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Practice Guidelines

Lyme disease: summary of NICE guidance

BMJ 2018; 361 doi: (Published 12 April 2018) Cite this as: BMJ 2018;361:k1261
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Antibiotic choices when treating Lyme disease

A visual summary summarises latest NICE guidance

  1. Maria Cruickshank, senior research fellow1,
  2. Norma O’Flynn, chief operating officer1,
  3. Saul N Faust, professor of paediatric immunology and infectious diseases, director of NIHR Clinical Research Facility2
  4. on behalf of the Guideline Committee
  1. 1National Guideline Centre, Royal College of Physicians, London
  2. 2Faculty of Medicine, University of Southampton, and University Hospital Southampton NHS Foundation Trust, Southampton, UK
  1. Correspondence to: S N Faust s.faust{at}

What you need to know

  • Lyme disease can occur anywhere in the UK

  • Erythema migrans is diagnostic of Lyme disease. Use a combination of clinical presentation and laboratory testing to guide diagnosis and treatment in people without erythema migrans

  • Serological testing is a two tier approach: a sensitive initial test is performed first (ELISA), followed by a more specific confirmatory test (immunoblot) in case of a positive or equivocal initial result

  • Symptoms of Lyme disease may take months or years to resolve even after treatment for several reasons, including alternative diagnoses, reinfection, treatment failure, immune reaction, and organ damage caused by Lyme disease

  • Consider a second course of antibiotics for people with ongoing symptoms as treatment may have failed

Lyme disease is caused by a specific group of Borrelia burgdorferi bacteria, which can be transmitted to humans through a bite from an infected tick. This can result in a number of clinical problems ranging from skin rash to serious involvement of organ systems, including arthritis, and neurological problems. People with skin and non-specific symptoms most commonly present to their general practitioner and are often treated in primary care, whereas people with symptoms affecting organ systems are commonly referred to specialists.

The guideline focuses on diagnosis and management of Lyme disease according to clinical presentation and symptoms rather than using the differing classifications of Lyme disease, which are poorly defined and contested. There is a lack of good quality evidence on the epidemiology, prevalence, diagnosis, and management of Lyme disease.

This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE).1

What’s new in this guidance

  • Tests used to support diagnosis should be carried out at UK accreditation service (UKAS) accredited laboratories that use validated tests and participate in a formal external quality assurance programme

  • Doses and durations of antibiotics at the higher ranges …

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