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NICE publish quality standard on the diagnosis and management of Lyme disease

For Lyme disease

The National Institute for Health and Care Excellence (NICE) have published a quality standard on the diagnosis and management of Lyme disease.

The quality standard covers diagnosing and managing Lyme disease in people of all ages. It also includes raising public awareness about prevention. It describes high-quality care in priority areas for improvement.

Quality statements
  • Statement 1 People presenting with erythema migrans (a large, raised, red spot that appears at the site of the bite, usually on the thigh, buttock, or trunk or in the armpit) are diagnosed and treated for Lyme disease based on clinical assessment, without laboratory testing.
  • Statement 2 People with suspected Lyme disease without erythema migrans who have a negative enzyme-linked immunosorbent assay (ELISA) test carried out within 4 weeks of their symptoms starting have the test repeated 4 to 6 weeks later if Lyme disease is still suspected.
  • Statement 3 People with Lyme disease have initial antibiotic treatment, with the antibiotic, dosage and duration determined by their symptoms.
  • Statement 4 Local authorities organise health promotion activities in conjunction with organisations in their area to raise public awareness about how to prevent Lyme disease.
About Lyme disease
Lyme disease is a bacterial infection that can be spread to humans by infected ticks. It's usually easier to treat if it's diagnosed early.

Symptoms of Lyme disease
Many people with early symptoms of Lyme disease develop a circular red skin rash around a tick bite.

The rash can appear up to 3 months after being bitten by a tick and usually lasts for several weeks. Most rashes appear within the first 4 weeks.

Not everyone with Lyme disease gets the rash. Some people also have flu-like symptoms in the early stages, such as:
  • a high temperature, or feeling hot and shivery
  • headaches
  • muscle and joint pain
  • tiredness and loss of energy

NICE website
NHS website for Lyme disease
Contains public sector information licensed under the Open Government Licence v3.0.
Accessed 11/07/19
Links available in full article

© NICE [2019]

Lyme disease. Quality standard [QS186]. Published date: July 2019
Available from: See Link below. All rights reserved. Subject to Notice of rights
NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.

The information provided by NICE was accurate at the time this article was issued.

NICE quality standard for Lyme disease

Reporting of suspected adverse reactions

Reporting suspected adverse reactions (side effects) after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals or patients are asked to report any suspected adverse reactions via the Yellow Card Scheme at or search for MHRA Yellow Card in the Google Play or Apple App Store.

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