Context. The use of serologic testing to diagnose Lyme
disease (LD) is a source of controversy. Expert recommendations
also discourage the routine use of antibiotic therapy for prophylaxis
of LD following tick bites, but the extent to which physicians
in endemic areas have adopted these recommendations is not known.
Objective. To assess the pattern of use of serologic
testing and antibiotic therapy for tick bites and LD and associated
charges for management in an endemic area.
Design. Active surveillance of patient-physician encounters
for tick bites and LD.
Setting. Primary care practices on the Eastern Shore
of Maryland.
Patients. Consecutive sample of 232 patients with tick
bites, LD (defined by physician diagnosis in medical record),
and suspected LD (physician notation of possible, but not definite
LD) seen in 1995.
Main Outcome Measures. Serologic testing for LD, test
results, antibiotic therapy, and direct costs of management.
Results. Surveillance identified 142 patients (61.2%)
with diagnoses of tick bites, 40 patients (17.2%) with LD, and
50 patients (21.6%) with suspected LD. Of the 142 patients seen
for tick bites, 95 (67%) underwent serologic testing for LD.
Of these, 93 patients had initial negative or equivocal results;
24 (26%) of the 93 had convalescent testing, with 1 seroconversion.
Seventy-eight patients (55%) with a diagnosis of tick bite received
antibiotic therapy. No patients with tick bite developed clinical
LD. Serologic testing for LD was performed for 36 patients (90%)
with a diagnosis of LD and 46 patients (92%) with suspected
LD. In most cases, antibiotics were prescribed before serologic
test results became available. Convalescent testing was not
performed for 37 (86%) of the 43 patients with suspected LD
who had initial negative or equivocal results. Of these 37 patients,
25 (68%) did not receive antibiotic therapy. Direct charges
for treatment of these 232 patients totaled $47595, one third
of which was attributable to serologic testing. A total of 32%
of direct charges were for patients with tick bites, 48% were
for patients with LD, and 20% were for patients with suspected
LD.
Conclusions. In this setting, most patients consulting
physicians for tick bites received prophylactic antibiotic therapy
of unproven efficacy and underwent unnecessary, costly serologic
testing. Despite almost universal use in this study, serologic
testing for LD did not appear to influence treatment of patients
diagnosed as having LD.
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