• Clinical Practice Guideline

    Lyme Disease

    Lyme Disease

    (Endorsed, July 2020)

    The “2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease” was developed by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) and endorsed by the American Academy of Family Physicians prior to publication.  

    Key Recommendations

    • Individuals should use protective measures to reduce exposure to ticks including chemical repellants such as N,N-Diethyl-meta-toluamide (DEET), picaridin, ethyl-3-(N-n-butyl-N-acetyl) aminopropionate (IR3535), oil of lemon eucalyptus (OLE), p-methane-3,8-diol (PMD), 2-undecanone, or permethrin.
    • Following a tick bite, prompt detection and removal of an attached tick can reduce the likelihood of disease transmission. Proper removal of the intact tick can be achieved mechanical means using an instrument like fine-tipped tweezers. Removal via burning is not recommended. 
    • Tick species identification is recommended to determine risk of infection and is available in most commercial laboratories and at some local health departments. 
    • Testing for Borrelia burgdorferi is not necessary. Individuals with a high-risk tick bite may be given prophylactic single dose of oral doxycycline within 72 hours of tick removal. 
    • Individuals with a potential tick exposure in a Lyme disease endemic area and one or more skin lesions, clinical diagnosis of erythema migrans is recommended. 
    • Individuals with diagnosed erythema migrans should be treated with doxycycline, amoxicillin, or cefuroxime axetil. Azithromycin should be used as a second line option for individuals unable to take doxycycline or beta-lactam antibiotics. 
    • Routine testing for Lyme disease is not recommended unless an individual has a known or plausible exposure and is presenting with one or more of the following: meningitis, painful radiculoneuritis, mononeuropathy multiplex including confluent mononeuropathy multiplex, acute cranial neuropathies (particularly VII, VIII, less commonly III, V, VI and others), or in patients with evidence of spinal cord (or rarely brain) inflammation.
    • Individuals with acute neurological manifestations of Lyme disease should be treated with intravenous ceftriaxone, cefotaxime, penicillin G, or oral doxycycline. Decisions about the choice of antibiotic, including the route of administration, should be based on an individual’s clinical history and preferences.
    • Individuals with signs of Lyme carditis (exercise intolerance, palpitations, presyncope, syncope, pericarditic pain, evidence of pericardial effusion, elevated biomarkers (such as troponin), edema, and shortness of breath) should be evaluated with an EKG.
    • Individuals with confirmed Lyme carditis who are not hospitalized should be treated with oral antibiotics. Options include doxycycline, amoxicillin, cefuroxime axetil, and azithromycin.
    • Individuals with Lyme arthritis should be treated with oral antibiotic therapy for 28 days. 

    See the full recommendation for more detailed information on testing, diagnosis, and clinical management of additional manifestations of Lyme disease.