After reviewing the available evidence on Lyme disease, a team of infectious disease specialists has proposed new guidelines for the management of the disease, which is unfortunately often misdiagnosed and mismanaged.
Current treatments for Lyme disease, particularly chronic forms of the disease, are inadequate, according to new evidence-based treatment guidelines written by a group of leading infectious disease experts.
Adopted by the International Lyme and Associated Disease Society (ILADS) and published in the Expert Review of Anti-infective Therapy, the guidelines also propose revamped treatment protocols to help clinicians across the globe deliver better care to patients.
Lyme disease is a bacterial infection caused by the bites of infected ticks. An early symptom is a bulls-eye-shaped temporary rash that appears around the area of the bite. Not everybody who gets Lyme notices the rash, and some of the other signs of the disease resemble the flu: fatigue, joint pain, chills, and mental confusion.
Chronic symptoms of the disease – which include long-lasting fatigue, headaches, and joint pain – are regularly misdiagnosed and mismanaged by clinicians.
The true burden of Lyme disease in the US has long been underestimated; only recently has the startlingly high prevalence come to light. In 2013, the Centers for Disease Control announced that Lyme is ten times more common than we thought: it strikes about 300,000 Americans each year. “Lyme disease is a tremendous public health problem in the United States,” the CDC’s Paul Mead said in a statement last year.
Although most physicians agree that Lyme disease is a problem, there remains a heated debate within the medical community over the diagnosis and management of the infection. For instance, some physicians do not believe that chronic Lyme disease symptoms even exist, and therefore do not treat patients who present with such symptoms.
According to the team behind the new guidelines, current antibiotic protocols used by many physicians to prevent and treat Lyme disease are ineffective, and can actually lead to an increased risk of Lyme disease developing into a chronic illness.
“We are seeing more people diagnosed with Lyme disease who simply don’t get better after being treated,” says Dr. Daniel Cameron MD, lead author of the study. “Our goal with these new guidelines is to provide evidence-based, patient-centered care for sufferers, helping clinicians make the right treatment decisions.”
The paper also notes the desperate need for better understanding of this complex illness. Currently there is limited available evidence regarding prognosis and treatment. Although Lyme disease is not rare, the treatment of Lyme disease “has not attracted pharmaceutical interest and the evidence base for treating Lyme disease is best described as sparse, conflicting and emerging,” the authors write. They continue:
The low quality of evidence seen in Lyme disease is consistent with the evidence base for the field as a whole. Indeed, the majority of recommendations in infectious disease medicine generally are based on low-quality evidence…
When the evidence base is of low or very low quality, guideline panels should be circumspect about making strong recommendations to avoid encouraging uniform practices that are not in the patient’s best interest and to ensure that research regarding benefits and risks is not suppressed.
Guidelines panels should also make the role of their values and those of patients in recommendations explicit and should promote informing and empowering patients to engage in shared decision-making
The new guidelines are based on a thorough review of the available evidence on Lyme disease diagnosis and treatment. The group provides a series of recommendations for disease management, including guidelines for the dosage and duration of antibiotic therapy as well as the role of patient preferences in decision-making.
Dr. Cameron notes that the lack of pharmaceutical interest in Lyme disease and its concomitant funding has led to inconsistencies in the treatment of the disease that ultimately end up hurting many patients. “We unquestionably need more research to better define the disease process and to establish highly effective therapeutic regimens,” he says.
To learn about why Lyme disease and other tick-borne illnesses are on the rise, check out this previous PublicHealthWatch article.