Which medications should be used to treat a tick bite in humans?

Introduction

Understanding Tick Bites

Immediate Actions After a Tick Bite

After a tick attaches, remove it promptly to reduce pathogen transmission. Grasp the tick as close to the skin as possible with fine‑point tweezers, pull upward with steady pressure, and avoid crushing the body. Once detached, cleanse the bite area and hands with soap and water or an antiseptic solution.

Document the encounter: note the date, location, and estimated duration of attachment. Monitor the site for expanding redness, rash, or flu‑like symptoms for up to four weeks. If any signs develop, seek medical evaluation without delay.

Apply a clean bandage if the skin is irritated.
Record the tick’s appearance (size, life stage) for possible identification.
Contact a healthcare provider to discuss the need for prophylactic antibiotics, especially if the bite occurred in an area with high incidence of Lyme disease or other tick‑borne illnesses.
Follow any prescribed treatment regimen precisely and complete the full course.

When to Seek Medical Attention

A prompt medical evaluation is essential after a tick bite because the decision to prescribe antibiotics, antiviral agents, or supportive therapy depends on clinical findings that cannot be assessed at home.

Seek professional care if any of the following occurs:

The bite site develops a rash larger than 5 mm, especially a target‑shaped erythema migrans.
Fever, chills, headache, fatigue, or muscle aches appear within two weeks of the bite.
The tick remained attached for more than 24 hours before removal.
The bite occurred in a region where Lyme disease, Rocky Mountain spotted fever, or other tick‑borne illnesses are endemic.
The person is pregnant, immunocompromised, or has a chronic condition such as diabetes or cardiovascular disease.
The tick is identified as a species known to transmit severe infections (e.g., Dermacentor or Amblyomma).

When a clinician confirms a tick‑borne infection, they will select the appropriate antimicrobial regimen, adjust dosage for age or comorbidities, and monitor for adverse reactions. Early treatment reduces the risk of complications and improves outcomes.

Medications for Tick-Borne Diseases

Antibiotics for Lyme Disease

Doxycycline

Doxycycline is the preferred oral antibiotic for most tick‑borne bacterial infections in adults. It provides reliable coverage against Borrelia burgdorferi, Anaplasma phagocytophilum, Ehrlichia chaffeensis and Rickettsia rickettsii. Early administration reduces disease severity and prevents complications.

For treatment of confirmed or suspected infection, the standard regimen is 100 mg taken twice daily for 10–21 days, depending on the specific pathogen and clinical response. For post‑exposure prophylaxis after a high‑risk bite, a single 200 mg dose administered within 72 hours is recommended.

Contraindications include pregnancy, lactation, children younger than eight years, and known doxycycline hypersensitivity. Caution is advised in patients with severe hepatic impairment or renal failure requiring dose adjustment.

Common adverse effects are mild gastrointestinal discomfort, photosensitivity, and esophageal irritation. Patients should ingest the medication with a full glass of water and remain upright for at least 30 minutes to minimize esophageal injury. Sun protection reduces the risk of photosensitive reactions.

Monitoring focuses on symptom resolution, emergence of rash, and, for prolonged courses, liver function tests. Switching to an alternative agent (e.g., ceftriaxone or azithromycin) is indicated if intolerance or contraindication develops.

Key prescribing points

First‑line oral agent for most tick‑borne bacterial diseases.
Treatment dose: 100 mg PO twice daily, 10–21 days.
Prophylaxis dose: 200 mg PO single dose, within 72 hours of bite.
Avoid in pregnancy, lactation, children < 8 years, hypersensitivity.
Advise water intake, upright posture, and sun protection.
Monitor clinical response and hepatic function for extended therapy.

Amoxicillin

Amoxicillin is the preferred oral antibiotic for preventing early Lyme disease after a confirmed tick bite when the tick is identified as Ixodes and the attachment time exceeds 36 hours. A single 200 mg dose taken within 72 hours of removal reduces the risk of infection to less than 2 percent. For established early Lyme disease, a 10‑day course of amoxicillin 500 mg three times daily is recommended. The drug is contraindicated in patients with a documented penicillin allergy; alternatives such as doxycycline or cefuroxime axetil should be used. Common adverse effects include gastrointestinal upset and, rarely, hypersensitivity reactions. Monitoring for rash, diarrhea, or signs of an allergic response is advised throughout therapy.

