Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease

Expert Rev Anti Infect Ther. 2014 Sep;12(9):1103-35. doi: 10.1586/14787210.2014.940900. Epub 2014 Jul 30.


Evidence-based guidelines for the management of patients with Lyme disease were developed by the International Lyme and Associated Diseases Society (ILADS). The guidelines address three clinical questions - the usefulness of antibiotic prophylaxis for known tick bites, the effectiveness of erythema migrans treatment and the role of antibiotic retreatment in patients with persistent manifestations of Lyme disease. Healthcare providers who evaluate and manage patients with Lyme disease are the intended users of the new ILADS guidelines, which replace those issued in 2004 (Exp Rev Anti-infect Ther 2004;2:S1-13). These clinical practice guidelines are intended to assist clinicians by presenting evidence-based treatment recommendations, which follow the Grading of Recommendations Assessment, Development and Evaluation system. ILADS guidelines are not intended to be the sole source of guidance in managing Lyme disease and they should not be viewed as a substitute for clinical judgment nor used to establish treatment protocols.

Keywords: GRADE; Lyme disease; antibiotic prophylaxis; antibiotics; erythema migrans; persistent disease; treatment.

Publication types

  • Review

MeSH terms

  • Antibiotic Prophylaxis / methods*
  • Borrelia burgdorferi / drug effects
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Drug Resistance, Bacterial
  • Evidence-Based Medicine
  • Glossitis, Benign Migratory / complications
  • Glossitis, Benign Migratory / drug therapy*
  • Glossitis, Benign Migratory / microbiology
  • Humans
  • Lyme Disease / etiology
  • Lyme Disease / microbiology
  • Lyme Disease / prevention & control*
  • Practice Guidelines as Topic
  • Tick Bites / complications
  • Tick Bites / drug therapy*
  • Tick Bites / microbiology