FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 327:534-541 August 20, 1992 Number 8 Next

	Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

Abstract

BACKGROUND. In areas of endemic disease, the probability of Lyme disease after a tick bite ranges from about 0.012 to 0.05. Early treatment with oral antibiotics prevents most complications of Lyme disease, but antibiotics are generally not prescribed until rash or other symptoms develop. METHODS. We used decision analysis to evaluate the outcomes, costs, and cost effectiveness of three alternative strategies to treat patients bitten by ixodes ticks in areas of endemic Lyme disease: empirically treat all patients with two weeks of doxycycline, treat only patients in whom erythema migrans develops, and treat only patients with erythema migrans or a positive serologic test for Lyme disease one month after exposure. RESULTS. Empirical treatment is the least expensive strategy and results in the fewest cases of Lyme disease and the fewest complications when the probability of Borrelia burgdorferi infection after a tick bite is 0.036 or higher. For probabilities of infection below 0.036, empirical therapy prevents most major complications, sequelae, and adverse events, but it incurs additional minor complications, especially as the probability of infection falls below 0.01. CONCLUSIONS. Empirical treatment of patients with tick bites is indicated when the probability of B. burgdorferi infection after a bite is 0.036 or higher, and this treatment may be preferred when the probability of infection ranges from 0.01 to 0.035. When the probability of infection after a tick bite is less than 0.01, empirical therapy is not warranted.

Source Information

Emergency Medical Services, Denver General Hospital.

This article has been cited by other articles:

• Pontrelli, L., Dattwyler, R., Nachman, S., Levy, P. D., Kirrane, B. M., Hexdall, A. H., Leenders, A.C.A.P., Bellovin, S. M., Nadelman, R. B., Wormser, G. P., Shapiro, E. D. (2001). Single-Dose Doxycycline for the Prevention of Lyme Disease. NEJM 345: 1348-1350 [Full Text]  
• Nuesch, R., Schroeder, K., Dieterle, T., Martina, B., Battegay, E. (2001). Relation between insufficient response to antihypertensive treatment and poor compliance with treatment: a prospective case-control study. BMJ 323: 142-146 [Abstract] [Full Text]  
• Nadelman, R. B., Nowakowski, J., Fish, D., Falco, R. C., Freeman, K., McKenna, D., Welch, P., Marcus, R., Aguero-Rosenfeld, M. E., Dennis, D. T., Wormser, G. P., the Tick Bite Study Group, (2001). Prophylaxis with Single-Dose Doxycycline for the Prevention of Lyme Disease after an Ixodes scapularis Tick Bite. NEJM 345: 79-84 [Abstract] [Full Text]  
• Shapiro, E. D. (2001). Doxycycline for Tick Bites -- Not for Everyone. NEJM 345: 133-134 [Full Text]  
• Shadick, N. A., Liang, M. H., Phillips, C. B., Fossel, K., Kuntz, K. M. (2001). The Cost-effectiveness of Vaccination Against Lyme Disease. Arch Intern Med 161: 554-561 [Abstract] [Full Text]  
• Committee on Infectious Diseases, (2000). Prevention of Lyme Disease. Pediatrics 105: 142-147 [Abstract] [Full Text]  
• Elston, D. M., Edlow, J. A., Horowitz, H., Kilchevsky, E. (1998). Perinatal Transmission of Human Granulocytic Ehrlichiosis. NEJM 339: 1941-1943 [Full Text]  
• Hayes, E. B., Dennis, D. T., Luger, S., Anderson, J. R., Steere, A. C., Parenti, D. L., Krause, D. S., Sigal, L. H., Zahradnik, J., Weinstein, A. (1998). Immunization against Lyme Disease. NEJM 339: 1637-1639 [Full Text]  
• Fix, A. D., Strickland, G. T., Grant, J. (1998). Tick Bites and Lyme Disease in an Endemic Setting: Problematic Use of Serologic Testing and Prophylactic Antibiotic Therapy. JAMA 279: 206-210 [Abstract] [Full Text]  
• Barbour, A. G. (1998). Expert Advice and Patient Expectations: Laboratory Testing and Antibiotics for Lyme Disease. JAMA 279: 239-240 [Full Text]  
• Dattwyler, R. J., Luft, B. J., Kunkel, M. J., Finkel, M. F., Wormser, G. P., Rush, T. J., Grunwaldt, E., Agger, W. A., Franklin, M., Oswald, D., Cockey, L., Maladorno, D. (1997). Ceftriaxone Compared with Doxycycline for the Treatment of Acute Disseminated Lyme Disease. NEJM 337: 289-295 [Abstract] [Full Text]  
• Malleson, P N (1997). Management of childhood arthritis. Part 1: acute arthritis. Arch. Dis. Child. 76: 460-462 [Full Text]  
• Lopez-Andreu, J. A., Sala-Lizarraga, J. V., Ferris-Tortajada, J., Salcedo, J., Canosa, C. A. (1994). Treatment of Deer Tick Bites: Still an Unanswered Question. Arch Pediatr Adolesc Med 148: 1229-1230 [Abstract]  
• Eppes, S. C., Klein, J. D., Caputo, G. M., Rose, C. D. (1994). Physician Beliefs, Attitudes, and Approaches Toward Lyme Disease in an Endemic Area. CLIN PEDIATR 33: 130-134 [Abstract]  
• Ley, C., Le, C., Olshen, E. M., Reingold, A. L. (1994). The Use of Serologic Tests for Lyme Disease in a Prepaid Health Plan in California. JAMA 271: 460-463 [Abstract]  
• Spach, D. H., Liles, W. C., Campbell, G. L., Quick, R. E., Anderson, D. E., Fritsche, T. R. (1993). Tick-Borne Diseases in the United States. NEJM 329: 936-947 [Full Text]  
• Genter, J., Berman, N. G., Madison, R. E., Drachman, D. A., Magid, D., Schwartz, B. S., Craft, J., Schwartz, J. S., Liegner, K. B., Shapiro, E. D., Berg, A. T., Gerber, M. A., Feder, H. M. (1993). Antimicrobial Prophylaxis after Tick Bites. NEJM 328: 1418-1420 [Full Text]  
• Aronowitz, R., Liegner, K. B., Salzman, M. B., Rubin, L. G., Sood, S. K., Nadelman, R. B., Sivak, S., Wormser, G. P., Nachman, S. A., McKiernan, F. E., Melski, J. W., Volkman, D. J., Kaell, A. T., Bosler, E. M., Benach, J. L., Magid, D., Schwartz, B., Craft, J., Schwartz, J. S. (1993). Prevention of Lyme Disease after Tick Bites. NEJM 328: 136-139 [Full Text]