Treatment of Lyme disease is the subject of much controversy and has been subjected to legal action.
The most controversial issue is empiric treatment of patients with symptoms that remain after a one month course of antibiotics. Many patients continue to complain of various hard to characterize symptoms and some physicians advocate continued antibiotic treatment and report that it helps. The Infectious Diseases Society of America IDSA) issued guidelines that do not recommend continued treatment after a month of therapy. In response, a group of physicans who treat Lyme Disease set up a Lyme Disease Association that issued a competing set of guidelines that includes chronic Lyme disease treatment and also took the IDSA to court. They also supported the passage of a bill in Connecticute. H.B. 6200 contains language that will protect CT licensed Lyme treating physicians from prosecution by the State of Connecticut Medical Examining Board solely on the basis of a clinical diagnosis and /or for treatment of long-term Lyme disease. The bill provides the definition for Lyme disease which includes , “the presence in a patient of signs and symptoms compatible with acute infection with Borrelia burgdorferi; or with late stage or persistent or chronic infection with Borrelia burgdorferi, or with complications related to such an infection.” The Connecticut Attorney General investigated the IDSA.
Attorney General Richard Blumenthal announced that his antitrust investigation has uncovered serious flaws in the Infectious Diseases Society of America’s (IDSA) process for writing its 2006 Lyme disease guidelines and the IDSA has agreed to reassess them with the assistance of an outside arbiter.
The IDSA guidelines have sweeping and significant impacts on Lyme disease medical care. They are commonly applied by insurance companies in restricting coverage for long-term antibiotic treatment or other medical care and also strongly influence physician treatment decisions.
Insurance companies have denied coverage for long-term antibiotic treatment relying on these guidelines as justification. The guidelines are also widely cited for conclusions that chronic Lyme disease is nonexistent.
The attorney Gneral of the state of CT, wrote: “This agreement vindicates my investigation — finding undisclosed financial interests and forcing a reassessment of IDSA guidelines,” IDSA has reached an agreement with Attorney General’s Office by calling for creation of a review panel to thoroughly scrutinize the 2006 Lyme disease guidelines and update or revise them if necessary. The panel — comprised of individuals without conflicts of interest — will comprehensively review medical and scientific evidence and hold a scientific hearing to provide a forum for additional evidence. It will then determine whether each recommendation in the 2006 Lyme disease guidelines is justified by the evidence or needs revision or updating.
Where does this leave us at this point in time? My recommendation is that until the legal process and the IDSA review is completed, the existing IDSA guideline continue to be considered authoritative and long term continuous treatment for Lyme disase be considered experimental and unproven and medically necessary.
Evidence-based guidelines for the management of Lyme disease. Expert Rev Anti Infect Ther 2004;2(1 Suppl):S1-13. [66 references]
Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, Krause PJ, Bakken JS, Strle F, Stanek G, Bockenstedt L, Fish D, Dumler JS, Nadelman RB. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006 Nov 1;43(9):1089-134.