Cost Effectiveness of Oral as Compared with Intravenous Antibiotic Therapy for Patients with Early Lyme Disease or Lyme Arthritis

Lyme disease, which is caused by the tick-transmitted spirochete Borrelia burgdorferi, 1 usually begins with an expanding skin lesion, erythema migrans, accompanied by malaise and fatigue, fever, headache, stiff neck, and myalgias or arthralgias.2,3 Weeks later, some patients have objective neurologic signs, such as meningitis, cranial neuritis, or radiculoneuritis,4 or cardiac abnormalities, particularly atrial–ventricular block.5 Months later, intermittent or chronic episodes of arthritis often develop in untreated patients.6 Months to years later, a small percentage of patients have subtle signs of encephalopathy (memory deficit, irritability, or somnolence), or polyneuropathy characterized by spinal radicular pain or distal paresthesias.7–10 The recommended . . .