Fall 2006
Vol. 16, Number 3

IDSA has updated its clinical practice guidelines on Lyme disease, significantly expanding their scope from that of the guidelines published nearly six years ago.

Panel Chair Gary P. Wormser, MD, FIDSA, said the panel “added more information on epidemiology, clinical features, and the diagnosis” of Lyme disease, adding that they wanted to develop guidelines that were “as comprehensive as possible.” They will be published in the Nov. 1 issue of Clinical Infectious Diseases, and are now available online.

The new guidelines include recommendations on two additional tick-borne diseases, human granulocytic anaplasmosis (HGA) and babesiosis, which are also transmitted by the deer tick, Ixodes scapularis. Lyme disease is the most common tick-borne infection in North America and Europe, but a bite from I. scapularis may lead to the development of Lyme disease, HGA, babesiosis or, less frequently, coinfection.

Along with several new recommendations, there is one substantive change to the previous recommendations. Dr. Wormser notes, “We now recommend that selected high-risk tick bites may be treated with a single dose of doxycycline for people who are eligible for the drug.”

The panel also went into much greater detail in the new guidelines to discuss post-Lyme disease syndromes. “We explain what the term refers to,” Dr. Wormser says, “and thoroughly go over the evidence to justify our recommendation against antibiotic treatment.”

The guidelines propose a definition for post-Lyme disease syndrome, as there has been no well-accepted definition to date. The panel asserted that objective evidence of prior B. burgdorferi infection must be part of any acceptable definition of post-Lyme disease syndrome.

The guidelines do not recommend antibiotic therapy for those with chronic symptoms who have received the recommended treatment for Lyme disease. “No convincing biologic evidence exists for symptomatic chronic B. burgdorferi infection in patients after recommended treatment regimens for Lyme disease,” the guidelines state.

The guidelines are available online on our website, www.idsociety.org, under “Practice Guidelines.”