Indication: prophylaxis after high‑risk tick bite; early Lyme disease treatment.
Dosage for prophylaxis: 200 mg once, within 72 h of bite.
Dosage for treatment: 500 mg orally every 8 h for 10 days.
Contraindication: penicillin hypersensitivity.
Common side effects: nausea, vomiting, diarrhea, rash.
Alternative agents (if allergic): doxycycline, cefuroxime axetil.

Cefuroxime

Cefuroxime is a second‑generation cephalosporin with activity against a range of Gram‑positive and Gram‑negative bacteria. It achieves therapeutic concentrations in skin, soft tissue, and the central nervous system after oral or intravenous administration, making it suitable for infections transmitted by ticks.

For tick‑borne bacterial diseases, cefuroxime is recommended primarily for early Lyme disease when the causative agent, Borrelia burgdorferi, is susceptible. The standard regimen consists of 500 mg taken orally twice daily for 10–14 days. Intravenous dosing of 750 mg every 8 hours is reserved for patients unable to tolerate oral therapy or with severe manifestations such as meningitis.

Cefuroxime does not cover intracellular pathogens such as Rickettsia spp., Anaplasma phagocytophilum, or Ehrlichia spp. These agents require doxycycline as the first‑line treatment. Consequently, cefuroxime alone is insufficient for most tick‑borne infections beyond early Lyme disease.

Key considerations when prescribing cefuroxime for tick bites include:

Renal function: dose adjustment required for creatinine clearance < 30 mL/min.
Allergy: contraindicated in patients with a known cephalosporin or severe penicillin allergy.
Drug interactions: avoid concurrent use of probenecid, which reduces renal excretion and may increase toxicity.
Adverse effects: monitor for diarrhea, rash, and rare hypersensitivity reactions.

In summary, cefuroxime serves as an effective option for early Lyme disease but should be combined with or replaced by doxycycline when the clinical picture suggests other tick‑borne pathogens.

Antibiotics for Other Tick-Borne Infections

Rickettsial Diseases (e.g., Rocky Mountain Spotted Fever)

Rickettsial infections transmitted by tick bites, such as Rocky Mountain spotted fever, require prompt antimicrobial therapy to prevent severe complications. The causative agents are obligate intracellular bacteria of the genus Rickettsia, which proliferate within endothelial cells, leading to vasculitis, fever, headache, and characteristic rash.

Doxycycline is the drug of choice for all age groups, including children and pregnant patients, because it achieves rapid intracellular concentrations and demonstrates consistent efficacy against spotted‑fever group rickettsiae. Typical regimens consist of 100 mg orally twice daily for adults and 2.2 mg/kg (maximum 100 mg) twice daily for children, administered for 7–14 days or until the patient has been afebrile for at least 48 hours.

When doxycycline is unavailable or contraindicated, alternative agents include:

Chloramphenicol 500 mg orally every 6 hours for 7–10 days (reserved for severe cases, monitored for hematologic toxicity).
Azithromycin 500 mg orally on day 1, then 250 mg daily for 4 days (considered for pregnant women or patients with doxycycline intolerance, though efficacy is lower).

Early initiation of therapy, ideally within 24 hours of symptom onset, markedly reduces mortality. Empirical treatment should begin based on clinical suspicion without waiting for laboratory confirmation, because serologic testing may remain negative during the first week of illness. Supportive care—fluid management, antipyretics, and monitoring for organ dysfunction—complements antimicrobial treatment.

In summary, effective management of tick‑borne rickettsial disease hinges on immediate administration of doxycycline, with chloramphenicol or azithromycin reserved for specific contraindications. Continuous assessment of therapeutic response guides duration and ensures resolution of infection.

Anaplasmosis and Ehrlichiosis

Anaplasmosis and ehrlichiosis are the most common bacterial illnesses transmitted by tick bites in humans. Both infections respond rapidly to tetracycline-class antibiotics, with doxycycline recognized as the drug of choice for uncomplicated and severe disease.

Doxycycline, 100 mg orally twice daily, administered for 10–14 days; intravenous formulation (100 mg every 12 hours) for patients unable to tolerate oral intake or presenting with serious complications.
Rifampin, 300 mg orally three times daily for 7–10 days, reserved for pregnant patients, infants younger than eight weeks, or individuals with documented doxycycline intolerance.
Chloramphenicol, 500 mg orally four times daily for 10–14 days, may be considered when tetracyclines and rifampin are contraindicated, though it carries a higher risk of adverse effects.

