Joint guidelines on Lyme disease prevention, diagnosis, treatment open for comment

Among other recommendations, the draft guidelines favor oral antibiotic therapy with doxycycline, amoxicillin, cefuroxime axetil, or phenoxymethylpenicillin over other antimicrobials for treatment of Lyme disease.


New joint guidelines for the prevention, diagnosis, and treatment of Lyme disease and related complications were recently released for public comment.

The draft guidelines were prepared by a multidisciplinary panel representing the Infectious Diseases Society of America, the American Academy of Neurology, and the American College of Rheumatology. They were based on a systematic review of current evidence and have an intended audience of primary care physicians and specialists who deal with Lyme disease. They were released on June 26 and are open for comment until Aug. 10.

Regarding diagnosis, the guidelines say that in patients with skin lesions compatible with erythema migrans, clinical diagnosis is recommended over laboratory testing (strong recommendation, moderate-quality evidence). In patients with lesions that are suggestive of erythema migrans but atypical, they suggest antibody testing on an acute-phase serum sample (weak recommendation, low-quality evidence).

For treatment of Lyme disease, the guidelines recommend oral antibiotic therapy with doxycycline for 10 days, or 14 days of amoxicillin, cefuroxime axetil, or phenoxymethylpenicillin over other antimicrobials (strong recommendation, moderate-quality evidence). Additional advice on dosing and alternative antibiotics is also included.

If patients have persistent or recurring nonspecific symptoms such as fatigue, pain, or cognitive impairment following treatment for appropriately diagnosed Lyme disease, but lack objective evidence of reinfection or treatment failure, the guidelines recommend against additional antibiotic therapy (strong recommendation, moderate-quality evidence).

Other recommendations in the guideline address Southern tick-associated rash illness, and diagnosis and treatment for Lyme neuroborreliosis, Lyme carditis, Lyme arthritis, borrelial lymphocytoma, acrodermatitis chronica atrophicans, and possible co-infections.

Feedback gathered during the public comment period will be taken into consideration by the guidelines panel, comprised of experts from 16 medical specialties, as well as patients, before the document is approved and published by the three medical organizations, according to a press release.