National Guideline Clearinghouse:
Lyme Disease Guideline Comparison
|
GUIDELINE TITLE |
Evidence-based guidelines for the management
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 Prevention |
|
CLINICAL SPECIALTY |
Emergency Medicine Family
Practice |
Family Practice Infectious
Diseases |
|
INTENDED USERS |
Advanced Practice Nurses Nurses |
Allied Health Personnel |
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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. |
á
Prevention
of Lyme disease á
Prevention
of other Ixodes-borne
illnesses, including babesiosis and human granulocytic ehrlichiosis á
Resolution
of symptoms and signs of early Lyme disease and prevention of late
complications á
Effective
treatment of late complications of Lyme disease while minimizing the adverse
effects of antibiotic therapy á
Risks
and consequences of developing Lyme disease á
Cost
and adverse effects of antimicrobial therapy á
Quality
of life |
|
COST ANALYSIS
PERFORMED/REVIEWED? (YES/NO) |
No |
Yes |
|
METHODS USED TO
COLLECT/SELECT EVIDENCE |
Hand-searches of Published
Literature (Primary Sources) |
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 |
|
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 |
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CLINICAL
ALGORITHM? (YES/NO) |
No |
No |
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IMPLEMENTATION
PLAN DEVELOPED? (YES/NO) |
No |
No |
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HAS PATIENT INFO?
(YES/NO) |
No |
No |
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VIEW MAJOR RECOMMENDATIONS |
||
|
VIEW AVAILABILITY
OF FULL TEXT |
View Full-text Guideline |
DR. SCHALLER NEITHER SUPPORTS NOR OPPOSES THE INFORMATION LISTED ABOVE. PLEASE DISCUSS WITH YOUR LICENSED MEDICAL PROFESSIONAL.
