IDSA/AAN/ACR Release New Lyme Disease Guidelines

The Infectious Diseases Society of America, American Academy of Neurology, and American College of Rheumatology have released draft guidelines on the diagnosis and treatment of early Lyme disease and the neurologic, cardiac, and rheumatologic complications associated with the disease.

The guidelines also address complications of Lyme disease from simultaneous coinfection with other tick-borne pathogens. The guidelines, however, do not address anaplasmosis or babesiosis, except in the context of coinfections.

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Among the recommendations:

Within 72 hours of a high-risk bite (one that is from an Ixodes tick in a highly endemic area engorged and attached for 36 hours or more), prophylactic antibiotics in the form of a single dose of oral doxycycline should be administered.

Preferred treatments for erythema migrans include 10 days of doxycycline or 14 days of amoxicillin, cefuroxime axetil, or phenoxymethylpenicillin.

Lyme testing is recommended for patients presenting with plausible exposure to high-risk ticks and meningitis, painful radiculoneuritis, mononeuropathy multiplex, or acute cranial neuropathies.

Routine testing in children presenting with developmental, behavioral, or psychiatric disorders is not recommended.

When no evidence of reinfection or treatment failure is evident, additional antibiotics are not recommended in patients with persistent nonspecific symptoms.

—Michael Potts

Reference:

Lantos P, Rumbaugh J, Bockenstedt L, et al. Draft clinical practice guidelines by The Infectious Diseases Society of America, American Academy of Neurology, and American College of Rheumatology: 2019 draft guidelines for the prevention, diagnosis and treatment of Lyme disease [published online June 26, 2019]. https://www.idsociety.org/practice-guideline/Lyme-Disease-Guideline-Public-Comments/.