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New Treatment Guidelines for Lyme Disease will benefit Minnesotans

Web posted August 12, 2014
Lyme disease infections are increasingly common in Minnesota yet the Minnesota Lyme Association (MLA) medical advisor Dr. Elizabeth Maloney notes that the diagnosis is frequently missed the first time a patient is seen for the illness and many patients remain ill after short courses of therapy. New guidelines for the treatment of Lyme disease by the International Lyme and Associated Diseases Society (ILADS) published today demonstrate that commonly used antibiotic regimens have unacceptably high failure rates and encourage clinicians to adopt new treatment approaches.

Published in the August 2014 edition of the journal Expert Review of Anti-infective  Therapy, the new guidelines, titled: Evidence Assessments and Guideline Recommendations in Lyme disease: The Clinical Management of Known Tick Bites, Erythema Migrans Rashes and Persistent Disease, call on physicians to provide evidence-based, patient-centered care for those with Lyme disease in order to reduce the risk of patients developing a chronic illness.

“Chronic manifestations of Lyme disease can continue long after other markers of the disease, such as the erythema migrans rash, have resolved,” said Daniel Cameron, M.D., M.P.H., and lead author. “Understanding this reality underlies the recommendation for careful follow-up to determine which individuals with Lyme disease could benefit from additional antibiotic therapy.”

ILADS is the first organization to issue guidelines on Lyme disease based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process. This rigorous review format is used by other well-respected medical organizations including the Cochrane Collaboration and the World Health Organization. ILADS also developed its guidelines with the goal of meeting the 8 standards identified by the Institute of Medicine as being critical to the development of trustworthy guidelines.

ILADS’ GRADE-based analyses demonstrated that research studies guiding current treatment protocols were of very low quality; and, the regimens based on these studies often failed. “For this reason, we moved away from designating a fixed duration for antibiotic therapy for tick borne illnesses and instead encourage clinicians to tailor therapy based on the patient’s response to treatment,” noted Dr. Cameron.

“We not only recommend clinicians perform a deliberate and individualized assessment of the potential risks and benefits of various treatment options before making their initial selection,” said guidelines coauthor Elizabeth Maloney, M.D., “we also recommend careful follow-up.

Monitoring a patient allows clinicians to adjust therapy as circumstances evolve. This more selective approach should reduce the risk of inadequate treatment giving rise to a chronic illness,” added Dr. Maloney, a family physician from Wyoming, MN who develops accredited continuing medical education courses on Lyme disease for healthcare professionals.

The guidelines encourage shared medical decision-making, which takes patient values into consideration. Lorraine Johnson, J.D., MBA, a coauthor and Executive Director of LymeDisease.org, noted, “A lot of the treatment decisions in Lyme disease depend on trade-offs. How sick is the patient? How invasive is the treatment? What is valued by the patient? Patients need to understand the risks and benefits of treatment options to make informed medical choices,” added Ms. Johnson. “These guidelines provide that information.”

MLA is a nonprofit organization which supports patients and families affected by Lyme disease and provides educational content on Lyme disease, primarily focusing on disease prevention. Learn more about the MLA at www.mnlyme.org.

The Brainerd Chapter of MLA holds a support group meeting every second Thursday of the month at the Eagle’s Nest Church on CR 11 east of Pequot Lakes at 6:00 PM. The next meeting is August 14. Local lawmakers are invited to the August meeting. Everyone is welcome to come to these free meetings.

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