Scenario 1: A patient with EM and no laboratory testing performed to date | • Yes, treat with an antibiotic at this time* | 670 (58.3) | 154 (54.8) |
• No antibiotic at this time; reassure and educate the patient, with no further follow-up | 2 (0.2) | 0 (0.0) |
• No antibiotic at this time; no treatment or testing now, but see the patient for follow-up | 24 (2.1) | 12 (4.3) |
• No antibiotic at this time; test patient for LD | 414 (36.0) | 99 (35.2) |
• No antibiotic at this time; refer patient to a specialist | 39 (3.4) | 16 (5.7) |
Scenario 2: A patient with a known tick bite, no symptoms, no laboratory testing performed to date, and normal examination findings | • Yes, treat with an antibiotic at this time | 86 (7.5) | 10 (3.5) |
• No antibiotic at this time; reassure and educate the patient, with follow-up as needed* | 592 (51.3) | 177 (61.2) |
• No antibiotic at this time; test patient for LD | 464 (40.2) | 91 (31.5) |
• No antibiotic at this time; refer patient to a specialist | 11 (1.0) | 11 (3.8) |
Scenario 3: A patient with recurrent, asymmetric arthritis that began 3 months previously, involving large, weight-bearing joints. The patient has no history of EM, and has had multiple negative Western blot test results for LD over the past 3 months. It is unknown if the patient has ever been bitten by a tick, but the patient spends a lot of time outdoors. No cause for the patient’s arthritis was found on initial workup | • Yes, treat with an antibiotic at this time | 123 (11.1) | 23 (8.2) |
• No antibiotic at this time; continue to investigate other possible causes of the arthritis* | 451 (40.8) | 134 (47.9) |
• No antibiotic at this time; no treatment or testing now, but see patient for follow-up | 17 (1.5) | 8 (2.9) |
• No antibiotic at this time; further testing for LD now | 63 (5.7) | 20 (7.1) |
• No antibiotic at this time; refer patient to a specialist* | 451 (40.8) | 95 (33.9) |