€ TITLE:
Prevention of Lyme disease after tick bites. A cost-effectiveness analysis [see comments]
AUTHORS:
Magid D; Schwartz B; Craft J; Schwartz JS
AUTHOR AFFILIATION:
Emergency Medical Services, Denver General Hospital.
SOURCE:
N Engl J Med 1992 Aug 20;327(8):534-41
COMMENT:
Comment in: N Engl J Med 1992 Aug 20;327(8):562-3
Comment in: N Engl J Med 1993 Jan 14;328(2):136; discussion 138-9
Comment in: N Engl J Med 1993 Jan 14;328(2):136-7; discussion 138-9
Comment in: N Engl J Med 1993 Jan 14;328(2):137; discussion 138-9
Comment in: N Engl J Med 1993 Jan 14;328(2):137-8; discussion 138-9
Comment in: N Engl J Med 1993 Jan 14;328(2):138; discussion 138-9
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."

€ TITLE:
Ticks parasitizing humans in a Lyme disease endemic area of southern New York State.
AUTHORS:
Falco RC; Fish D
AUTHOR AFFILIATION:
Bureau of Disease Control, Westchester County Department of Health, White Plains, NY.
SOURCE:
Am J Epidemiol 1988 Nov;128(5):1146-52
"A total of 126 tick specimens were submitted by tick bite victims to the Westchester County Department of Health, White Plains, New York, and to the New York Medical College, Medical Entomology Laboratory, Armonk, New York, during 1985. ...Prophylactic antibiotic treatment was prescribed by a physician for 40.8% of I. dammini victims, compared with 4.5% of the D. variabilis victims. Lyme disease was reported by two patients during the course of the study. Neither had received prophylactic therapy at the time of the reported tick bite."

Nonsupportive of antibiotic prophylaxis after tick bite:

€ TITLE:
Chemoprophylaxis for Lyme borreliosis? [In Process Citation]
AUTHORS:
Stanek G; Kahl O
AUTHOR AFFILIATION:
Hygiene Institute, University of Vienna, Austria. gerold.stanek@uni-vie.ac.at
SOURCE: Zentralbl Bakteriol 1999 Dec;289(5-7):655-65
"Chemoprophylaxis is a term which describes treatment with an antimicrobial chemotherapeutic before, during or shortly after an actual or suspected exposure to an infectious agent in order to prevent clinical disease, which may be severe or even fatal. ...We conclude that only a reliable diagnosis of symptoms is the basis for a rational antibiotic treatment, and that instead of chemoprophylaxis for Lyme borreliosis after a vector tick-bite the wait and watch policy is recommended."

€ TITLE:
Tick bites and Lyme disease in an endemic setting: problematic use of serologic testing and prophylactic antibiotic therapy [see comments]
AUTHORS:
Fix AD; Strickland GT; Grant J
AUTHOR AFFILIATION:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore 21201, USA. afix@epin.ab.umd.edu
SOURCE:
JAMA 1998 Jan 21;279(3):206-10
COMMENT:
Comment in: JAMA 1998 Jan 21;279(3):239-40
Comment in: JAMA 1998 Sep 23-30;280(12):1049; discussion 1051
Comment in: JAMA 1998 Sep 23-30;280(12):1049-50; discussion 1051
Comment in: JAMA 1998 Sep 23-30;280(12):1050; discussion 1051
"CONCLUSIONS: In this setting, most patients consulting physicians for tick bites received prophylactic antibiotic therapy of unproven efficacy and underwent unnecessary, costly serologic testing."

€ TITLE:
Willy Burgdorfer: Lyme disease.
AUTHORS:
Sternbach G; Dibble CL
AUTHOR AFFILIATION:
Emergency Medicine Service, Stanford University Medical Center, CA 94305, USA.
SOURCE:
J Emerg Med 1996 Sep-Oct;14(5):631-4
"With respect to antibiotic prophylaxis, the few studies performed have led to the conclusion that, even in endemic areas, the risk of infection is so low that routinely instituting treatment following a tick bite is not warranted."

€ TITLE:
The public health impact of Lyme disease in Maryland.
AUTHORS:
Coyle BS; Strickland GT; Liang YY; Pena C; McCarter R; Israel E
AUTHOR AFFILIATION:
Dept. of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore 21201, USA.
SOURCE:
J Infect Dis 1996 May;173(5):1260-2
"In addition, the much greater numbers of patients treated for presumptive LD, seen and given prophylaxis for tick bites, and having diagnostic tests indicate that real and perceived LD is a far greater public health problem and uses more medical resources than official surveillance data suggest."

€ TITLE:
[Lyme disease]
VERNACULAR TITLE:
La maladie de Lyme.
AUTHORS:
Belaich S
AUTHOR AFFILIATION:
Service de Dermatologie, Groupe Hospitalier Bichat-Claude Bernard, Paris.
SOURCE:
Presse Med 1995 Jan 14;24(2):81-7
"Antibiotic prophylaxis is not necessary but rapid extraction of the tick after the bite can prevent the disease as transmission from tick to man takes several hours."

