2019 Guideline Notes- Draft Review
Looking for a topic to comment about? Here are the rough notes I took while reading the boring 100 page document that may give you some ideas of what could be addressed.
Why didn’t they use PubMed in search? Pg. 6
Admits more research is needed in every category Pg. 8
If mouth parts of ticks can’t be easily removed they should be left alone and allowed to “fall out”. pg. 19
Even in highly endemic areas the probability of getting Lyme is low.
One dose antibiotics ONLY if the tick is Ixodes, if it came from a highly endemic area (greater than 20% infection rate based on CDC maps) and was engorged and attached for more than 36 hours. pg. 21
If tick bite can’t be determined as a high risk incident- wait and watch approach is recommended. pg. 21
“Unengorged ticks do not pose a significant risk for B. burgdorferi infection.” pg. 22
Early removal of tick and one dose Doxy reduces risk of Lyme by 2% pg. 22
Still says prevention is to “avoid exposure” to ticks. Pg. 10
Recommends against use of essential oils to repel ticks. Pg. 17
Says DEET is safe even though reports say it isn’t. pg. 17
Recommend against testing ticks pg. 20
If humans don’t have symptoms after a tick bite they shouldn’t be tested. pg. 20
Denies lone star and dog ticks can cause Lyme pg. 14
Denies larva ticks have and can transmit Lyme. pg. 14
Lone star ticks are unable to transmit Lyme pg. 31
Still won’t acknowledge ticks and Lyme as a problem in large areas of the US
Recommend same lab tests that miss 74.9% of those infected and insists they are good tests- pg. 10
Recommends against using other labs and tests- pg. 10
Cost of antibiotics was a factor- pg. 8, pg. 13, pg. 31, pg. 54, pg. 55
Same treatment- 10 days Doxy. pg. 30
Don’t test patients (adults or children) with psychiatric illness for Lyme. pg. 38-39
In ALS, MS, Parkinson’s, dementia, cognitive decline, new onset of seizures, or any other neuro conditions, brain white matter abnormalities- Lyme testing is NOT recommended. pg. 36
“Similarly, direct detection of B. bugdorferi in blood by PCR or culture is seldom helpful in patients with Lyme neuroborreliosis…” pg. 34
** Recommend against second course of oral antibiotics in patients where arthritis remains. pg. 55
For those who failed one course of orals and a course of IV therapy for Lyme arthritis- they should be referred to rheumatologists for anti-rheumatic drugs, biologic agents, steroids or synovectomy. pg. 58
No longer antibiotic refractory arthritis- now called “post-antibiotic Lyme arthritis”. pg. 58
Mentions consult with rheumatologist again… conflict of interest? pg. 60
Recommend against antibiotic therapy for people still ill after regular treatment unless they have arthritis, meningitis or neuropathy. pg. 62
Basically the aches and pains of daily living. pg. 63
Change “chronic Lyme” to “late manifestations”. pg. 64
No such thing as chronic Lyme disease. pg. 64
When examining patients with symptoms after antibiotics practitioner should try to find the “best fitting diagnosis” and treat that diagnosis, not Lyme. pg. 64
Many patients with no other diagnosis than chronic lyme have MUS. pg. 65
Treatment for ACA and borrelia lymphocytoma is to prevent dissemination to other tissues. pg. 66
The most common coinfections are Anaplasma and Babesia. pg. 67
Bartonella is not a co-infection. pg. 67
7-14 days treatment, depending on the antibiotic used. pg. 81
Link To Guideline Draft
Last Updated- July 2019
Lucy Barnes
scc