Prompt initiation of therapy, ideally within 24 hours of symptom onset, shortens illness duration and reduces the likelihood of severe organ involvement. Laboratory monitoring should include complete blood counts and liver function tests, as both infections can cause leukopenia, thrombocytopenia, and elevated transaminases. If clinical improvement is not observed within 48 hours of appropriate antimicrobial treatment, reassessment for alternative diagnoses or co‑infection with other tick‑borne pathogens is warranted.

Antivirals and Other Treatments

Powassan Virus

Powassan virus, a flavivirus transmitted by Ixodes ticks, can cause severe encephalitis after a bite. The infection lacks a specific antiviral drug; therapeutic decisions focus on mitigating symptoms and preventing complications.

Immediate removal of the attached tick reduces viral load.
Analgesics and antipyretics (e.g., acetaminophen, ibuprofen) control fever and pain.
Intravenous fluids maintain hydration and electrolyte balance.
Close neurological monitoring identifies early signs of meningitis or encephalitis; intensive care support may be required.
Empiric antibiotics (such as doxycycline) are appropriate only if co‑infection with bacterial tick‑borne pathogens is suspected; they do not affect Powassan virus.

Because no approved medication directly targets the virus, clinicians rely on supportive care, vigilant observation, and management of secondary complications. Early recognition and prompt supportive treatment improve patient outcomes.

Alpha-gal Syndrome

Alpha‑gal syndrome (AGS) is an IgE‑mediated allergy triggered by the carbohydrate galactose‑α‑1,3‑galactose, which is introduced into humans through the saliva of certain hard‑tick species. After a tick bite, sensitisation may develop, and subsequent exposure to mammalian meat or gelatin can provoke urticaria, angio‑edema, gastrointestinal distress, or anaphylaxis. Management of a tick bite in individuals at risk for AGS focuses on immediate symptom control and prevention of severe allergic reactions rather than antimicrobial therapy.

When clinical signs of an allergic response appear after a bite, the following pharmacologic interventions are recommended:

Second‑generation H1 antihistamine (e.g., cetirizine 10 mg orally once daily) to relieve urticaria and pruritus.
Short course of oral corticosteroid (e.g., prednisone 40 mg daily for 5 days) for moderate to severe cutaneous or systemic symptoms.
Intramuscular epinephrine (0.3 mg of 1:1000 solution) for anaphylaxis, followed by observation and possible repeat dosing.
Prescription of an epinephrine auto‑injector (e.g., 0.15 mg for adults <75 kg, 0.3 mg for larger adults) for future self‑administration.

Patients with confirmed AGS should receive education on avoidance of mammalian meat, gelatin, and other known sources of the alpha‑gal epitope. Referral to an allergist for skin‑prick testing or serum‑specific IgE measurement confirms diagnosis and guides long‑term management. In the absence of allergic symptoms, routine prophylactic antibiotics are not indicated for tick bites solely to prevent AGS.

Symptomatic Treatment and Prevention

Pain and Inflammation Relief

Over-the-Counter Analgesics

Over‑the‑counter analgesics provide symptomatic relief after a tick bite, addressing pain and fever while the body’s immune response works against potential infection. They do not eliminate the tick‑borne pathogen; prompt medical evaluation and appropriate antimicrobial therapy remain essential.

Commonly available options include:

Acetaminophen (500 mg tablets, repeat every 4–6 hours, maximum 3000 mg per day). Suitable for individuals who cannot tolerate non‑steroidal anti‑inflammatory drugs (NSAIDs) or who have gastric sensitivity.
Ibuprofen (200–400 mg tablets, repeat every 6–8 hours, maximum 1200 mg per day). Reduces inflammation as well as pain; contraindicated in patients with active gastrointestinal ulcers, severe renal impairment, or uncontrolled hypertension.
Naproxen (220 mg tablets, repeat every 8–12 hours, maximum 660 mg per day). Longer duration of action; caution in those with cardiovascular disease or chronic kidney disease.
Aspirin (325 mg tablets, repeat every 4–6 hours, maximum 4000 mg per day). Provides antiplatelet effect; avoid in children and teenagers with viral infections due to risk of Reye’s syndrome, and in patients with bleeding disorders.