€ TITLE:
Antibiotic prophylaxis: update on common clinical uses.
AUTHORS:
Weitekamp MR; Caputo GM
AUTHOR AFFILIATION:
Division of General Internal Medicine, Pennsylvania State University College of Medicine, Hershey.
SOURCE:
Am Fam Physician 1993 Sep 15;48(4):597-604
"Most patients with tick bites do not need antibiotics for the prevention of Lyme disease."

€ TITLE:
The value of early treatment of deer tick bites for the prevention of Lyme disease [see comments]
AUTHORS:
Agre F; Schwartz R
AUTHOR AFFILIATION:
Department of Pediatrics, College of Physicians & Surgeons, Columbia University, Columbia-Presbyterian Medical Center, New York, NY.
SOURCE:
Am J Dis Child 1993 Sep;147(9):945-7
COMMENT:
Comment in: Arch Pediatr Adolesc Med 1994 Nov;148(11):1229-30
"CONCLUSION--Based on the low frequency of illness, the absence of stage II disease, and the inability to establish the efficacy of early antibiotic treatment, we suggest that physicians not routinely use prophylactic antibiotics for deer tick bites."

€ TITLE:
A controlled trial of antimicrobial prophylaxis for Lyme disease after deer-tick bites [see comments]
AUTHORS:
Shapiro ED; Gerber MA; Holabird NB; Berg AT; Feder HM Jr; Bell GL; Rys PN; Persing DH
AUTHOR AFFILIATION:
Department of Pediatrics, Yale University School of Medicine, New Haven, Conn. 06510-8064.
SOURCE:
N Engl J Med 1992 Dec 17;327(25):1769-73
COMMENT:
Comment in: N Engl J Med 1993 May 13;328(19):1418; discussion 1420
Comment in: N Engl J Med 1993 May 13;328(19):1418-9; discussion 1420
Comment in: N Engl J Med 1993 May 13;328(19):1419; discussion 1420
Comment in: N Engl J Med 1993 May 13;328(19):1419-20
"CONCLUSIONS. Even in an area in which Lyme disease is endemic, the risk of infection with B. burgdorferi after a recognized deer-tick bite is so low that prophylactic antimicrobial treatment is not routinely indicated."

€ TITLE:
[Borrelia infections from a dermatological viewpoint]
AUTHORS:
Vocks E; Engst R; Borelli S
AUTHOR AFFILIATION:
Dermatologische Klinik und Poliklinik Technischen Universitat Munchen.
SOURCE:
Monatsschr Kinderheilkd 1991 Jul;139(7):425-8
"Prophylactic antibiotic therapy for tick bites is not recommended."

Unspecified or uncertain support of antibiotic prophylaxis after tick bite:

€ TITLE:
Too much tick bite testing and treatment.
SOURCE:
Health News 1998 Feb 17;4(2):5
"[No abstract, no authors, no antibiotics?]"

€ TITLE:
Expert advice and patient expectations: laboratory testing and antibiotics for Lyme disease [editorial; comment] [see comments]
AUTHORS:
Barbour AG
SOURCE:
JAMA 1998 Jan 21;279(3):239-40
COMMENT:
Comment on: JAMA 1998 Jan 21;279(3):206-10
Comment in: JAMA 1998 Sep 23-30;280(12):1049; discussion 1051
Comment in: JAMA 1998 Sep 23-30;280(12):1050-1
"[No abstract available.]"

€ TITLE:
Antibiotic prophylaxis after tick bites.
AUTHORS:
Dennis DT; Meltzer MI
AUTHORAFFILIATION:
National Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA.
SOURCE:
Lancet 1997 Oct 25;350(9086):1191-2
"[No abstract available.]"

€ TITLE:
Efficacy of antibiotic prophylaxis for prevention of Lyme disease.
AUTHORS:
Warshafsky S; Nowakowski J; Nadelman RB; Kamer RS; Peterson SJ; Wormser GP
AUTHOR AFFILIATION:
Department of Medicine, New York Medical College, Valhalia 10595, USA.
SOURCE:
J Gen Intern Med 1996 Jun;11(6):329-33
"OBJECTIVE: To determine if antibiotic prophylaxis following a dear tick bite is effective in reducing the risk of developing Lyme disease. ...CONCLUSIONS: The available evidence to date suggests that the routine use of antibiotic prophylaxis for the prevention of Lyme disease remains uncertain. Meta-analysis of the controlled trials failed to establish definitive treatment efficacy owing to the small sample size of the combined trials and the low rates of infection following a deer tick bite. A larger randomized trial is needed to demonstrate definitively that prophylaxis is more effective than placebo in reducing the risk of early Lyme disease in endemic areas."

€ TITLE:
[The role of ticks in the epidemiology of Lyme borreliosis]
AUTHORS:
Wegner Z; Stanczak J
AUTHOR AFFILIATION:
Zaklad Parazytologii Tropikalnej Instytutu Medycyny Morskiej i Tropikalnej w Gdyni.
SOURCE:
Przegl Epidemiol 1995;49(3):245-50
"The modes of transmission of borreliae (by salivation, regurgitation, defecation) by ticks to their animal hosts and men as well as prophylactic measures against tick-bites are also discussed."

