ILADS Lyme Disease Treatment Guidelines Summary
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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:
- Fatigue
- Low grade fevers, “hot flashes” or chills
- Night sweats
- Sore throat
- Swollen glands
- Stiff neck
- Migrating arthralgias, stiffness and frank arthritis
- Myalgia
- Chest pain and palpitations
- Abdominal pain, nausea
- Diarrhea
- Sleep disturbance
- Poor concentration and memory loss
- Irritability and mood swings
- Depression
- Back pain
- Blurred vision and eye pain
- Jaw pain
- Testicular/pelvic pain
- Tinnitus
- Vertigo
- Cranial nerve disturbance ( facial numbness, pain, tingling, palsy or optic neuritis)
- Headaches
- Lightheadedness
- Dizziness
ILADS’ Lyme Treatment Guidelines address 45 subjects:
- ILADS defined
- Chronic Lyme disease: A growing epidemic
- The need for new guidelines
- A problem of definitions
- Competency and training
- The increasing role of primary care
- Highlights of guidelines
- Symptomatic presentations
- symptoms of Lyme disease
- Increasing evidence of persistent infection
- Disappointing results of symptomatic treatment
- Severity of chronic Lyme disease
- Atypical early presentations
- New chronic Lyme disease presentations
- The limitations of physical findings
- Sensitivity limitations of testing
- Seronegative Lyme disease
- Continued importance of differential diagnosis
- Clinical judgment
- Testing for coinfection
- Prompt use of antibiotics
- Choosing an antibiotic
- Oral antibiotic options
- Intravenous antibiotic options
- Intramuscular antibiotic options
- Combination antibiotic treatment
- Sequential treatment
- Dosage
- Duration of therapy
- Empiric treatment
- Persistent Lyme disease
- Recurrent Lyme disease
- Refractory Lyme disease
- Treatment failure
- Symptomatic treatment
- Fibromyalgia
- Decision to stop antibiotics
- Alternative antibiotics
- Therapy for coinfection
- Ongoing development of treatment guidelines
- Validation of guidelines
- Comparative studies
- Grading system for evidence-based guidelines
- Comparison of key IDSA and ILADS guidelines
- 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.
