June 27, 2019

New Draft Lyme Disease Guidelines Issued

By Kelly Young

The Infectious Diseases Society of America, American Academy of Neurology, and American College of Rheumatology have issued new draft guidelines on Lyme disease. Among the many recommendations:

Prophylactic antibiotics (a single dose of oral doxycycline) should be administered to patients within 72 hours of removing a tick after a high-risk bite, but not after lower-risk bites. High-risk bites must meet all of the following criteria: from an Ixodes tick, in a highly endemic area, and from a tick engorged and attached for 36 hours or more.
For erythema migrans, preferred treatments include 10 days of doxycycline or 14 days of amoxicillin, cefuroxime axetil, or phenoxymethylpenicillin.
For patients presenting with meningitis, painful radiculoneuritis, mononeuropathy multiplex, or acute cranial neuropathies, along with plausible exposure to high-risk ticks, Lyme testing is recommended. Routine testing is not recommended for patients with other neurological syndromes or psychiatric illnesses.
The groups suggest against routine testing in children presenting with developmental, behavioral, or psychiatric disorders.
Additional antibiotics are not recommended in patients with persistent or recurring nonspecific symptoms (e.g., pain, fatigue) after treatment for Lyme disease but who don't have evidence of reinfection or treatment failure.

The guideline also includes information on evaluating patients presenting with "chronic" Lyme disease, who often have other underlying disorders.

Infectious diseases specialist Dr. Paul Sax comments: "Comprehensive and evidenced-based, these guidelines are a welcome update to the previous version, which is now more than a decade old. Nonetheless, their release will undoubtedly engender controversy given the widely disparate and strongly held views on the topic."