Empiric antibiotic treatment of erythema migrans-like skin lesions as a function of geography: a clinical and cost effectiveness modeling study.

Journal Article (Journal Article)

The skin lesion of early Lyme disease, erythema migrans (EM), is so characteristic that routine practice is to treat all such patients with antibiotics. Because other skin lesions may resemble EM, it is not known whether presumptive treatment of EM is appropriate in regions where Lyme disease is rare. We constructed a decision model to compare the cost and clinical effectiveness of three strategies for the management of EM: Treat All, Observe, and Serology as a function of the probability that an EM-like lesion is Lyme disease. Treat All was found to be the preferred strategy in regions that are endemic for Lyme disease. Where Lyme disease is rare, Observe is the preferred strategy, as presumptive treatment would be expected to produce excessive harm and increased costs. Where Lyme disease is rare, clinicians and public health officials should consider observing patients with EM-like lesions who lack travel to Lyme disease-endemic areas.

Full Text

Duke Authors

Cited Authors

  • Lantos, PM; Brinkerhoff, RJ; Wormser, GP; Clemen, R

Published Date

  • December 2013

Published In

Volume / Issue

  • 13 / 12

Start / End Page

  • 877 - 883

PubMed ID

  • 24107201

Pubmed Central ID

  • PMC3868279

Electronic International Standard Serial Number (EISSN)

  • 1557-7759

Digital Object Identifier (DOI)

  • 10.1089/vbz.2013.1365


  • eng

Conference Location

  • United States