Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Lyme disease - Management
How should I manage a person with suspected Lyme disease?

  • For people with erythema migrans and a history of a tick bite or possible exposure to ticks, who have no evidence of neurological, cardiac, or joint involvement:
    • Treat with an oral antibiotic.
    • Laboratory confirmation of infection is not necessary.
  • If the person has a rash that is thought to be erythema migrans but there is no history of a tick bite or possible exposure to ticks:
    • Seek immediate specialist advice or refer for immediate specialist assessment (by a dermatologist or infectious diseases specialist) to determine if testing for Lyme disease is needed and if an oral antibiotic should be prescribed (antibodies to Borrelia burgdorferi may not be detectable if the sample was taken within 4 weeks of the onset of symptoms).
  • If the person has flu-like symptoms and no other features of Lyme disease, but has a recent history of a tick bite or possible exposure to ticks:
    • Seek immediate specialist advice (from an infectious diseases specialist).
  • For people with isolated unilateral facial palsy (as seen with Bell's palsy) who have a history of a tick bite or possible exposure to ticks, or have had erythema migrans within the last few months:
    • Test for antibodies to Borrelia burgdorferi.
    • Seek specialist advice (from an infectious diseases specialist) regarding treatment if either the test is positive; or the test is negative but the tick bite or possible exposure was in the previous 4 weeks.
      • Treatment is usually with an oral antibiotic, as used to treat erythema migrans.
    • While waiting for the test result, corticosteroids can be used if indicated for Bell's palsy (see the CKS topic on Bell's palsy).
  • For people with any other neurological involvement, or with cardiac involvement or arthritis:
    • Refer for immediate specialist assessment, or admit if the symptoms are severe (for example, fainting, breathlessness, or chest pain).
  • For people with suspected acrodermatitis chronica atrophicans or Borrelia lymphocytoma:
    • Refer to a dermatologist.
  • For people with any other persistent symptoms:
    • Refer to an infectious diseases specialist.

© NHS Institute for Innovation and Improvement