The Infectious Diseases Society of America, the American Academy of Neurology, and the American College of Rheumatology have released a draft of their joint clinical practice guidelines for the management of Lyme disease.
Paul Lantos, M.D., from the Duke University Health System in Durham, North Carolina, and colleagues address the prevention, diagnosis, and treatment of Lyme disease and Lyme disease complicated by coinfection, as well as the neurologic, cardiac, and rheumatologic complications of Lyme disease.
The authors note that for prevention of tick bites and tick-borne infections, wearing protective clothing, checking for ticks, bathing after outdoor activities, drying clothing, and limiting pet exposure are recommended. Repellents to prevent tick bites include permethrin-treated clothing; attached ticks should be removed promptly. Following a tick bite, testing for Borrelia burgdorferi is not recommended in an Ixodes tick, and asymptomatic patients should not be tested for exposure to Borrelia burgdorferifollowing an Ixodes tick bite.
Prophylactic antibiotic treatment should be given to adults and children within 72 hours of removal of an identified high-risk tick. A single dose of oral doxycycline is recommended within 72 hours of tick removal during observation for high-risk Ixodes bites. Erythema migrans skin lesions are the most common clinical manifestation of Lyme disease. Clinical diagnosis is recommended over laboratory testing for patients with lesions compatible with erythema migrans.
The public comment period for these draft guidelines has been extended for an additional 30 days, and the deadline for comment is Sept. 9, 2019.