxis requires an additional and essentially “primary” step – testing the tick that has bitten the woman for the presence of Borrelia. Even though the risk of Borrelia transmission is low at the early stages of tick attachment, it remains significant, especially in highly endemic regions such as Ukraine. Therefore, in order to rationally administer or avoid unnecessary PEP, the main and, in fact, decisive criterion for its prescription is the detection of the Lyme disease pathogen in the tick.
The problem of selecting antibiotics to which LB pathogens are sensitive, and which are either non-toxic to the fetus or unable to cross the placental barrier (thus not embryotoxic), is analyzed in detail.
A primary algorithm of PEP application is proposed, including: identification of the tick as belonging to the Ixodidae family (although Borrelia reservoirs may also include argasid ticks and even mosquitoes); testing the tick for the presence of Lyme disease pathogens (B. burgdorferi, B. garinii, B. afzelii); testing women’s blood for specific anti-Borrelia IgM and IgG (each antibody type separately, not total antibodies). Immunoblotting for Borrelia-specific IgG is not performed at the primary stage.
Algorithms for the justification of PEP in LB, detection of Borrelia in tick tissues, as well as a practical algorithm for PEP use in pregnant women, breastfeeding women, and children under 8 years of age are presented.
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