Dosage adjustments are required for children, pregnant or lactating individuals, and patients with hepatic or renal dysfunction. Analgesics should be taken with food or water to minimize gastrointestinal irritation. If symptoms persist beyond 48 hours, worsen, or are accompanied by a rash, fever, or joint pain, immediate medical assessment is warranted.

Topical Steroids

Topical corticosteroids are employed to alleviate local inflammation, erythema, and pruritus that frequently follow a tick bite. They act by suppressing cytokine release, reducing capillary permeability, and inhibiting leukocyte migration, thereby limiting the acute skin response.

Commonly used preparations include:

Hydrocortisone 1 % (low‑potency)
Triamcinolone acetonide 0.1 % (medium‑potency)
Betamethasone valerate 0.05 % (high‑potency)

Application guidelines recommend a thin layer to the affected area two to three times daily for no more than seven days. Occlusive dressings are unnecessary and may increase systemic absorption. Use is contraindicated on broken skin, in the presence of active infection, or when the tick remains attached. Caution is advised for pediatric patients and individuals with known steroid hypersensitivity.

Clinical data demonstrate that topical steroids reduce severity of cutaneous symptoms within 48–72 hours, but they do not eradicate tick‑borne pathogens. Therefore, they should complement, not replace, definitive measures such as prompt tick removal and, when indicated, systemic antimicrobial therapy.

In practice, topical steroids serve as a symptomatic adjunct for tick‑bite–related dermatitis, providing rapid relief of inflammation while other therapeutic interventions address infection risk.

Preventing Secondary Infections

Antiseptics

Antiseptics are applied to the skin after a tick is removed to reduce the risk of secondary bacterial infection. The wound should be cleaned promptly, before the site is covered.

Povidone‑iodine (10 % solution) – applied with a sterile swab, left to dry, then rinsed with saline if irritation occurs. Effective against a broad spectrum of bacteria and fungi.
Chlorhexidine gluconate (0.5 %–2 %) – applied similarly to povidone‑iodine; provides persistent activity for several hours. Not suitable for patients with known hypersensitivity.
Isopropyl alcohol (70 %) – used for rapid antisepsis; evaporates quickly, leaving no residue. May cause stinging; avoid on extensive skin breaks.
Hydrogen peroxide (3 %) – limited to initial irrigation; excessive use can damage tissue and delay healing.

Application steps:

Wash hands, wear gloves.
Irrigate the bite area with sterile saline.
Apply the chosen antiseptic using a sterile gauze or swab.
Allow the agent to act for at least 30 seconds before gently patting dry.
Cover with a clean, non‑adhesive dressing if bleeding persists.

Contraindications include allergy to iodine, chlorhexidine, or alcohol, and open wounds larger than a few millimeters where prolonged exposure may impair tissue repair. Antiseptics do not replace systemic antibiotics when Lyme disease or other tick‑borne infections are suspected; they serve solely to protect the puncture site from bacterial colonization.

Post-Exposure Prophylaxis (PEP)

Guidelines for Doxycycline PEP

Doxycycline is the preferred agent for post‑exposure prophylaxis (PEP) after a potentially infectious tick bite. The regimen consists of a single oral dose of 200 mg taken within 72 hours of removal of the attached tick. This dose has demonstrated efficacy in preventing early Lyme disease caused by Borrelia burgdorferi in endemic regions.

Eligibility criteria:

Tick identified as Ixodes species, attached for ≥36 hours or unknown attachment duration in high‑risk areas.
Patient age ≥8 years; children 8–15 years receive 4 mg/kg (maximum 200 mg) as a single dose.
No known hypersensitivity to tetracyclines, no pregnancy, and no severe hepatic impairment.

Contraindications:

Allergy to doxycycline or other tetracyclines.
Pregnant or lactating individuals.
Children younger than 8 years, unless risk assessment justifies off‑label use.

Administration considerations:

Take the dose with a full glass of water; avoid lying down for 30 minutes to reduce esophageal irritation.
Food does not significantly affect absorption, but a light meal may improve tolerability.
Advise patients to monitor for gastrointestinal upset, photosensitivity, or rash; seek medical attention if severe reactions occur.

