An anti-trust investigation was initiated against the IDSA ...



Infectious Diseases Society of America’s Recommendations on the

Diagnosis and Treatment of Lyme Disease Unanimously Approved by an

Independent Review Panel

In November, 2006, an investigation was initiated to determine whether the Infectious Diseases Society of America (IDSA) violated antitrust laws in promulgating its 2006 guidelines on the diagnosis and treatment of Lyme disease (1). This unprecedented legal action prompted an extensive review of the published IDSA guidelines by an independent review panel. The review panel recently issued a final report in which it unanimously approved all of the recommendations made in the IDSA’s current guidelines (2).

The review panel, which relied on >1,000 published scientific papers in making its deliberations, also affirmed that there is no published evidence to indicate that extended antibiotic therapy is beneficial for the treatment of “chronic Lyme disease”. It also affirmed that there is “no well-accepted definition of post-Lyme disease syndrome”, and that there is “no convincing biologic evidence for the existence of symptomatic chronic Borrelia burgdorferi infection among patients after receipt of recommended treatment regimens for Lyme disease” (2).

It should be noted that the IDSA’s recommendations for the treatment of Lyme disease are in agreement with those of the European Federation of Neurological Societies (3), the European Union of Concerted Action on Lyme Borreliosis (4), the American Academy of Neurology (5), the Canadian Public Health Network (6), and the German Society for Hygiene and Microbiology (7). They also are in agreement with recommendations made by expert panels from 10 European countries, namely, The Czech Republic, Denmark, Finland, France, The Netherlands, Norway, Poland, Slovenia, Sweden, and Switzerland. [An excellent summary of these expert panel recommendations may be found in the presentation by O’Connell in the guidelines section posted on this website]. None of these organizations or expert panels, as well as the Centers for Disease Control (CDC) and the National Institutes of Health (NIH), recommend extended antibiotic therapy for the treatment of “chronic Lyme disease”. In contrast to much of the false and misleading information being propagated on the internet and in the lay media, the IDSA guidelines (1), in addition to the websites sponsored by the NIH () , the CDC () , and the ALDF () , are considered to be the best source of evidenced-based information on Lyme disease for community physicians, medical practitioners, and the general public.

References

1. G. P. Wormser, R.J. Dattwyler, E.D. Shapiro, J.J. Halperin, A.C. Steere, M.S

Klempner, P.J. Krause, J.S. Bakken, F. Strle, G. Stanek, L. Bockenstedt, D. Fish, J.S. Dumler, R.B. Nadelman, 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., 43, 1089-1134, 2006.

2.

3. Mygland, U. Ljostad, V. Fingerle, T. Rupprecht, E. Schmutzhard, I. Steiner,

EFNS guidelines on the diagnosis and management of European Lyme

neuroborreliosis. Euro. J. Neurol. 17, 8-16, 2010.

4.

5. J.J. Halperin, E.D. Shapiro, E. Logigian, A.L. Belman, L. Dotevall, G.P.

Wormser, L. Krupp, G. Gronseth, C.T. Bever, Jr. Practice parameter:

treatment of nervous system Lyme disease (as evidence-based review).

Report of the Quality Standards Subcommittee of the American Academy of

Neurology. Neurol. 69, 91-102, 2007.

6. Canadian Public Health Network, The laboratory diagnosis of Lyme

borreliosis: guidelines from the Canadian Public Health Laboratory Network,

Can. J. Infect. Dis. Med. Microbiol. 18, 145-148, 2007.

7. R. Nau, H. Christen, H. Effert, Lyme disease- current state of knowledge,

Dtsch. Arztebl. Int. 106, 72-81, 2009.

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