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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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.





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Lantos, Paul M, R Jory Brinkerhoff, Gary P Wormser and Robert Clemen (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.

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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. Additionally I am interested in maternal-child health, and I have a number of ongoing studies of neighborhood health disparities in obstetrical care and birth outcomes. I am interested in GIS education and have conducted workshops on public health GIS in Mongolia and China.


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’s daytime, Global Executive, Weekend Executive, and Cross continent MBA programs.

Professor Clemen has achieved notoriety as the author of the widely-used text, Making Hard Decisions. The first edition of this decision-analysis textbook, recognized as Best Publication in 1991 by the Decision Analysis Society, became the most widely used book of its kind almost overnight. Subsequent editions appeared in 1996, 2001, 2004, with another in preparation. Written at a level that is accessible for all students, this text represents a comprehensive overview of the field of decision analysis.

Professor Clemen’s consulting and executive teaching include work for corporations, utilities, and government agencies, and have covered such diverse areas as salmon farming, offshore oil leasing, avalanche prediction, nuclear waste storage, and environmental policy.

Aside from his teaching and consulting activities, Professor Clemen’s research, much of which has been funded by the National Science Foundation, has contributed in many ways to the disciplines of decision analysis and forecasting. He has published over 50 scholarly articles and reports, three of which have won awards (three from the Decision Analysis Society, 1990, 2005; and one from the International Journal of Forecasting, 1991). In addition, he has served as founding co-Editor-in-Chief of the journal Decision Analysis and currently serves on its editorial board.

Prior to coming to Duke in 1995, Professor Clemen served on the faculty of the Lundquist College of Business at the University of Oregon for 11 years. He holds a Ph.D. from Indiana University and resides in Durham, NC.

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