NICE publishes ‘Quality Standard’ for Lyme disease

erythema migrans image

9 August 2019

Dr Anne Cruikshank, RCGP Clinical Champion for Lyme disease

Lyme disease is a bacterial infection caused by the spirochaete Borrelia burgdorferi and transmitted via the bite of an infected tick. Whilst early recognition and treatment lead to resolution of the illness for many patients, late or missed diagnosis may result in persistent, debilitating symptoms.

As the incidence of ticks and Lyme disease continues to increase throughout the UK, primary care clinicians are urged to take note of the recently published NICE Quality Standard for Lyme disease (QS186). The primary aim of the quality standard is to achieve measurable quality improvement in four high-priority areas, thereby improving patient outcomes.

The NICE guideline (NG95) on Lyme disease highlighted the need to increase awareness amongst both the medical profession and the general population. The RCGP Lyme disease Spotlight Project was launched in 2018 with the aim of meeting these recommendations via a series of GP educational workshops and the development of the RCGP Lyme Disease Toolkit.

The NICE Quality Standard for Lyme disease has endorsed both the RCGP Lyme Disease Toolkit and the RCGP and LDA Lyme disease e-learning module as recommended resources for education, training and quality improvement. Both resources are freely accessible to all clinical staff.

NICE Quality Standard 

The NICE Quality Standard includes four Quality Statements:

  • Statement 1: People presenting with erythema migrans (EM) 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 four weeks of their symptoms starting have the test repeated four to six weeks later if Lyme disease is still suspected. visual summary
  • 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 with organisations in their area to raise public awareness about how to prevent Lyme disease.

Implementation of these Quality Statements will hopefully lead to measurable ongoing improvement in the management of Lyme disease within primary care. However, these statements should not be taken in isolation and clinicians should also take note of the following:

  1. An EM rash is often atypical, can be difficult to diagnose and may be absent in one third of cases.
  2. The diagnostic process is summarised in NICE's visual summary of the recommendations for testing for Lyme disease and includes the following advice:
    1. consider starting treatment with antibiotics while waiting for the results if there is a high clinical suspicion.
    2. a negative test does not exclude the diagnosis.
  1. Recommendations on antibiotic treatment are contained within the NICE guideline. Be aware that the guideline committee has noted the poor-quality evidence available on both diagnosis and treatment.
  2. GP Practices are well placed to support local authorities in raising public awareness of ticks and Lyme disease. Educational resources are accessible via the RCGP Lyme disease Toolkit and PHE Lyme Awareness Toolkit.

Develop a Lyme-aware practice

As the incidence of tick bites increases over the summer months, GP should anticipate an increased likelihood of Lyme disease presentations well into the autumn.  Development of a Lyme-aware practice team, utilising the resources listed above, will ensure consistent advice and improved diagnostic skills, thereby increasing the likelihood of patients receiving early and effective treatment of this potentially devastating disease.

 Additional information:

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