New evidence-based clinical practice guidelines for the prevention, diagnosis, and treatment of Lyme disease have been developed by a multidisciplinary panel led by the Infectious Diseases Society of America, the American Academy of Neurology, and the American College of Rheumatology. Representatives from an additional 12 medical specialties and patients also served on the panel.
The guidelines provide practical recommendations for clinicians treating patients with Lyme disease, including, but not limited to, primary care physicians, infectious diseases specialists, emergency physicians, internists, pediatricians, family physicians, neurologists, rheumatologists, cardiologists, and dermatologists.
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These recommendations aim to serve as a meaningful resource for the safe, effective, evidence-based care of people with Lyme disease. They address clinical questions related to the prevention, diagnosis, and treatment of Lyme disease; complications from neurologic, cardiac, and rheumatic symptoms; disease expression commonly seen in Eurasia; and complications from coinfection with other tick-borne pathogens.
The guidelines include 43 recommendations related to diagnostic testing, including testing scenarios (such as for certain neurologic, psychologic, behavioral, cardiac, and rheumatologic syndromes); detailed recommendations about Lyme carditis; and a discussion of “chronic Lyme disease.”
Among the diagnostic testing recommendations, the guidelines recommend clinical diagnosis without laboratory testing for people with a skin rash characteristic of early Lyme disease. For people with other signs of Lyme disease, such as swollen joints or meningitis, the guidelines recommend antibody testing.
Among the treatment recommendations, the guidelines recommend oral antibiotic therapy for most patients with Lyme disease. The recommended duration of therapy is 10 to 14 days for early Lyme disease, 14 days for Lyme carditis, 14 to 21 days for neurologic Lyme disease, and 28 days for late Lyme arthritis. Retreatment may be indicated for individuals with arthritis who have failed a first course of treatment.
The recommendations are grounded in a rigorous, systematic review of available evidence surrounding prevention, diagnosis, and treatment of the disease. The panel adhered to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of the evidence and strength of recommendations. The guidelines are voluntary and it is up to clinicians to determine which treatments are best for individual patient scenarios.
Each of the three sponsoring organizations elected a co-chair to lead the guideline panel. A fourth co-chair was selected for their expertise in guideline methodology. A total of 36 panelists comprised the full panel, and the panel also included three patient representatives and one healthcare consumer representative.
About 30,000 cases of Lyme disease are reported annually, but the Centers for Disease Control and Prevention estimates there are more than 300,000 cases in the United States each year.