Prevention, Diagnosis and Treatment of Lyme Disease

Document Overview

Document Title

Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease

Authoring Societies

American Academy of Neurology

American College of Rheumatology

Infectious Diseases Society of America

Document Publication Date

Dec 31, 2020

Page Last Reviewed/Updated

May 5, 2026

Document Type

Guideline

Country of Publication

United States

Full Text Freely Available

Yes

Full Text Guideline

doi.org/10.1093/cid/ciaa1215

Source Citation

Paul M Lantos, Jeffrey Rumbaugh, Linda K Bockenstedt, Yngve T Falck-Ytter, Maria E Aguero-Rosenfeld, Paul G Auwaerter, Kelly Baldwin, Raveendhara R Bannuru, Kiran K Belani, William R Bowie, John A Branda, David B Clifford, Francis J DiMario, Jr, John J Halperin, Peter J Krause, Valery Lavergne, Matthew H Liang, H Cody Meissner, Lise E Nigrovic, James (Jay) J Nocton, Mikala C Osani, Amy A Pruitt, Jane Rips, Lynda E Rosenfeld, Margot L Savoy, Sunil K Sood, Allen C Steere, Franc Strle, Robert Sundel, Jean Tsao, Elizaveta E Vaysbrot, Gary P Wormser, Lawrence S Zemel, Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease, Clinical Infectious Diseases, ciaa1215, https://doi.org/10.1093/cid/ciaa1215

Supplemental Implementation Resources

• Quick-Reference Guide
• Patient Information
• Podcast

Document Scope, Criteria, and Use Cases

Document Objectives

This guideline encompasses the prevention, diagnosis, and treatment of Lyme disease, as well as Lyme disease complicated by simultaneous coinfection with other tick-borne pathogens in North America.

Scope

Assessment and Screening, Diagnosis, Prevention, Treatment

Diseases/Conditions (MeSH)

D008193 - Lyme Disease

D008193 - Lyme Disease

Keywords

Lyme Disease, babesiosis, tick-borne rickettsial infections, ticks

Target Patient Population

patients who present with borrelia lymphocytoma and acrodermatitis chronica atrophicans after travel to endemic areas

Target Provider Population

Medical practitioners in North America

Inclusion Criteria

Male, Female, Adolescent, Adult, Child

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Nurse, Nurse Practitioner, Physician, Physician Assistant, Social Worker

Recommendation Development Processes & Methodology

PICO Questions

1. Which measures should be used to prevent tick bites and tick-borne infections?
2. Which diagnostic tests should be used following a tick bite?
3. Who should receive antibiotic prophylaxis to prevent Lyme disease following presentation with a tick bite?
4. What is the preferred antibiotic regimen for the chemoprophylaxis of Lyme disease following a high-risk tick bite?
5. What is the preferred diagnostic testing strategy for erythema migrans?
6. What are the preferred antibiotic regimens for the treatment of erythema migrans?
7. How long should a patient with erythema migrans be treated?
8. Should patients with the Southern Tick-Associated Rash Illness (STARI) be treated with antibiotics?
9. What is the preferred diagnostic testing strategy for Lyme neuroborreliosis?
10. For which neurological presentations should patients be tested for Lyme disease?
11. Should adult patients with psychiatric illnesses be tested for Lyme disease?
12. Should children with developmental, behavioral or psychiatric disorders be tested for Lyme disease?
13. What are the preferred antibiotic regimens for the treatment of acute neurologic manifestations of Lyme disease without parenchymal involvement of the brain or spinal cord?
14. Should patients with Lyme disease and facial nerve palsy receive corticosteroids in addition to antimicrobial therapy?
15. Should all patients with early Lyme disease receive an electrocardiogram (ECG) to screen for Lyme carditis?
16. Which patients with Lyme carditis require hospitalization?
17. What pacing modality should be used for the management of Lyme carditis?
18. What are the preferred antibiotics regimens for the treatment of Lyme carditis?
19. Should patients being evaluated for acute myocarditis/pericarditis or chronic cardiomyopathy of unknown cause be tested for Lyme disease?
20. What is the preferred diagnostic testing strategy for Lyme arthritis?
21. What are the preferred antibiotic regimens for the initial treatment of Lyme arthritis?
22. What are the approaches to patients in whom Lyme arthritis has not completely resolved?
23. How should post-antibiotic (previously termed antibiotic-refractory) Lyme arthritis be treated?
24. Should patients with persistent symptoms following standard treatment of Lyme disease receive additional antibiotics?
25. What is the preferred antibiotic regimen for the treatment of borrelial lymphocytoma?
26. What is the preferred antibiotic regimen for the treatment of acrodermatitis chronica atrophicans?
27. Under what circumstances should a patient with Lyme disease be evaluated for co-infection with A. phagocytophilum or B. microti?

Supplemental Methodology Resource

Data Supplement

Number of Source Documents

414

Includes peer/external review process?

Yes

Includes public comment process?

No

Methodologist involvement?

Yes

Patient involvement?

No

Includes multi-disciplinary group?

Yes

Includes systematic review?

Yes

Grades quality of strength of evidence?

Yes

Grades quality of strength of recommendation?

Yes

Discloses funding source?

Yes

Discloses conflicts of interest?

Yes

Includes benefits/harms analysis with recommendations?

Yes