Follow‑up instructions:

Observe for signs of erythema migrans or systemic symptoms for up to 30 days post‑exposure.
If symptoms develop, initiate appropriate diagnostic testing and therapeutic regimen, regardless of prior PEP administration.

Documentation:

Record tick species, attachment time, geographic location, and date of doxycycline administration in the patient’s chart.
Include contraindication assessment and patient consent for off‑label use when applicable.

Special Considerations

Pediatric Patients

Tick bites in children require prompt evaluation and appropriate pharmacologic management to prevent infection and minimize complications. Initial assessment should confirm bite location, duration of attachment, and tick species when possible. If the tick was attached for less than 24 hours and the region is low‑risk for tick‑borne diseases, observation without medication may be sufficient. Longer attachment times or exposure in endemic areas warrant prophylactic treatment.

Prophylactic antimicrobial therapy is recommended when the following criteria are met: attachment ≥ 36 hours, tick identified as Ixodes species, and residence or travel in an area with a ≥ 15 % prevalence of infection. The preferred agent for children weighing ≥ 15 kg is a single dose of doxycycline 4 mg/kg (maximum 200 mg). For children under 15 kg, doxycycline 2.2 mg/kg is acceptable, with careful monitoring for gastrointestinal irritation. Alternative regimens include amoxicillin 50 mg/kg divided twice daily for 10 days, reserved for cases where doxycycline is contraindicated (e.g., allergy, severe photosensitivity).

If a child develops early localized erythema migrans, oral doxycycline 4 mg/kg twice daily for 10 days is the drug of choice. For patients unable to receive doxycycline, amoxicillin 50 mg/kg twice daily for 14 days or cefuroxime axetil 30 mg/kg twice daily for 14 days may be used. In cases of severe systemic disease (e.g., Lyme meningitis, high‑grade fever, organ involvement), intravenous ceftriaxone 50–75 mg/kg once daily for 14–21 days is indicated.

Monitoring includes daily temperature checks, inspection of the bite site for expanding rash, and education of caregivers about signs of neurologic or cardiac involvement. Follow‑up visits should occur within one week to reassess symptoms and adjust therapy if needed.

Pregnant and Breastfeeding Individuals

Pregnant or nursing patients who have been bitten by a tick require prompt assessment of infection risk and selection of agents that are both effective and safe for the fetus or infant.

Prophylactic therapy – Doxycycline, the standard preventive drug for high‑risk bites, is contraindicated in pregnancy and during lactation. The recommended alternative is amoxicillin 500 mg orally twice daily for 7 days, which has an established safety profile for both conditions.
Early localized Lyme disease (erythema migrans) – Doxycycline is avoided. First‑line treatment is amoxicillin 500 mg three times daily for 14–21 days. Cefuroxime axetil 250 mg twice daily may be used when amoxicillin intolerance occurs; both agents are classified as pregnancy‑ and lactation‑compatible.
Disseminated or neurologic Lyme disease – Intravenous ceftriaxone 2 g daily for 14–28 days is the preferred regimen. Ceftriaxone crosses the placenta without adverse fetal effects and is excreted in breast milk at levels considered safe for nursing infants.
Symptomatic relief – Acetaminophen up to 3 g per day is appropriate for fever and pain. Cetirizine 10 mg once daily can be used for itching; both are compatible with pregnancy and breastfeeding. Topical corticosteroids of low to medium potency may be applied to local inflammation, provided they are not occlusive.

In summary, the medication hierarchy for pregnant or lactating individuals after a tick bite prioritizes amoxicillin for prophylaxis and early disease, cefuroxime as a secondary oral option, and ceftriaxone for severe manifestations, while supporting symptomatic agents that have documented safety in these populations.

Allergic Reactions and Side Effects

When a tick bite requires pharmacologic intervention, clinicians must anticipate possible hypersensitivity and adverse drug events. Antihistamines (e.g., diphenhydramine, cetirizine) relieve pruritus but can trigger rash, urticaria, or, rarely, anaphylaxis. Oral antihistamines may cause sedation, dry mouth, or cardiac conduction abnormalities with first‑generation agents.

