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The ILADS guidelines address three clinical questions – the usefulness of antibiotic prophylaxis for known tick bites, the effectiveness of erythema migrans treatment and the role of antibiotic retreatment in patients with persistent manifestations of Lyme disease.
Reconciling divergent guidelines
The ILADS panel recommendations differ from those of the IDSA. Different guideline panels reviewing the same evidence can develop disparate recommendations that reflect the underlying values of the panel members, which may result in conflicting guidelines. The IOM explains that conflicting guidelines most often result ‘when evidence is weak; developers differ in their approach to evidence reviews (systematic vs non-systematic), evidence synthesis or interpretation and/or developers have varying assumptions about intervention benefits and harms. Conflicting guidelines exist for over 25 conditions and there is no current system for reconciling conflicting guidelines. Supplementary Appendix I reconciles the differences between the ILADS and IDSA treatment recommendations by clinical situation.
1. Shaneyfelt TM, Centor RM. Reassessment of clinical practice guidelines: go gently into that good night. Jama, 301(8), 868-869 (2009).
2. Clinical Practice Guidelines we can trust , Available from http://www.nap.edu/catalog.php?record_id=13058, last accessed 10/30/14.
In general, you can think of Lyme disease as having three categories: acute, early disseminated, and chronic. The sooner treatment is begun after the start of the infection, the higher the success rate. Undertreated infections will inevitably resurface, usually as chronic Lyme, with its tremendous problems of morbidity and difficulty with diagnosis and treatment So, while the bulk of this document focuses of the more problematic chronic patient, strong emphasis is also placed on earlier stages of this illness where closest attention and care must be made.
Amazingly, this edition is not only the sixteenth in the series, but as the first edition appeared in 1984, this reflects twenty four years of effort!
Since the last edition, enough new information has become available to justify this revision. New insights regarding co-infections, tests and treatment regimens are included. Information included here is based on the literature, presentations at scientific meetings, the many valuable observations noted by my colleagues, plus experience from caring for my own patients. Please use the information presented in this document as an information resource and guide. It can never replace your own experience and clinical judgment. To download the entire 16th edition of the guidelines, click below
Below is a letter from ILADS to the Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN), and the American College of Rheumatology (ACR) regarding their Lyme Disease Clinical Practice Guideline Development Panel.
ILADS is a nonprofit, international, multi-disciplinary medical society, dedicated to the diagnosis and appropriate treatment of Lyme and its associated diseases. ILADS promotes understanding of Lyme through research and education and strongly supports physicians and other health care professionals dedicated to advancing the standard of care for Lyme and its associated diseases. Learn more about us →
PO Box 341461