€ TITLE:
Treatment of deer tick bites: still an unanswered question [comment]
AUTHORS:
Lopez-Andrew JA; Sala-Lizarraga JV; Ferris-Tortajada J; Salcedo J; Canosa CA
AUTHORAFFILIATION:
Department of Pediatrics, Hospital Infantil "La Fe", Valencia, Spain.
SOURCE:
Arch Pediatr Adolesc Med 1994 Nov;148(11):1229-30
COMMENT:
Comment on: Am J Dis Child 1993 Sep;147(9):945-7
"[No abstract available.]"

€ TITLE:
Antibiotic prophylaxis of Lyme disease following recognized tick bite. Bacterial Zoonoses Branch, Division of Vector-Borne Infectious Diseases National Center for Infectious Diseases, Centers for Disease Control.
SOURCE:
Conn Med 1991 Dec;55(12):691-3
"[No authors, no abstract, no antibiotics?]"

€ TITLE:
Lyme disease and antibiotic prophylaxis.
AUTHORS:
Fabrizio T
SOURCE:
Conn Med 1989 Jun;53(6):376
"[No abstract available.]"

Miscellaneous unspecified support of antibiotic prophylaxis after tick bite:

€ TITLE:
[Leisure-time the "best" time for tick bites. No causal FSME-therapy-- Lyme borreliosis most of the time diagnosed too late]
AUTHORS:
Knauer RH
SOURCE:
Fortschr Med 1999 May 10;117(13):16-7
"[No abstract available.]"

€ TITLE:
[Prevention of early summer meningoencephalitis and Lyme borreliosis before and after tick bites]
AUTHORS:
Kaiser R
AUTHOR AFFILIATION:
Neurologische Universitatsklinik und Poliklinik - Neurozentrum, Albert- Ludwigs-Universitat Freiburg. kaiser@we11.nkl.univ-freiburg.de
SOURCE:
Dtsch Med Wochenschr 1998 Jul 3;123(27):847-53
"[No abstract available.]"

€ TITLE:
Can Lyme borreliosis be prevented after tick bite? [letter; comment]
AUTHORS:
Nadelman RD; Nowakowski J; Wormser GP
SOURCE:
Lancet 1993 Oct 23;342(8878):1052
COMMENT:
Comment on: Lancet 1993 Aug 28;342(8870):529-30
"[No abstract available.]"

€ TITLE:
Risk of infection from and treatment of tick bite [see comments]
AUTHORS:
Matuschka FR; Spielman A
AUTHORAFFILIATION:
Institut fur Pathologie, Universitatsklinikum Rudolf Virchow, Freie Universitat Berlin, Germany.
SOURCE:
Lancet 1993 Aug 28;342(8870):529-30
COMMENT:
Comment in: Lancet 1993 Oct 23;342(8878):1052
"[No abstract available.]"

€ TITLE:
Prevention of Lyme disease after tick bites [letter; comment]
AUTHORS:
Salzman MB; Rubin LG; Sood SK
SOURCE:
N Engl J Med 1993 Jan 14;328(2):137; discussion 138-9
COMMENT:
Comment on: N Engl J Med 1992 Aug 20;327(8):534-41
"[No abstract available.]"

€ TITLE:
Prevention of Lyme disease after tick bites [letter; comment]
AUTHORS:
Nadelman RB; Sivak S; Wormser GP
SOURCE:
N Engl J Med 1993 Jan 14;328(2):137; discussion 138-9
COMMENT: Comment on: N Engl J Med 1992 Aug 20;327(8):534-41
"[No abstract available.]"

€ TITLE:
Prevention of Lyme disease after tick bites [letter; comment]
AUTHORS:
Nachman SA
SOURCE:
N Engl J Med 1993 Jan 14;328(2):137; discussion 138-9
COMMENT:
Comment on: N Engl J Med 1992 Aug 20;327(8):534-41
"[No abstract available.]"

€ TITLE:
Prevention of Lyme disease after tick bites [letter; comment]
AUTHORS:
Aronowitz R
SOURCE:
N Engl J Med 1993 Jan 14;328(2):136; discussion 138-9
COMMENT:
Comment on: N Engl J Med 1992 Aug 20;327(8):534-41
"[No abstract available.]"

€ TITLE:
A prospective study of tick bites in an endemic area for Lyme disease.
AUTHORS:
Costello CM; Steere AC; Pinkerton RE; Feder HM Jr
AUTHOR AFFILIATION:
Middlesex Memorial Hospital, Middletown, Farmington, Connecticut.
SOURCE:
J Infect Dis 1989 Jan;159(1):136-9
"[No abstract available.]"

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For more information about Lyme disease, see: Lots Of Links On Lyme Disease

Comments or questions concerning this page should be directed to Art Doherty.

Last updated on 18 September 1999 by
Art Doherty
Lompoc, California
doherty@utech.net

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