New Guidelines for Prevention, Diagnosis, and Treatment of Lyme Disease

New evidence-based clinical practice guidelines for the prevention, diagnosis, and treatment of Lyme disease have been developed by a multidisciplinary panel. The guidelines provide practical recommendations for clinicians treating individuals with Lyme disease, including, but not limited to, cardiologists, dermatologists, emergency physicians, family physicians, infectious diseases specialists, internists, neurologists, pediatricians, primary care physicians, and rheumatologists. The goal of the recommendations is to provide a meaningful resource for safe and effective evidence-based care of individuals with Lyme disease.

The guidelines include 43 recommendations for clinical questions related to prevention, diagnosis, and treatment of Lyme disease; complications from neurologic, cardiac, and rheumatic symptoms; disease expression commonly seen in Eurasia; and complications from coinfection with other tick-borne pathogens. Detailed recommendations for Lyme carditis and a discussion of long-term Lyme disease are also included. 

For diagnostic testing, clinical diagnosis alone is recommended for people with a skin rash characteristic of early Lyme disease, and antibody testing is recommended for all other signs of Lyme disease in the absence of rash. Treatment recommendations include oral antibiotic therapy for most 10 to 14 days for early Lyme disease, 14 days for Lyme carditis, 14 to 21 days for neurologic Lyme disease, and 28 days for late Lyme arthritis. For those with arthritis who have failed a first course of treatment, retreatment may be warranted.

The recommendations are grounded in a rigorous, systematic review of available evidence surrounding prevention, diagnosis and treatment of the disease. The panel adhered to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of the evidence and strength of recommendations. 
Each of the 3 sponsoring organizations elected a cochair to lead the guideline panel. A fourth cochair was selected for their expertise in guideline methodology. There was a total of 36 panelists, including 1 health care consume representative and 3 patient representatives.