ISDA: Our Lyme disease treatment guidelines were rigorously researched

LETTER — Posted Feb. 5, 2007

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Regarding "Lyme disease debate provokes treatment divide, legal action" (Article, Dec. 25, 2006): Some points are worth clarifying concerning your recent article on the different practice guidelines for Lyme disease, published by the Infectious Diseases Society of America and the International Lyme and Associated Diseases Society.

Lyme disease is a tick-transmitted spirochetal infection that has objective cutaneous, rheumatologic, neurologic and/or cardiac manifestations. Although some patients continue to have subjective complaints, such as fatigue or musculoskeletal pain, after appropriate antibiotic therapy (usually two to four weeks) and resolution of all objective clinical findings, there is no credible scientific evidence linking such symptoms with the presence of viable Borrelia burgdorferi, the organism that causes Lyme disease.

Identical complaints occur in the general population, unrelated to Lyme disease.

Placebo-controlled studies in patients previously treated for well-documented acute Lyme disease who have persistent subjective complaints following antibiotic therapy have convincingly shown that the risk of long-term antibiotic therapy exceeds the benefit.

State-of-the-art methodologies have not detected evidence of persistent infection with B. burgdorferi in these patients, nor do these patients ever develop objective clinical findings that are associated with the presence of viable B. burgdorferi. Long-term antibiotic therapy endangers patients, and has been clearly associated with a variety of serious adverse effects including Clostridium difficile enterocolitis, antibiotic resistance, and IV catheter-related bacterial and fungal sepsis. Fatal complications of unnecessary therapy for Lyme disease have been reported.

As physicians, we are committed to enhancing the safe and effective care of our patients. Because practice guidelines play such an important role in helping physicians and patients make decisions about their care, it is important for readers to understand IDSA's approach to the development of guidelines:

IDSA represents more than 8,000 infectious disease specialists in the United States, including more than 90% of physicians who are board certified in this specialty. IDSA's Lyme disease guidelines were based on rigorous review of clinical practice and scientific literature by a panel of 14 experienced clinicians and scientists (including experts in the fields of infectious diseases, rheumatology, neurology, immunology and entomology) from 10 leading medical centers and universities in three countries. IDSA's Lyme disease guidelines were rigorously peer reviewed. IDSA's Lyme disease guidelines are consistent with other major professional society guidelines, with recommendations in all major textbooks, and conform to a common-sense standard of care. IDSA constantly reassesses its guidelines in light of new developments and supports research to enhance our understanding of this disease, and to improve patient care.

Our most important mission is to find out what is best for patients. IDSA's Lyme disease guidelines have developed a reputation for accuracy and relevance: These guidelines are important tools for enabling providers to deliver the best care possible to their patients.

Henry Masur, MD, president, Infectious Diseases Society of America, Bethesda, Md.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2007/02/05/edlt0205.htm.

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