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National Guideline Clearinghouse:
Lyme Disease Guideline Comparison

GUIDELINE TITLE

Evidence-based guidelines for the management of Lyme disease.

Practice guidelines for the treatment of Lyme disease.

DATE RELEASED

2004

2000 Jul

ADAPTATION

Not applicable: The guideline was not adapted from another source.

Not applicable: The guideline was not adapted from another source.

GUIDELINE DEVELOPER(S)

International Lyme and Associated Diseases Society - Disease Specific Society

Infectious Diseases Society of America - Medical Specialty Society

SOURCE(S) OF FUNDING

International Lyme and Associated Diseases Society (ILADS)

Infectious Diseases Society of America (IDSA)

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Daniel Cameron, MD, MPH, Internal Medicine and Epidemiology; Andrea Gaito, MD, Rheumatology; Nick Harris, PhD, Immunology; Gregory Bach, DO, Family and Integrative Medicine; Sabra Bellovin, MD, Family Practice; Kenneth Bock, MD, Family Practice; Steven Bock, MD, Family Practice; Joseph Burrascano, MD, Internal Medicine; Constance Dickey, RN, Registered Nurse; Richard Horowitz, MD, Internal Medicine; Steven Phillips, MD, Internal Medicine; Laurence Meer-Scherrer, MD, Internal Medicine; Bernard Raxlen, MD; Psychiatry; Virginia Sherr, MD, Psychiatry; Harold Smith, MD, Emergency Medicine; Pat Smith, President, Lyme Disease Association, Inc.; Raphael Stricker, MD, Hematology and Immunotherapy.

Authors: Gary P. Wormser, Robert B. Nadelman, Raymond J. Dattwyler, David T. Dennis, Eugene D. Shapiro, Allen C. Steere, Thomas J. Rush, Daniel W. Rahn, Patricia K. Coyle, David H. Persing, Durland Fish, and Benjamin J. Luft.

CONFLICTS OF INTEREST

Not stated

Not stated

DISEASE/CONDITION(S)

Lyme disease

Lyme disease

GUIDELINE CATEGORY

Diagnosis           Evaluation
Management       Treatment

Management       Prevention
Treatment

CLINICAL SPECIALTY

Emergency Medicine                    Family Practice
Infectious Diseases                     Internal Medicine
Nursing                                      Psychiatry
Rheumatology

Family Practice               Infectious Diseases
Internal Medicine Neurology
Rheumatology

INTENDED USERS

Advanced Practice Nurses           Nurses
Physician Assistants                   Physicians
Public Health Departments

Allied Health Personnel
Physicians

GUIDELINE OBJECTIVE(S)

To serve as a resource for physicians, public health officials, and organizations involved in the evaluation and treatment of Lyme disease

To present practitioners with practical and defensible guidelines for treating all individuals with Lyme disease including those with persistent, recurrent and relapsing symptoms of Borrelia burgdorferi infection.

To provide clinicians and other health care practitioners with recommendations for the management of patients diagnosed with Lyme disease, or patients bitten by an Ixodes tick in North America

TARGET POPULATION

Patients presenting with symptoms associated with Lyme disease

Patients diagnosed with Lyme disease

Patients with Lyme disease or patients bitten by an Ixodes tick in North America

MAJOR OUTCOMES CONSIDERED

In developing these treatment guidelines, the guideline developers considered factors such as incidence of Lyme disease; severity of disease in terms of morbidity; comorbidities and determinants of when Lyme disease is most likely to become chronic; feasibility, efficacy, and cost of antibiotic treatment; impact of antibiotic therapy on quality of life, including adverse drug events; and the potential for drug resistance to develop.

Prevention of Lyme disease

Prevention of other Ixodes-borne illnesses, including babesiosis and human granulocytic ehrlichiosis

Resolution of symptoms and signs of early Lyme disease and prevention of late complications

Effective treatment of late complications of Lyme disease while minimizing the adverse effects of antibiotic therapy

Risks and consequences of developing Lyme disease

Cost and adverse effects of antimicrobial therapy

Quality of life

COST ANALYSIS PERFORMED/REVIEWED? (YES/NO)

No

Yes

METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases

Searches of Electronic Databases

DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

English-language articles published from 1975 to 2003 were selected. The selection panel synthesized the recommendations from published and expert opinion. Human studies of Lyme disease were identified from MEDLINE (1975 to 2003) and from references in pertinent articles and reviews. Also included were abstracts and material presented at professional meetings and the collective experiences of the International Lyme and Associated Diseases Society (ILADS) Working Group treating tens of thousands of Lyme disease patients.

Not stated

METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Given)

Weighting According to a Rating Scheme (Scheme Given)

RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Quality of the Data

         I.  At least one randomized controlled trial supports the recommendation

          II.  Evidence from at least one well-designed clinical trial without randomization supports the recommendation

            III. "Expert opinion"

         I.  Evidence from at least one properly randomized, controlled trial

          II.  Evidence from at least one well-designed clinical trial without randomization, from cohort or case-controlled analytic studies (preferably from more than one center), from multiple time-series studies, or from dramatic results of uncontrolled  experiments

            III. Evidence from opinions of respected authorities based on clinical experience, descriptive studies, or reports of expert committees

METHODS USED TO ANALYZE THE EVIDENCE

Review

Review of Published Meta-Analyses
Systematic Review

METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

Not stated

DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

Not stated

Not stated

RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Recommendations rated

A.              Good evidence to support the recommendation.

B.              Moderate evidence to support the recommendation.

C.              Optional.

D.              Generally should not be offered.

E.              Contraindicated.

Strength of recommendation:

A.          Good evidence to support a recommendation for use

B.          Moderate evidence to support a recommendation for use

C.          Poor evidence to support a recommendation

D.          Moderate evidence to support a recommendation against         use

E.          Good evidence to support a recommendation against use

METHOD OF GUIDELINE VALIDATION

Peer Review

Peer Review

DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Not stated

Not stated

CLINICAL ALGORITHM? (YES/NO)

No

No

IMPLEMENTATION PLAN DEVELOPED? (YES/NO)

No

No

HAS PATIENT INFO? (YES/NO)

No

No

VIEW MAJOR RECOMMENDATIONS

View Major Recommendations

View Major Recommendations

VIEW AVAILABILITY OF FULL TEXT

View Availability Information

View Full-text Guideline

DR. SCHALLER NEITHER SUPPORTS NOR OPPOSES THE INFORMATION LISTED ABOVE. PLEASE DISCUSS WITH YOUR LICENSED MEDICAL PROFESSIONAL.



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