Lyme Education Materials
2014 ILADS Treatment Guidelines Summary:
Management of patients with Ixodes species bites:
1. Recommends against single 200 mg dose of doxycycline.
2. Recommends prompt prophylaxis with doxycycline 100 -200 mg twice daily for a minimum of 20 days for all Ixodes tick bites in which there is evidence of tick feeding, regardless of the degree of tick engorgement or the infection rate in the local tick population.
3. Recommends patient education on prevention of future tick bites, on the manifestations of Lyme and other Ixodes-borne diseases and the manifestations and prevention of antibiotic-associated C. difficile infections.
Management of patients with Erythema Migrans (EM) rashes:
1. Recommends against treatment regimens using 20 or fewer days of phenoxymethylpenicillin, amoxicillin, cefuroxime or doxycycline and 10 or fewer days of azithromycin.
2. Recommends a minimum of 4 – 6 weeks of amoxicillin, cefuroxime or doxycycline or a minimum of 3 weeks of azithromycin.
3. Recommends ongoing assessments to detect persistence, progression or relapse of Lyme disease or the presence of other tick-borne illnesses. The initial assessment follows the completion of therapy; subsequent evaluations are done on an as-needed basis.
4. Recommends extending treatment in patients who remain symptomatic after initial therapy.
5. Recommends retreatment of persistent, recurrent or newly developed manifestations of Lyme disease.
6. Recommends patient education regarding potential manifestations of Lyme disease and other Ixodes-transmitted infections, as well as the manifestations and prevention of antibiotic-associated C. difficile infections.
Management of patients with persistent post-treatment manifestations:
1. Strongly recommends discussing the possibility of antibiotic retreatment with all patients and performing individualized risk-benefit assessments for patient-appropriate options. Information on reducing the risk of antibiotic-associated C. difficile infections should be included in these discussions.
2. Recommends 4 – 6 weeks of antibiotics when retreatment is undertaken, with antibiotic selection based on several factors.
3. Recommends reassessment immediately following the initial course of retreatment and basing decisions regarding the subsequent modification or discontinuation of treatment on several factors.
If the initial course of antibiotic retreatment does not produce a complete response, clinicians should consider various options. Patients who had an incomplete response with one agent may be responsive to another; thus, switching agents may prove successful. Alternatively, combination therapy may be appropriate in select patients. Examples include those with known or suspected co-infections and patients who had incomplete responses to single agent therapy.
Important Reference Articles:
The ILADS guidelines are available in open access in the August 2014 edition of Expert Review of Anti-infective Therapy
Advanced Topics in Lyme disease - Diagnostic Hints and Treatment Guidelines for Lyme and Other Tick Borne Illnesses.
Dr. Joseph Burrascano
Neuropsychological Functioning in Chronic Lyme disease
Westervelt and McCaffrey
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