We are very happy to report that this summer, Canada’s Public Health Agency of Canada (PHAC) added a link on their website to include the 2014 Lyme disease guidelines developed by the International Lyme & Associated Diseases Society (ILADS), under their section “for medical professionals”.
You must scroll down to the very end of the PHAC page to find the ILADS guidelines link under a heading called “international treatment guidelines”: https://www.canada.ca/en/public-health/services/diseases/lyme-disease/health-professionals-lyme-disease.html
This is a very significant positive step for Canadians and something that Lyme patient and advocacy groups have been recommending for some time.
Why Is this Important?
Currently Canada, along with other countries, follows the Lyme treatment guidelines recommended by the U.S. Centres for Diseases Control (CDC) from 2006 which are very outdated.
These guidelines, called the IDSA guidelines, have also been heavily criticized as being unduly restrictive, potentially biased, and have some concerns of conflicts of interests around the process and the authors. There is currently a U.S. class action lawsuit involving these IDSA guidelines and their authors which you can read about here: https://www.lymedisease.org/lyme-patients-sue-idsa-insurers/
The ILADS guidelines, updated in 2014, are much more up to date, were authored by physicians who have extensive experience in treating patients with chronic, disseminated Lyme and Co-Infections, and call for longer courses of treatment and patient preference in treatment duration. They are listed on, and recognized as, an example of trustworthy guidelines by the Institute of Medicine (IOM).
One of the major challenges patients face in Canada is health care professionals who are not comfortable prescribing more than ONE dose of an antibiotic (called a “prophylactic dose”), or more than 14-21 days – because they feel obliged to strictly adhere to the limitations in the IDSA guidelines.
The addition of the ILADS guidelines is wonderful news because now patients and physicians have a CHOICE on Lyme treatment in Canada! Patients can take in the ILADS guidelines, show their physician that PHAC now lists them under their advice on Lyme treatment for medical professionals as alternate guidelines, and work with their physician on an appropriate personalized treatment plan with greater flexibility for individual cases.
How are the Guidelines Different?
A key difference is the current IDSA guidelines take a very conservative approach with treatment, for the most part, applying an arbitrary short course of duration of treatment and relying heavily on testing (which has been shown to have a risk of false results).
The ILADS guidelines emphasize fuller disclosure to patients of the risks/benefits of varying lengths of treatment, incorporate patient preference, and generally recommend longer courses of antibiotics, guided by patients’ ongoing symptoms, response to treatments, and physician's clinical judgement.
Here is a chart which provides a summary of the major differences between the two sets of guidelines:
https://www.tandfonline.com/doi/suppl/10.1586/14787210.2014.940900?scroll=top& w
3 of the most significant differences between the two guidelines are:
1. ILADS guidelines specifically recommend AGAINST a “one-dose” "prophylactic treatment" for a tick bite. The reason for this is discussed in this 3 minute video by Holly Ahern, a microbiologist, which is – IF you are infected, 2 pills of antibiotics will NOT treat your infection: https://www.youtube.com/watch?time_continue=5&v=QmSJnIszv28
2. ILADS guidelines call for a minimum of 4-6 weeks of treatment if a patient develops a clear sign of infection of Lyme disease in the form of an “Erythema Migrans” (EM) rash. The classic “bullseye" rash is only ONE type of an EM rash. The current Canadian standard of 10-14 days or sometimes – a “watch and wait” strategy can be dangerous as the best chance of cure comes with immediate treatment of appropriate duration for the stage of infection. Note: many infected people never see or develop a rash.
3. ILADS guidelines call for extended treatment until symptoms are gone.
On our website, there is a downloadable / printable summary of these ILADS guidelines, under the heading “symptoms and treatment” and there are some other one page handouts to be found here as well: https://www.lymehope.ca/resources.html
PS: the current 2006 IDSA guidelines are in the process of being updated and expected to be finalized this year. We hope these guidelines will incorporate all the relevant research since the last update, as well as include opposing views from practicing clinicians with Lyme patients and patient preference!
We thank you, as always, for your continued engagement and support.
Warmly,
Jennifer Kravis & Sue Faber
Co-founders
LymeHope
*Please continue to encourage other Canadians to sign, comment and share the ticking Lyme Petition: http://bit.ly/2lfBuNL
#LymeHope