Lyme Disease Practice and Research

Guidelines Validation

• Cameron DJ, Glushanok G, McCoy K. Mt. Kisco, New York, USA, board member, International Lyme and Associated Diseases Society (ILADS)
• Background: Both ILADS and the IDSA have developed practice guidelines for the management of Lyme disease, yet little data exist regarding their validation.
• Objectives: To examine the validity of ILADS Practice Treatment Guidelines for the diagnosis and treatment of Lyme disease on clinical success, relapse rate, and success of retreatment.
• Design: Observational study
• Setting: A single center, prospective, surveillance database.
• Participants: From 2575 patients in whom Lyme disease was identified during 1997-2001; 100 were examined that were confirmed with at least 5 bands on a IgG Western blot.
• Results: Seventy-five percent of the patients who entered the surveillance database were successfully treated the first time. Only 20 patients remained well on long term follow-up, the others developing recurrent Lyme disease during prospective follow-up. Of the 20 patients who were not successfully treated initially, 10 (50%) were successfully retreated. Of the 70 patients with a relapse of symptoms, 70% were successfully retreated. There was no evidence of serious adverse events utilizing ILADS practice guidelines.
• Conclusion: Implementation of ILADS practice treatment guidelines for diagnosis and treatment of Lyme disease were shown to be effective. Centers that treat large numbers of patients symptomatically should formally evaluate the value of their own programs. This may also allow comparison of results of practice treatment guidelines that use more antibiotics with those that do not.

Summary Guidelines

A short summary of ILADS' recommendations include:

• Treatment for symptomatic presentations
• Treatment should not be withheld based on laboratory testing
• Early use of antibiotics
• Longer courses of antibiotics treatment
• Repeat antibiotics for recurrence

A more indept summary is being drafted.

Adapted from Cameron DJ, Gaito A, Harris N, Bach G, Bellovin S, Bock S, Burrascano J, Dickey C, Horowitz R, Phillips S, Meer-Sheerer L, Raxlen B, Sherr V, Smith H, Smith P, Stricker R. Evidence-based guidelines for the management of Lyme disease. Expert Rev. Anti-infect. Ther. 2(1), 2004.

To order a copy of these guidelines visit www.ILADS.org.