Treatment for Lyme Disease
DESCRIPTION
Lyme disease is a multisystem inflammatory disease caused by the spirochete Borrelia (B.) burgdorferi and transmitted by the bite of an infected tick. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, infection can spread to the joints, heart, and nervous system. Lyme disease is diagnosed based on symptoms, physical findings (e.g., rash), and the possibility of exposure to infected ticks. Laboratory testing can be helpful if used correctly and performed using validated methods.
While most manifestations of Lyme disease can be adequately treated with oral antibiotics, intravenous antibiotics are indicated in some individuals with neurologic involvement or atrioventricular heart block. Typical intravenous therapy consists of a 2- to 4-week course of ceftriaxone or penicillin.
Over-diagnosis and over-treatment of Lyme disease is common due to its nonspecific symptoms, a lack of standardization of serologic tests, and difficulties in interpreting serologic test results. Individuals with chronic fatigue syndrome or fibromyalgia are commonly misdiagnosed as possibly having Lyme disease.
The terms post-Lyme disease, late Lyme disease, post-treatment chronic Lyme disease, and chronic Lyme disease are intended to describe individuals who have had well-documented Lyme disease, have been treated with antibiotic therapy, and who have continued to be symptomatic. Following antibiotic treatment, some symptoms may persist, such as in Lyme arthritis. These symptoms may be related to various self-sustaining inflammatory mechanisms rather than persistent infection. There is no credible evidence to support the existence of continued or chronic infection of the spirochete B. burgdorferi organism itself.
This medical policy does not apply to BlueCare. Please refer to the BlueCare policy.
POLICY
Treatment for the following conditions is considered medically necessary:
Lyme disease
Neuroborreliosis
Lyme carditis
Lyme arthritis
Repeat or prolonged courses of antibiotic therapy greater than 4 weeks are considered investigational.
IMPORTANT REMINDERS
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Does not apply to BlueCare, please refer to the BlueCare policy.
ADDITIONAL INFORMATION
No evidence was found to support the safety or efficacy of repeated or prolonged antibiotic treatment (greater than 4 weeks). Fibromyalgia and chronic fatigue syndrome may be confused with Lyme disease and neither has been shown to be responsive to antibiotic therapy.
No data were found in the published literature to show that repetition of PCR-based direct detection of B. burgdorferi in urine samples, evaluation of the genotype or phenotype of B. burgdorferi, or the B lymphocyte chemoattractant CXCL13 are effective in improving diagnosis, individual management, or outcomes.
SOURCES
BlueCross BlueShield Association. Evidence Positioning System. (11:2023). Intravenous antibiotic therapy and associated diagnostic testing for Lyme disease (5.01.08). Retrieved February 9, 2024 from http://www.evidencepositioningsystem.com. (29 articles and/or guidelines reviewed)
Centers for Disease Control and Prevention. (2024, January). Lyme disease: Chronic symptoms and lyme disease. Retrieved February 9, 2024 from http://www.cdc.gov.
Infectious Diseases Society of America, American Academy of Neurology, and American College of Rheumatology. (2021, February). Guidelines for the prevention, diagnosis, and treatment of lyme disease. Retrieved June 10, 2022 from https://n.neurology.org/content/neurology/96/6/262.full.pdf.
International Lyme and Associated Diseases Society. (2014). Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Retrieved October 2, 2019 from https://www.ilads.org/patient-care/ilads-treatment-guidelines/.
National Institute of Health and Care Excellence. (2018, April). Lyme disease. Retrieved August 14, 2020 from www.nice.org/uk.
National Institute of Health. National Institute of Allergy and Infectious Diseases. (2018, November). Lyme disease antibiotic treatment research. Retrieved November 9, 2019 from www.niaid.nih.gov.
Yang, J., Han, X., Liu, A., Bao, F., Peng, Y., Tao, L., et al. (2017). Chemokine CXC ligand 13 in cerebrospinal fluid can be used as an early diagnostic biomarker for lyme neuroborreliosis: a meta-analysis. Journal of Interferon & Cytokine Research, 37 (10), 433-439. Abstract retrieved October 16, 2017 from PubMed database.
ORIGINAL EFFECTIVE DATE: 5/9/2009
MOST RECENT REVIEW DATE: 4/11/2024
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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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