Lyme Disease Clinical Practice Guidelines (IDSA, AAN, ACR, 2021)

Infectious Diseases Society of America, American Academy of Neurology, American College of Rheumatology

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

April 02, 2021

Guidelines for preventing, diagnosing, and treating Lyme disease were published in February 2021 by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) in Neurology.[1]


Individuals at risk of exposure to ticks should implement personal protective measures, including using N,N-diethyl-meta-toluamide (DEET), picaridin, ethyl-3-(N-n-butyl-N-acetyl)aminopropionate (IR3535), oil of lemon eucalyptus (OLE), p-menthane-3,8-diol (PMD), 2-undecanone, or permethrin as repellants.

Ticks should be removed mechanically using a fine-tipped tweezer inserted between the tick body and the skin. Burning of attached ticks is not recommended.


The removed tick should be submitted for species identification.

Testing a removed Ixodes tick for Borrelia burgdorferi is not recommended.

Testing asymptomatic patients for exposure to B. burgdorferi following an Ixodes spp. tick bite is not recommended.


Prophylactic antibiotic therapy should be given only to adults and children within 72 hours of removal of an identified high-risk tick bite, but not for bites that are equivocal risk or low risk.

A single dose of oral doxycycline within 72 hours of tick removal should be administered for high-risk Ixodes spp. bites in all age groups.

Oral antibiotic therapy with doxycycline (10-day course), amoxicillin (14-day course), or cefuroxime axetil (14-day course) is recommended for patients with erythema migrans.

For more information, go to Lyme Disease.


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