Table 1 Characteristics of included guidelines
From: Methodological quality of guidelines for management of Lyme neuroborreliosis
Short guideline name | Full guideline name (name of responsible body, if not in title) | Year | Country | Type of organization | Key recommendations for diagnosis | Key recommendations for therapy |
|---|---|---|---|---|---|---|
AAN | Practice Parameter: Treatment of nervous system Lyme disease (an evidence-based review) (American Academy of Neurology) | 2007 | USA | Scientific society | None, focus on treatment | Antibiotic regimens for 14 days, either oral or parenteral, doxycycline is the preferred drug for peripheral affections, for more severe manifestations (meningitis, encephalomyelitis) parenteral treatments (ceftriaxone, cefotaxime or penicillin G) are recommended (alternative antibiotics specified) |
IDSA | The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America | 2006 | USA | Scientific society | No specific recommendations, focus on treatment | For cranial nerve palsy oral regimen, other neurologic manifestations parenteral regimen for 14-28 days, preferred oral drugs are amoxicillin, doxycycline and cefuroxime, preferred parenteral drug is ceftriaxone (alternative antibiotics specified) |
EFNS | EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis (European Federation of Neurological Societies) | 2009 | Europe | Scientific society | Investigation of CSF/serum pair for Bb-specific antibodies, intrathecal antibody production and signs of CSF inflammation. Diagnosis according to case definitions (definite/possible). | Early LNB: ceftriaxone IV for 14 days Late LNB: ceftriaxone IV for 21 days Peripheral neuropathy + acrodermatitis chronica atrophicans: doxycycline oral or ceftriaxone IV for 21 days (alternative antibiotics specified) |
DGN | S1-Leitlinie Neuroborreliose (German Academy of Neurology) | 2012 | Germany | Scientific society | Investigation of CSF/serum pair for Bb-specific antibodies, intrathecal antibody production, specific CSF/serum antibody index and signs of CSF inflammation (e.g. pleocytosis). Diagnosis according to case definitions. (definite/probable/possible) | Early LNB: doxycycline oral for 14 days (preferred) Late LNB: ceftriaxone IV for 14-21 days (alternative antibiotics specified) |
ILADS | Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease (The International Lyme and Associated Diseases Society) | 2004 | USA | Patient advocacy group | No clear recommendations, emphasis on clinical judgment for diagnosing Lyme disease | No specific recommendations, discussion of a wide range of options, including carbapenems, macrolides, combination of antibiotics and adjuvant treatments (hydroxychloroquine), no clear recommendation for length of treatment but endorsement of longer (>30 days) antibiotic courses |
DBG | Diagnostik und Therapie der Lyme-Borreliose – Leitlinien (German Borreliosis Society) | 2011 | Germany | Patient advocacy group | No clear recommendations, discussion of several diagnostic options | No specific recommendations, discussion of a range of options, including carbapenems, macrolides, metronidazole, combination of antibiotics and adjuvant treatments (hydroxychloroquine). Length of treatment should be at least 28 days, for late LNB 3 months or more. |
BIA | The epidemiology, prevention, investigation and treatment of Lyme borreliosis in United Kingdom patients: A position statement by the British Infection Association | 2011 | UK | Scientific society | Single or paired serum tests for Bb antibodies, intrathecal specific antibody production, specific CSF/serum antibody index, signs of CSF inflammation (e.g. pleocytosis) | Isolated facial nerve palsy or uncomplicated meningitis: doxycycline oral for at least 14 days Complicated meningitis or late LNB: ceftriaxone for 14-28 days (alternative antibiotics specified) |
DGPI | Diagnostik und Therapie der Lyme-Borreliose im Kindesalter. Empfehlungen der Deutschen Gesellschaft für Pädiatrische Infektiologie. (Diagnosis and therapy of Lyme borreliosis in children. Recommendations of the German Society of Pediatric Infectiology) | 1999 | Germany | Scientific society | No clear recommendations, discussion of obligate findings like investigation of CSF/serum pair for Bb-specific antibodies, intrathecal specific antibody production, signs of CSF inflammation (e.g. pleocytosis) | Ceftriaxone, cefotaxime or penicillin G for 14 days |