How is Lyme disease treated after a tick bite? - briefly
Early Lyme infection is usually managed with a 2‑ to 3‑week oral regimen of doxycycline, amoxicillin, or cefuroxime axetil; severe manifestations may require a 2‑ to 4‑week intravenous course of ceftriaxone.
How is Lyme disease treated after a tick bite? - in detail
A tick bite that may transmit Borrelia burgdorferi requires prompt medical assessment. The first action is to remove the attached tick with fine‑point tweezers, grasping it as close to the skin as possible and pulling straight upward. After removal, the bite site should be cleaned with antiseptic and the patient observed for the characteristic erythema migrans rash or systemic signs.
If the bite occurred in an area where Lyme disease is endemic and the tick was attached for ≥36 hours, a single prophylactic dose of doxycycline (200 mg for adults, 4 mg/kg for children) is recommended within 72 hours of removal, provided the patient is not pregnant, not allergic to tetracyclines, and can tolerate oral medication.
When infection is confirmed or strongly suspected, treatment depends on disease stage and patient characteristics:
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Early localized infection (erythema migrans, ≤30 days):
- Doxycycline 100 mg orally twice daily for 10–21 days (preferred).
- Amoxicillin 500 mg orally three times daily for 14–21 days (alternative for pregnant patients, infants, or doxycycline‑intolerant individuals).
- Cefuroxime axetil 500 mg orally twice daily for 14–21 days (alternative).
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Early disseminated disease (multiple erythema migrans lesions, neurologic or cardiac involvement):
- Oral doxycycline as above for 21–28 days, or
- Intravenous ceftriaxone 2 g once daily for 14–28 days when severe neurologic or cardiac manifestations are present.
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Late disease (arthritis, chronic neurologic symptoms):
- Oral doxycycline 100 mg twice daily for 28 days, or
- Intravenous ceftriaxone 2 g daily for 14–28 days, followed by an oral course if necessary.
Adjunctive therapy may include non‑steroidal anti‑inflammatory drugs for joint pain and fever control. Patients should be re‑evaluated after completion of antibiotics to ensure symptom resolution; persistent or recurrent manifestations may warrant repeat serologic testing or extended antimicrobial regimens.
Special considerations:
- Pregnant or lactating women receive amoxicillin or cefuroxime; doxycycline is contraindicated.
- Children under eight years receive amoxicillin; doxycycline is reserved for those ≥8 years when benefits outweigh risks.
- Known hypersensitivity to β‑lactams necessitates alternative agents such as clarithromycin, though efficacy data are limited.
Timely initiation of the appropriate antimicrobial regimen markedly reduces the risk of chronic complications and supports full recovery.