Lyme Disease Practice and Research

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Guidelines of the Infectious Disease Society of America (IDSA) fall short of meeting the needs for diagnosis and treatment of individuals with chronic Lyme disease. The latest IDSA Guidelines (2000) fail to take into account the compelling, peer-reviewed, published evidence confirming persistent, recurrent and refractory Lyme disease and, in fact, deny its existence.

The IDSA’s symptomatic approaches to Lyme disease are limited and exclude many individuals with persisting clinical and laboratory evidence of active B. burgdorferi infection. In addition, physicians treating individuals with Lyme and other tick-borne infections recognize the need for new guidelines to better serve the patient population.

Our goal is to present practitioners with practical and defensible guidelines for treating all individuals with Lyme disease including those with persistent, recurrent and relapsing symptoms of B. burgdorferi infection.

The ILADS Guidelines focus on which patients to evaluate, what tests to order, what antibiotics to use and what steps to take to ensure that concerns over antibiotic use are addressed.

The ILADS Working Group that formulated these guidelines included primary care clinicians, researchers, community healthcare providers and patient advocates. In developing these treatment guidelines, the group considered factors such as incidence of Lyme disease; severity of disease in terms of morbidity; comorbidities and determinants of when Lyme disease is most likely to become chronic; feasibility, efficacy and cost of antibiotic treatment; impact of antibiotic therapy on quality of life, including adverse drug events; and the potential for drug resistance to develop.

Because of the complexity and variability of Lyme disease symptoms, the guidelines are flexible. Treatment depends on the severity of each case, the patient’s response to therapy and the physician’s own clinical judgment.

The ILADS Working Group encourages centers that treat large numbers of Lyme disease patients symptomatically using IDSA treatment guidelines to perform a formal evaluation of their own programs. This will allow researchers to compare the results of treatment guidelines that use more antibiotics with those that do not.

The IDSA guidelines recommending one-time short-term antibiotic therapy have not been successful. Physician demands for better outcomes have led to the development of the ILADS guidelines, and the continued evolution of an evidence-based approach is critical for the treatment of persistent, recurrent and refractory Lyme disease.