How can you treat borreliosis after a tick bite? - briefly
Administer a short course of doxycycline (or amoxicillin/cefuroxime for contraindications) as soon as possible after the bite, typically 10–14 days, to eradicate the infection and prevent complications.
How can you treat borreliosis after a tick bite? - in detail
Prompt antimicrobial therapy is essential after a confirmed tick exposure that may have transmitted Borrelia burgdorferi. Diagnosis relies on clinical signs (e.g., erythema migrans) and, when necessary, serologic testing. Immediate treatment reduces the risk of disseminated infection and long‑term sequelae.
First‑line regimens
- Doxycycline 100 mg orally twice daily for 10–21 days (adult dosage; contraindicated in pregnancy and children < 8 years).
- Amoxicillin 500 mg orally three times daily for 14–21 days (preferred for pregnant patients and young children).
- Cefuroxime axetil 500 mg orally twice daily for 14–21 days (alternative for doxycycline intolerance).
Alternative options
- Ceftriaxone 2 g intravenously once daily for 14–28 days (used for neurological involvement, cardiac manifestations, or severe arthritis).
- Intravenous penicillin G 18–24 million units per day divided every 4 hours (alternative for central nervous system disease when ceftriaxone is unavailable).
- Azithromycin 500 mg orally once daily for 5 days (limited evidence; reserved for patients unable to tolerate first‑line agents).
Management according to disease stage
- Early localized infection: oral therapy as above, typically 10 days for doxycycline, 14 days for amoxicillin or cefuroxime.
- Early disseminated disease (multiple skin lesions, facial palsy, myocarditis): consider extending oral treatment to 21 days or switching to intravenous ceftriaxone for 14–28 days.
- Late disseminated disease (arthritis, chronic neurologic symptoms): oral doxycycline or amoxicillin for 28 days; intravenous ceftriaxone may be required for persistent neurologic involvement.
Follow‑up and monitoring
- Reassess clinical response after 2–4 weeks; resolution of erythema migrans and systemic symptoms indicates effective therapy.
- Persisting joint swelling warrants a 4‑week course of oral doxycycline; refractory cases may need intra‑articular steroid injection after antimicrobial completion.
- Neurologic or cardiac complications require serial electrocardiograms, echocardiography, or lumbar puncture as indicated, with treatment adjustments based on laboratory findings.
Prompt initiation of the appropriate antibiotic, adherence to the prescribed duration, and systematic follow‑up constitute the definitive strategy for managing Borrelia infection following a tick bite.