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

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Date
2013-12
Authors
Lantos, Paul M
Brinkerhoff, R Jory
Wormser, Gary P
Clemen, Robert
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Abstract
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.
Type
Journal article
Subject
Animals
Anti-Bacterial Agents
Arachnid Vectors
Borrelia burgdorferi
Cost-Benefit Analysis
Decision Making
Decision Support Techniques
Erythema Chronicum Migrans
Geography
Humans
Ixodes
Ixodidae
Skin
United States
Permalink
https://hdl.handle.net/10161/13965
Published Version (Please cite this version)
10.1089/vbz.2013.1365
Publication Info
Lantos, Paul M; Brinkerhoff, R Jory; Wormser, Gary P; & Clemen, Robert (2013). Empiric antibiotic treatment of erythema migrans-like skin lesions as a function of geography: a clinical and cost effectiveness modeling study. Vector Borne Zoonotic Dis, 13(12). pp. 877-883. 10.1089/vbz.2013.1365. Retrieved from https://hdl.handle.net/10161/13965.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Clemen

Robert T. Clemen

Professor Emeritus
Robert T. Clemen is Professor of Decision Sciences at Duke University’s Fuqua School of Business. He has broad interests in the use of decision analysis for organizational decision making, and special interests in the psychology of judgment, assessing expert probabilities, the effectiveness of decision-making techniques, and using decision analysis to help organizations become environmentally sustainable. He has taught courses on decision making and environmental sustainability in Duke&rsq
Lantos

Paul Michael Lantos

Professor of Medicine
I am interested in the spatial epidemiology of infectious diseases. My research utilizes geographic information systems (GIS) and geostatistical analyses to understand the spatial and spatiotemporal distribution of diseases, and their relationship with environmental and demographic factors. I currently have active studies evaluating the spatial distribution of numerous domestic and international infectious diseases, including SARS-CoV-2 (COVID-19), cytomegalovirus, influenza, and Lyme disease. A
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