HPA Statement on IDSA Guidelines on Lyme disease Diagnosis and Treatment

• The Infectious Diseases Society of America (IDSA) drew up and published guidelines on the diagnosis and treatment of Lyme disease. These guidelines, published in 2006, are based on the best scientific evidence, and updated their previous guidelines which had been published in 2000. They are comprehensive and well-referenced, and the IDSA has made them easily and freely accessible. They are influential but, as with other medical guidelines, they are not binding on clinicians. Several European societies and expert groups have similar recommendations for diagnosis and treatment of Lyme disease.
• The IDSA guidelines recommend relatively short courses of oral antibiotics for the treatment of most cases of Lyme disease. Some patients with complicated or late stage infections may require intravenous antibiotics, and in certain circumstances, may also benefit from treatment with other types of drugs eg anti-inflammatory agents. There is no scientific evidence to support the need for very prolonged or multiple repeated courses of antibiotics.
• The Connecticut Attorney General accused the IDSA of harbouring conflicts of interest, and launched an investigation under antitrust statutes, claiming that the IDSA monopolised treatment standards. An agreement has been reached between the IDSA and the Connecticut Attorney General on this issue. The IDSA issued a news release on 1 May 2008 entitled 'Agreement Ends Lyme Disease Investigation By Connecticut Attorney General Medical Validity of IDSA Guidelines Not Challenged.' The news release, which gives additional information on the issues, is available here
• Under the agreement the guidelines remain in effect. The medical and scientific basis of the 2006 guidelines remains in place and is unchallenged. The agreement does not call for revision of the IDSA guidelines, nor does it identify any inaccuracies or deficiencies in the conclusions or recommendations of the guidelines. IDSA has voluntarily agreed to a one-time special review of the Lyme disease guidelines in an effort to clear the air.
• The IDSA has convened a review panel of physicians and scientists to conduct a comprehensive review of the Lyme-related literature to determine whether the 2006 guidelines should be revised or updated. While IDSA periodically reviews all of its treatment guidelines in order to keep them current, the agreement allows for an expanded process that includes an opportunity for public presentation and submission of information to ensure that all points of view are presented to and considered by the review panel. The review panel will also be able to incorporate scientific evidence published in the peer-reviewed literature since publication of the 2006 guidelines.
• Members of the IDSA panel that drew up the guidelines do not stand to profit from any recommendation in the guidelines. In fact, the panel members denied themselves and their colleagues an opportunity to generate a significant amount of revenue when they recommended against expensive, repeated, long-term antibiotic herapy.
• The view of the HPA is that the IDSA Guidelines continue to represent the best available synthesis of the medical literature on the diagnosis and treatment of Lyme disease available in the English language, and they are in keeping with European expert recommendations.

Last reviewed: 21 May 2009