National Institute for Health and Clinical Excellence (NICE)
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New advice will help doctors spot and treat Lyme disease early, says NICE

NICE has issued new advice to help doctors quickly spot Lyme disease, so they can offer people NHS treatment as soon as possible.

The guideline has advice for GPs and specialists on symptoms to look out for, tests to help confirm a diagnosis and what treatments to use. It also calls for more UK research into Lyme disease and the best long-term treatment options.

Saul Faust, Professor of paediatric immunology and infectious diseases at the University of Southampton and chair of the NICE guideline committee, said: “We want people to be diagnosed early so they get the right treatment as soon as possible.

“This new guideline gives more clarity on how clinicians can spot Lyme disease and provide early treatment. It guides through when to use tests and what antibiotics to prescribe according to symptoms.”

The guideline says doctors should use their clinical judgement to check people’s symptoms. Lyme disease can cause a circular red rash – medically referred to as erythema migrans – in the days or weeks after a tick bite. If this occurs, doctors can diagnose Lyme disease immediately and give the person antibiotics.

Lyme disease symptoms are common with those of other conditions and so NICE says lab tests can be useful to help confirm a diagnosis. Typical symptoms can include combinations of headache, fever, joint pain or fatigue as well as others that are more specific such as problems with nerves or joints.

To address uncertainty in the evidence, NICE recommends using a combination of tests alongside the clinician’s judgement. The tests, called ELISA and immunoblot, look for antibodies created by the body’s immune system to fight infection.

Not everyone with Lyme disease will have a positive test, clinicians that strongly suspect someone has Lyme disease should start them on antibiotic treatment while waiting for test results.

Professor Mark Baker, director of the NICE centre for guidelines, said: “This new guideline will help raise awareness and drive up the standard of care right now on the NHS so we can spot Lyme disease sooner and provide people with prompt treatment. Our committee reviewed the best available evidence and identified gaps in what we know about prevalence in this country and the benefit of long-term treatment options. Further research into Lyme disease should be a high-priority area in the UK so we can continue to improve care.”

People who have had initial treatment for Lyme disease sometimes continue to experience symptoms. NICE says a secondcourse of antibiotics may be considered if there is a chance the first treatment did not clear the infection.

The evidence on the benefit of prolonged antibiotic treatment was limited. If unexplained symptoms persist, NICE says clinicians should seek a second opinion from a specialist.

The guideline highlights that persistent symptoms can affect people’s ability to continue with day-to-day life. It says clinicians should inform family, employers or schools that the person may need time to gradually return to usual activities.

Lyme disease spreads to humans through an infected tick bite. Ticks are mainly found in grassy and wooded areas, including gardens and parks, but only a small number carry the bacteria that causes Lyme disease.

Women who had Lyme disease during their pregnancy are encouraged to highlight this to their doctor if they have any concerns about their baby. If this happens, their doctor should discuss the details with a child health specialist. 

NICE regularly reviews its guidelines for new evidence that may affect recommendations.


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