How should Lyme disease be treated after a tick bite in a person? - briefly
Administer doxycycline 100 mg orally twice daily for 10–21 days, or amoxicillin or cefuroxime if doxycycline is contraindicated; begin therapy promptly after tick removal when erythema migrans or high‑risk exposure is identified. Early treatment reduces progression to disseminated infection and associated complications.
How should Lyme disease be treated after a tick bite in a person? - in detail
Lyme disease management after a tick bite begins with prompt assessment of exposure risk. Immediate removal of the attached tick with fine‑tipped tweezers, grasping close to the skin and pulling straight upward, reduces the likelihood of pathogen transmission. The bite site should be cleaned with antiseptic; documentation of the date, location, and tick identification, if possible, aids clinical decision‑making.
If the tick was attached for less than 24 hours, prophylactic antibiotics are generally not required. When attachment exceeds 36 hours, or when the tick is identified as Ixodes scapularis or Ixodes pacificus in endemic areas, a single dose of doxycycline (200 mg for adults, 4.4 mg/kg for children ≥8 years) is recommended within 72 hours of removal. Contraindications (pregnancy, allergy, age <8 years) necessitate alternative regimens such as amoxicillin (500 mg three times daily for 10 days) or cefuroxime axetil (250 mg twice daily for 10 days).
Should early localized disease develop—characterized by erythema migrans—antibiotic therapy must continue for a full course: doxycycline 100 mg twice daily for 10–21 days, amoxicillin 500 mg three times daily for 14–21 days, or cefuroxime axetil 250 mg twice daily for 14–21 days. Intravenous ceftriaxone (2 g daily) is reserved for disseminated infection with neurological or cardiac involvement, administered for 14–28 days.
Follow‑up evaluation includes monitoring for resolution of skin lesions, fever, arthralgia, and neurologic signs. Persistent symptoms after appropriate therapy warrant reassessment for possible co‑infection, treatment failure, or post‑treatment Lyme disease syndrome. Laboratory testing (ELISA, Western blot) assists in confirming diagnosis when clinical presentation is ambiguous, but serology is not required before initiating prophylaxis in high‑risk exposures.