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13 mars 2011 7 13 /03 /mars /2011 11:04

ILADS Lyme Disease Treatment Guidelines Summary



In early 2004, The International Lyme and Associated Diseases Society (ILADS) released the first evidence-based comprehensive set of Lyme Disease Treatment Guidelines to assist physicians, public health officials and organizations involved in the evaluation and treatment of Lyme disease. The Lyme Disease Association (national) and the California Lyme Disease Association endorsed the Guidelines which were then peer-reviewed and made available to professionals and to the public.

Lyme is the number one tick-borne illness in the US. The CDC reports there are 24,000 new cases of Lyme disease in the US but the CDC says that figure could be under reported by tenfold. ILADS believes newly diagnosed cases of Lyme may occur at a rate five times higher than the number of new AIDS cases. Chronic Lyme is reported in up to half of patients treated for Lyme.

ILADS Lyme Treatment Guidelines suggest more aggressive treatment for people at risk.

A short summary of ILADS’ recommendations includes:

Treatment for symptomatic presentations

Treatment should not be withheld based on laboratory testing

Early use of antibiotics

Longer courses of antibiotics treatment

Repeat antibiotics for recurrence

Symptomatic Presentations of Lyme Disease include:


Low grade fevers, “hot flashes” or chills

Night sweats

Sore throat

Swollen glands

Stiff neck

Migrating arthralgias, stiffness and frank arthritis


Chest pain and palpitations

Abdominal pain, nausea


Sleep disturbance

Poor concentration and memory loss

Irritability and mood swings


Back pain

Blurred vision and eye pain

Jaw pain

Testicular/pelvic pain



Cranial nerve disturbance ( facial numbness, pain, tingling, palsy or optic neuritis)




ILADS’ Lyme Treatment Guidelines address 45 subjects:

1.            ILADS defined

2.            Chronic Lyme disease: A growing epidemic

3.            The need for new guidelines

4.            A problem of definitions

5.            Competency and training

6.            The increasing role of primary care

7.            Highlights of guidelines

8.            Symptomatic presentations

9.            symptoms of Lyme disease

10.       Increasing evidence of persistent infection

11.       Disappointing results of symptomatic treatment

12.       Severity of chronic Lyme disease

13.       Atypical early presentations

14.       New chronic Lyme disease presentations

15.       The limitations of physical findings

16.       Sensitivity limitations of testing

17.       Seronegative Lyme disease

18.       Continued importance of differential diagnosis

19.       Clinical judgment

20.       Testing for coinfection

21.       Prompt use of antibiotics

22.       Choosing an antibiotic

23.       Oral antibiotic options

24.       Intravenous antibiotic options

25.       Intramuscular antibiotic options

26.       Combination antibiotic treatment

27.       Sequential treatment

28.       Dosage

29.       Duration of therapy

30.       Empiric treatment

31.       Persistent Lyme disease

32.       Recurrent Lyme disease

33.       Refractory Lyme disease

34.       Treatment failure

35.       Symptomatic treatment

36.       Fibromyalgia

37.       Decision to stop antibiotics

38.       Alternative antibiotics

39.       Therapy for coinfection

40.       Ongoing development of treatment guidelines

41.       Validation of guidelines

42.       Comparative studies

43.       Grading system for evidence-based guidelines

44.       Comparison of key IDSA and ILADS guidelines

45.       Criteria for evidence-based guidelines

Adapted from Cameron DJ, Gaito A, Harris N, Bach G, Bellovin S, Bock K, Bock S, Burrascano J, Dickey C, Horowitz R, Phillips S, Meer-Sheerer L, Raxlen B, Sherr V, Smith H, Smith P, Stricker R. Evidence-based guidelines for the management of Lyme disease. Expert Rev. Anti-infect. Ther. 2(1), 2004.

ILADS thanks Turn the Corner Foundation and the Lyme Disease Association for their financial support of the guideline development process.



South Med J. 2009 Jun;102(6):626-30.

In the lymelight: law and clinical practice guidelines.

Ronn S.

Almost from the beginning, the Ixodes scapularis and I pacificus, adult deer ticks, have been a breeding ground not only for Lyme disease, but also for political dissent.

Most recently, the battleground moved into the arena of clinical practice guidelines.

Both camps in the "Lyme Wars"-the Infectious Diseases Society of America (IDSA) and the International Lyme and Associated Diseases Society (ILADS)-have published Lyme disease practice guidelines.

The guidelines conflict regarding diagnosis and treatment.

The state of Connecticut's Attorney General's office conducted an investigation, under antitrust laws, into the development and promulgation of IDSA's 2006 guidelines.

In an unprecedented move, IDSA and the AG have entered into a legal agreement that necessitates a rethinking of the guidelines, requiring a new review panel reflecting balanced, conflict-of-interest-free perspectives on Lyme disease.

PMID: 19434013 [PubMed - in process]


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