How are tick bites with borreliosis treated? - briefly
Standard therapy involves oral doxycycline (or amoxicillin or cefuroxime) taken for 2–4 weeks, started promptly after diagnosis. Severe manifestations, especially neurologic involvement, require intravenous ceftriaxone.
How are tick bites with borreliosis treated? - in detail
Prompt removal of the attached arthropod is the first step after a suspected bite. The mouthparts should be grasped with fine tweezers and withdrawn without squeezing the body. After extraction, the site must be cleaned with antiseptic solution and examined for signs of erythema, swelling, or a characteristic expanding rash.
If the bite occurred in an area where Borrelia infection is endemic and the tick has been attached for at least 36 hours, a single dose of doxycycline (200 mg) is recommended as prophylaxis, provided the patient is not pregnant, under eight years old, or allergic to tetracyclines. This regimen reduces the risk of developing Lyme disease by approximately 80 %.
When early localized infection is confirmed—typically by the appearance of erythema migrans—systemic antibiotic therapy is required. Preferred agents and schedules are:
- Doxycycline 100 mg orally twice daily for 10–21 days (first‑line for adults and children ≥8 years).
- Amoxicillin 500 mg orally three times daily for 14–21 days (alternative for doxycycline‑contraindicated patients).
- Cefuroxime axetil 500 mg orally twice daily for 14–21 days (alternative for penicillin‑allergic patients).
For disseminated disease with neurological or cardiac involvement, intravenous therapy is indicated:
- Ceftriaxone 2 g intravenously once daily for 14–28 days, or
- Penicillin G 18–24 million units per day, divided every four hours, for 14–28 days.
Patients with severe arthritis may receive oral doxycycline or amoxicillin for 28 days, followed by a second course if symptoms persist.
Monitoring includes weekly assessment of skin lesions, joint pain, and neurologic signs. Serologic testing (ELISA followed by Western blot) is performed only when the clinical picture is ambiguous, as early infection may yield false‑negative results. Persistent fatigue or musculoskeletal complaints after treatment warrant re‑evaluation for possible post‑treatment Lyme disease syndrome; repeat antibiotic courses are not routinely recommended.
Special populations require dosage adjustments: renal impairment necessitates reduced cefuroxime or amoxicillin doses; weight‑based dosing is applied for pediatric patients. Pregnant or lactating women should receive amoxicillin; doxycycline is avoided.
Effective management combines immediate tick removal, appropriate prophylactic dosing when indicated, targeted antibiotic regimens based on disease stage, and systematic follow‑up to detect complications promptly.