Learn more about diagnosing lyme disease

Different Perspectives

There are two polarized views of Lyme disease, both in terms of diagnostic criteria and treatment:

1. A narrowly defined, rigidly-interpreted point of view is held by some organizations such as the Infectious Disease Society of America (IDSA), the US Centers for Disease Control (CDC), and endorsed by the Association of Medical Microbiology and Infectious Disease Canada (AMMI)

2. A broader defined, less rigidly-interpreted point of view held by other organizations such as the International Lyme and Associated Disease Society (ILADS)


The IDSA Lyme disease Guidelines (which Canada follows) suggest that Lyme disease is hard to catch, easy to cure, and that short-term antibiotic use of a few weeks can cure most cases of Lyme disease. Those who hold this view don’t believe in the existence of a chronic form of Lyme disease. They maintain that a small number of patients may have lingering symptoms after short-term antibiotic use, and they refer to these symptoms as “Post-Lyme Syndrome.” It is their opinion that unresolved symptoms are not persistent infection by Borrelia burgdorferi. The IDSA recommends against long-term courses of antibiotics. The National Guidelines Clearinghouse–a federal database that provides treatment information to health care professionals and insurance companies–has removed the IDSA Lyme disease treatment guidelines from its website. This means that the only Lyme disease guidelines listed on the NGC are those of ILADS, which were posted in 2014. 

The ILADS Lyme disease Guidelines contest that chronic Lyme disease and persistent infection with Borrelia burgdorferi (even after treatment with antibiotics) are realities and in growing frequency are the norm rather than the exception. ILADS advises that treatment with long-term antibiotic therapy is often needed to manage chronic Lyme symptoms. ILADS supports their point of view by stating that peer-reviewed, scientific research published in reputable medical and scientific journals demonstrates that Lyme bacteria can survive after treatment with long-term antibiotics. Physicians from this prspective use varied combinations and repeated courses of antibiotics to treat Lyme disease. ILADS-trained physicians frequently report that patients with persistent infections of Lyme benefit from and have been helped to regain self-sufficiency by way of long-term antibiotic treatment.

Some may argue against the usage of long-term antibiotics stating that this may develop a resistance to bacteria. ILADS refutes this claim and contends that antibiotic resistance generally develops as a result of improper usage of the antibiotics and thus recommends patients take antibiotics as prescribed and until symptoms have resolved.

The ILADS position defends the long-term use of antibiotics by arguing that the consequences of untreated chronic Lyme disease far outweigh the consequences of long-term antibiotic use. They maintain that there has never been a published study demonstrating that 30 days of antibiotics will cure chronic Lyme disease.