Paper - Primary
changes in ILADS Evidence-Based Practice Treatment Guidelines.
Cameron
DJ, Gaito A, Harris N, Bach G, Bellovin S, Bock K, Bock
S, Burrascano J, Dickey CE, Horowitz R, Phillips S,
Merr-Sherrer L, Raxlen B, Sherr V, Smith H, Smith P,
Stricker R. International Lyme and Associated Diseases
Society (ILADS), Bethesda Maryland
Objective: These guidelines build upon the Infectious
Diseases Society of America (IDSA) 2000 Practice Treatment
Guidelines for Lyme disease to incorporate the growing
body of evidence of the complexity of persistent and
recurrent Lyme disease.
Limitations of IDSA guidelines: The IDSA Lyme
Disease Practice Guidelines concluded there was no evidence
that chronic Lyme disease existed as a separate diagnostic
entity and there is no data to support prolonged and
repeated treatment.
Data Sources: English-language articles published
1975 to 2002 identified through MEDLINE and bibliographies.
Major Additions in the ILADS Guidelines:
1. Laboratory testing is meant to contribute to rather
than to supersede physicians' judgment.
2. Clinical judgment is necessary to identify individuals
who may benefit from antibiotics to avoid preventable
persistent, recurrent, and refractory Lyme disease.
3. Empiric treatment should be considered as routine
treatment of patients for whom Lyme disease is a likely
diagnosis.
4. The previously recommended practice of stopping antibiotics
to allow for a delayed recovery is no longer recommended
for patients with persistent, recurrent and refractory
Lyme disease.
5. Duration of therapy should be guided by clinical
response rather than any arbitrary 30-day treatment
course.
6. A reasonable course would be to continue therapy
to treat Lyme disease, after clinical and laboratory
abnormalities are resolving and symptoms have resolved.
7. Indications for retreatment should be broadened from
meningitis, heart block, and arthritis to include symptomatic
presentations.
Conclusions: The ILADS Practice Treatment Guidelines
revises and expand use of clinical judgment and empiric
treatment.
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