Updated Lyme disease guidelines confirm current best practices

In November 2020, the interdisciplinary Infectious Diseases Society of America, American Academy Neurology, and College Rheumatology (IDSA-AAN-ACR) issued an update to clinical practice guidelines for prevention, diagnosis, treatment Lyme disease. The followed public comment first released in 2019. disease, infectious disease caused by Borrelia bacterium, is most common tick-borne United States, according CDC. only hallmark manifestation diagnosis erythema migrans rash following a tick bite, without laboratory confirmation. Oftentimes this sign not present, if does resemble classical “bull's eye” rash. “Lyme controversial [with] conflicting views among practitioners, especially [regarding] persistent manifestations disease,” said Christine Arseneau, PharmD, FMCHC, founder Support Mill Valley, CA, who has been affected herself. previous guidelines, Arseneau said, IDSA ranked adverse outcomes from as critically important, while other emphasized cure infection relapse prevention. If left untreated, can be complicated long-term multisystem issues affecting joints, heart, nervous system. Latency also feature which further complicates since symptoms sometimes present weeks or even years infection. Because gaps understanding, plan review every 2 determine new updates are warranted, Erika Ernst, BCPS, BCIDP, FCCP, associate professor at University Iowa Pharmacy. She added that IDSA's collaboration with AAN ACR greatly improved 2006 through use Grading Recommendations Assessment, Development, Evaluation (GRADE) methodology strength recommendations based on quality evidence practice. describe any potential conflicts interest, well. They widely accepted standard CDC recommendations. “Overall, largely unchanged,” Ernst. Antibiotic prophylaxis recommended patients high risk Ixodes species bite attached more than 36 hours, attachment occurred highly endemic area, treated within 72 hours removal. recommends single prophylactic dose doxycycline 200 mg adults 4.4 mg/kg (up mg) children. Patients should receive 10-day course 14-day amoxicillin cefuroxime, guidelines. clearly indicate acceptable short-course children younger 8 years. “Short-course associated tooth discoloration,” “This distinction important pharmacists may extend warnings staining tetracycline—which occur young children—to doxycycline.” For arthritis, initial 28-day oral therapy preferred. “Those responding I.V. ceftriaxone 28 days. Additional antibiotics recommended,” Ernst said. Especially areas, play role recommending measures prevent bites infections three ways: ▪Advise personal protective exposure bites, such wearing full-coverage, tight-fitting clothing.▪Recommend repellents like N,N-diethyl-m-toluamide (DEET), picaridin, ethyl-3-(N-n-butyl-N-acetyl) aminopropionate (IR3535), oil lemon eucalyptus (OLE), p-methane-3,8-diol (PMD), 2-undecanone, permethrin deter attachment.▪Educate proper mechanical removal ticks using clean, fine-tipped tweezer between body skin. recommend avoiding tick-infested areas during specific times year. “The greatest opportunity achieve earlier development This where individualized medicine support decision-making come in,” Pharmacists ideal position help current understanding patients.