| GUIDELINE TITLE |
Evidence-based
guidelines for the management of Lyme disease. |
Practice guidelines for the treatment of Lyme disease. |
| DATE RELEASED |
2004 |
2000
July (revised 2006 Jun) |
| ADAPTATION |
Not applicable: The guideline was not adapted from another source.
|
Not applicable: The guideline was not adapted from another source. |
| GUIDELINE
DEVELOPER(S) |
International
Lyme and Associated Diseases Society — Disease Specific
Society |
Infectious
Diseases Society of America — Medical Specialty Society |
| SOURCE(S)
OF FUNDING |
International
Lyme and Associated Diseases Society (ILADS) |
Infectious
Diseases Society of America (IDSA) |
| COMPOSITION
OF GROUP THAT AUTHORED THE GUIDELINE |
Daniel Cameron, MD, MPH, Internal Medicine and Epidemiology; Andrea
Gaito, MD, Rheumatology; Nick Harris, PhD, Immunology; Gregory
Bach, DO, Family and Integrative Medicine; Sabra Bellovin,
MD, Family Practice; Kenneth Bock, MD, Family Practice;
Steven Bock, MD, Family Practice; Joseph Burrascano, MD,
Internal Medicine; Constance Dickey, RN, Registered Nurse;
Richard Horowitz, MD, Internal Medicine; Steven Phillips,
MD, Internal Medicine; Laurence Meer-Scherrer, MD, Internal
Medicine; Bernard Raxlen, MD; Psychiatry; Virginia Sherr,
MD, Psychiatry; Harold Smith, MD, Emergency Medicine; Pat
Smith, President, Lyme Disease Association, Inc.; Raphael
Stricker, MD, Hematology and Immunotherapy. |
Gary
P. Wormser, Robert B. Nadelman, Raymond J. Dattwyler, David
T. Dennis, Eugene D. Shapiro, Allen C. Steere, Thomas J.
Rush, Daniel W. Rahn, Patricia K. Coyle, David H. Persing,
Durland Fish, and Benjamin J. Luft. |
| CONFLICTS
OF INTEREST |
Not
stated |
Not
stated |
| DISEASE/CONDITION(S)
|
Lyme
disease |
Lyme
disease |
| GUIDELINE
CATEGORY |
Diagnosis
— Evaluation — Management — Treatment |
Management
— Prevention — Treatment |
| CLINICAL
SPECIALTY |
Emergency
Medicine
Family Practice
Infectious Diseases
Internal Medicine
Nursing
Psychiatry
Rheumatology |
Family
Practice
Infectious Diseases
Internal Medicine Neurology
Rheumatology |
|
INTENDED USERS |
Advanced
Practice Nurses
Nurses
Physician Assistants
Physicians
Public Health Departments |
Allied
Health Personnel
Physicians |
| GUIDELINE
OBJECTIVE(S) |
- To
serve as a resource for physicians, public health officials,
and organizations involved in the evaluation and treatment
of Lyme disease
- To
present practitioners with practical and defensible
guidelines for treating all individuals with Lyme disease
including those with persistent, recurrent and relapsing
symptoms of Borrelia burgdorferi infection
|
To
provide clinicians and other health care practitioners with
recommendations for the management of patients diagnosed
with Lyme disease, or patients bitten by an Ixodes
tick in North America |
| TARGET
POPULATION |
- Patients
presenting with symptoms associated with Lyme disease
- Patients
diagnosed with Lyme disease
|
Patients
with Lyme disease or patients bitten by an Ixodes tick in
North America |
| MAJOR
OUTCOMES CONSIDERED |
In
developing these treatment guidelines, the guideline developers
considered factors such as incidence of Lyme disease; severity
of disease in terms of morbidity; co-morbidities 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. |
- Prevention
of Lyme disease
- Prevention
of other Ixodes-borne illnesses, including babesiosis
and human granulocytic ehrlichiosis
- Resolution
of symptoms and signs of early Lyme disease and prevention
of late complications
- Effective
treatment of late complications of Lyme disease while
minimizing the adverse effects of antibiotic therapy
- Risks
and consequences of developing Lyme disease
- Cost
and adverse effects of antimicrobial therapy
- Quality
of life
|
|
COST ANALYSIS PERFORMED/REVIEWED? (YES/NO) |
No |
No |
| METHODS
USED TO COLLECT/SELECT EVIDENCE |
Hand-searches
of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases
|
Searches
of Electronic Databases |
| DESCRIPTION
OF METHODS USED TO COLLECT/SELECT THE EVIDENCE |
English-language
articles published from 1975 to 2003 were selected. The
selection panel synthesized the recommendations from published
and expert opinion. Human studies of Lyme disease were identified
from MEDLINE (1975 to 2003) and from references in pertinent
articles and reviews. Also included were abstracts and material
presented at professional meetings and the collective experiences
of the International Lyme and Associated Diseases Society
(ILADS) Working Group treating tens of thousands of Lyme
disease patients. |
Not
stated |
| METHODS
USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE |
Weighting
According to a Rating Scheme (Scheme Given) |
Weighting
According to a Rating Scheme (Scheme Given) |
| RATING
SCHEME FOR THE STRENGTH OF THE EVIDENCE |
Quality
of the Data
I.
At least one randomized controlled trial supports the
recommendation
II.
Evidence from at least one well-designed clinical trial
without randomization supports the recommendation
III.
“Expert opinion”
|
I.
Evidence from at least one properly randomized, controlled
trial
II.
Evidence from at least one well-designed clinical trial
without randomization, from cohort or case-controlled
analytic studies (preferably from more than one center),
from multiple time-series studies, or from dramatic results
of uncontrolled experiments
III.
Evidence from opinions of respected authorities based
on clinical experience, descriptive studies, or reports
of expert committees
|
| METHODS
USED TO ANALYZE THE EVIDENCE |
Review |
Review
of Published Meta-AnalysesSystematic Review |
| METHODS
USED TO FORMULATE THE RECOMMENDATIONS |
Expert
Consensus |
Not
stated |
| DESCRIPTION
OF METHODS USED TO FORMULATE THE RECOMMENDATIONS |
Not
stated |
Not
stated |
| RATING
SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS |
Recommendations
rated
A.
Good evidence to support the recommendation.
B. Moderate evidence to support the recommendation.
C. Optional.
D. Generally should not be offered.
E. Contraindicated.
|
Strength
of recommendation:
A.
Good evidence to support a recommendation for use
B. Moderate evidence to support a recommendation for use
C. Poor evidence to support a recommendation
D. Moderate evidence to support a recommendation against
use
E. Good evidence to support a recommendation against use
|
| METHOD
OF GUIDELINE VALIDATION |
Peer
Review |
Peer
Review |
| DESCRIPTION OF METHOD OF GUIDELINE VALIDATION |
Not
stated |
Not
stated |
| CLINICAL ALGORITHM? (YES/NO) |
No |
No |
| IMPLEMENTATION
PLAN DEVELOPED? (YES/NO) |
No |
No |
| HAS
PATIENT INFO? (YES/NO) |
No |
No |
| VIEW
MAJOR RECOMMENDATIONS |
View
Major Recommendations |
View
Major Recommendations |
| VIEW
AVAILABILITY OF FULL TEXT |
View
Availability Information |
View Full-text Guideline |