Antibiotics prescribed for tick‑borne infections, primarily doxycycline, amoxicillin, or ceftriaxone, carry distinct risk profiles. Doxycycline may induce photosensitivity, esophageal irritation, and, in rare cases, severe skin reactions such as Stevens‑Johnson syndrome. Amoxicillin can cause maculopapular eruptions, angioedema, and, infrequently, anaphylactic shock. Ceftriaxone is associated with biliary sludging, thrombophlebitis at the injection site, and hypersensitivity ranging from mild rash to life‑threatening anaphylaxis.

Corticosteroids, occasionally added for severe inflammatory responses, present systemic side effects. Short‑course prednisone may lead to hyperglycemia, mood changes, and insomnia; prolonged use increases risk of osteoporosis, adrenal suppression, and infection. Topical steroids applied to the bite area can cause local skin atrophy and contact dermatitis.

Common allergic reactions and side effects

Rash, urticaria, or erythema
Angioedema, facial swelling
Anaphylaxis (rapid onset, airway compromise)
Gastrointestinal upset (nausea, diarrhea)
Neurologic symptoms (dizziness, headache)
Hematologic changes (eosinophilia, neutropenia)

Prompt recognition of these manifestations enables immediate discontinuation of the offending agent and initiation of appropriate emergency measures, such as epinephrine for anaphylaxis or alternative antimicrobial therapy when necessary.

Monitoring and Follow-up

Observing for Symptoms

Observing for symptoms after a tick bite is essential for determining the need for pharmacologic intervention. The timing and nature of clinical signs guide the selection of appropriate antimicrobial agents.

Typical manifestations appear within days to weeks. Early local reactions may include a red, expanding erythema at the bite site, often described as a “bull’s‑eye” pattern. Systemic signs develop later and vary by pathogen:

Fever or chills
Headache, often severe
Muscle or joint pain
Fatigue or malaise
Nausea or vomiting
Neurologic symptoms such as facial palsy or meningitis signs
Cardiac involvement: palpitations, chest discomfort, conduction abnormalities

Specific patterns suggest particular infections. A single erythematous lesion larger than 5 cm, especially with central clearing, points to early Lyme disease. A maculopapular rash that spreads rapidly, sometimes accompanied by high fever, may indicate Rocky Mountain spotted fever. Persistent fever with leukopenia and thrombocytopenia raises suspicion for anaplasmosis or ehrlichiosis. Hemolytic anemia and dark urine suggest babesiosis.

Monitoring should continue for at least 30 days post‑exposure. Immediate medical evaluation is warranted if any of the above signs emerge, particularly rash, fever, or neurologic symptoms. Prompt diagnosis enables targeted antibiotic therapy—doxycycline for most tick‑borne bacterial infections, amoxicillin for early Lyme disease in certain populations, and adjunctive agents when co‑infection is suspected.

In the absence of symptoms, routine prophylactic antibiotics are not recommended; observation remains the primary strategy. Regular self‑examination and documentation of any changes facilitate timely treatment decisions.

When to Revisit a Healthcare Provider

After a tick bite, a patient should arrange a follow‑up visit if any of the following conditions develop:

Expanding erythema migrans or other skin lesions at the bite site
Fever, chills, headache, muscle aches, or joint pain
Nausea, vomiting, or gastrointestinal upset that began after starting medication
Difficulty breathing, swelling of the face or throat, or rash suggestive of an allergic reaction

If prophylactic doxycycline or another recommended antimicrobial was prescribed, a review is advised within 48–72 hours to confirm tolerance and verify that the full course can be completed. Absence of side effects does not eliminate the need for a later appointment; a final assessment at the end of therapy (typically 7–10 days) ensures that treatment was effective and that no late manifestations of infection appear.

Patients who experience adverse drug reactions must seek immediate evaluation, regardless of the severity of symptoms. Early identification of hypersensitivity or gastrointestinal intolerance allows the clinician to switch to an alternative agent, such as amoxicillin or a macrolide, before complications arise.

Documentation of the bite date, tick removal method, and any administered medication should be presented at each visit. Providing this information enables the provider to calculate the incubation period, adjust therapeutic decisions, and determine whether additional testing, such as serology for Lyme disease, is warranted.

A follow‑up appointment is also appropriate when the patient is uncertain about the adequacy of the initial treatment, when travel history suggests exposure to other tick‑borne pathogens, or when underlying health conditions (e.g., immunosuppression) increase the risk of severe disease. In such cases, the clinician may order extended laboratory work‑up or modify the medication regimen to address the broader risk profile.