Two professional bodies publish Lyme guidelines: the Infectious Diseases Society of America, with the American Academy of Neurology and the American College of Rheumatology (2020), and the International Lyme and Associated Diseases Society (2014). The 2020 document covers prevention, and the diagnosis and treatment of the early rash, of neurologic, cardiac and rheumatologic Lyme disease, of Eurasian manifestations, and of coinfection. The 2014 ILADS document answers three clinical questions: antibiotic prophylaxis after a known tick bite, treating the erythema migrans rash, and retreating persistent manifestations. Where only one document speaks, the other’s silence is not agreement. What each recommends is in the documents; this page links both and does not restate either.
Two bodies wrote two documents, for different questions and at different times. This page takes no position on which is right and recommends no treatment. It also declines to explain a mechanism, because explaining one would put this page inside an argument it exists not to adjudicate.
The two documents
Both are shown at the same size, in the same type and the same colour. Each citation is the document’s full record; the scope is what its own abstract says it covers.
IDSA / AAN / ACR · 2020
Infectious Diseases Society of America, American Academy of Neurology, American College of Rheumatology
Covers: Prevention of Lyme disease, and the diagnosis and treatment of Lyme disease presenting as erythema migrans, Lyme disease complicated by neurologic, cardiac and rheumatologic manifestations, Eurasian manifestations of Lyme disease, and Lyme disease complicated by coinfection with other tick-borne pathogens.
Lantos PM, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clin Infect Dis. 2021;72(1):e1–e48
ILADS · 2014
International Lyme and Associated Diseases Society
Covers: Three clinical questions: the usefulness of antibiotic prophylaxis for known tick bites, the effectiveness of treatment for the erythema migrans rash, and the role of antibiotic retreatment in patients with persistent manifestations of Lyme disease.
Cameron DJ, Johnson LB, Maloney EL. Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Rev Anti Infect Ther. 2014;12(9):1103–1135
Citations read 18 October 2026.
The rule this page keeps
What causes symptoms to persist after treatment, and whether more treatment changes them, is not settled here. This page states no view on mechanism. Nor does it say where the two documents agree or disagree on a recommendation: that comparison is in the documents themselves.
- “Which guideline are you working from — and where, for me, do you depart from it?”
- “Does that guideline address my situation, or is it outside what it covers?”
- “What would change your mind about my treatment, in either direction?”
Review statePending clinical review
The scope each guideline states for itself, as its published abstract gives it (read on 18 October 2026). Nothing on the page restates what either document recommends: the comparison that did was withheld on 18 October 2026 until it can be checked against the documents. A clinically-informed reviewer has not yet signed this off, and it stays marked until one does.