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
Migrating arthralgias, stiffness and frank arthritis
Chest pain and palpitations
Abdominal pain, nausea
Poor concentration and memory loss
Irritability and mood swings
Blurred vision and eye 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
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
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.
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]