Review of Lyme disease treatment guidelines begins

Conflicts erupted over length of time for using antibiotics and selection process for review panel.

By Susan J. Landers, AMNews staff. Posted March 17.
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A review of 2006 guidelines on treating Lyme disease that were drafted by the Infectious Diseases Society of America is now under way.

The review, expected to take eight to 12 months, was required by the Connecticut attorney general after controversy erupted over whether a lengthy course of antibiotics should be included as a treatment option for the tick-borne disease.

The guidelines developed three years ago by IDSA characterize Lyme disease as an acute infection that should be treated with antibiotics for a few weeks at most. This recommendation is similar to that of the Centers for Disease Control and Prevention.

But several patient groups and the International Lyme and Associated Diseases Society, which also has guidelines, say long-term treatment with antibiotics for more than 30 days may be necessary for some patients with persistent and severe joint pain and fever. This presentation of the illness has been called chronic Lyme disease or post-Lyme syndrome.

The warring groups caught the attention of Connecticut Attorney General Richard Blumenthal. He conducted an antitrust investigation of IDSA's guideline development process and ruled in April 2008 that the society must convene an impartial panel to review evidence and determine if its guidelines should be revised. Meanwhile, the group's document as originally drafted remains in effect. (See Clarification)

The 10-member panel selected for the review is headed by Carol J. Baker, MD, an infectious diseases specialist and pediatrician with Texas Children's Hospital in Houston. She is a past president of IDSA. Several of the other panelists also come from academic medical centers.

The patient groups have criticized the panel's composition because it "excludes physicians who treat patients with chronic Lyme disease," according to a joint statement from the Lyme Disease Assn., The California Lyme Disease Assn. and Time for Lyme.

"The situation is dÃ©jÃ vu all over again," said Lyme Disease Assn. President Pat Smith. "All Lyme disease-treating physicians who applied for a seat [on the panel] were denied, based on having a 'conflict' if they made over $10,000 treating Lyme disease." Yet these are the physicians who understand what makes patients well, Smith said.

All panel members were screened for potential conflicts of interest and were deemed eligible by medical ethicist Howard Brody, MD, PhD, who directs the Institute for the Medical Humanities at the University of Texas Medical Branch in Galveston. Dr. Brody was chosen as ombudsman for the panel selection process by Blumenthal and IDSA.

The panel also will hear public testimony at an April 27 hearing in the Washington, D.C., area. Comments are being accepted until April 3 and can be sent to the Lyme Disease Review Panel via e-mail (lyme@idsociety.org). More information about the panel can be found online (www.idsociety.org/lymedisease.htm).

This content was published online only.

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ADDITIONAL INFORMATION:
Clarification
The decision by Connecticut's Attorney General Richard Blumenthal should not have been characterized as a ruling. Convening an impartial panel was, instead, a mutual agreement reached by the attorney general and the Infectious Diseases Society of America.