How to treat Lyme disease after a tick bite? - briefly
Begin oral doxycycline (100 mg twice daily) promptly, usually for 10–21 days; if doxycycline is contraindicated, use amoxicillin or cefuroxime for an equivalent course. Early therapy prevents dissemination and lowers the risk of chronic complications.
How to treat Lyme disease after a tick bite? - in detail
After a tick attachment, remove the arthropod promptly with fine‑tipped tweezers, grasping close to the skin and pulling straight upward. Clean the site with antiseptic; do not crush the mouthparts.
If the tick was attached for ≥36 hours and the region is endemic for Borrelia burgdorferi, a single dose of doxycycline (200 mg for adults, 4.4 mg/kg for children ≥8 years) may be given within 72 hours to reduce the risk of infection. For patients allergic to tetracyclines, amoxicillin (2 g single dose) or cefuroxime axetil (800 mg single dose) are alternatives.
When erythema migrans or other clinical signs develop, initiate antimicrobial therapy without waiting for serology. Recommended regimens:
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Early localized disease
- Doxycycline 100 mg twice daily for 10–14 days (adults).
- Children <8 years: amoxicillin 50 mg/kg/day divided three times for 14 days.
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Early disseminated disease (multiple skin lesions, neurologic or cardiac involvement)
- Doxycycline 100 mg twice daily for 21 days, or
- Intravenous ceftriaxone 2 g once daily for 14–28 days for meningitis or severe cardiac manifestations.
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Late disease (arthritis, chronic neuroborreliosis)
- Oral doxycycline 100 mg twice daily for 28 days, or
- Intravenous ceftriaxone 2 g daily for 14–28 days, followed by oral therapy if needed.
Monitor patients for symptom resolution. Persistent joint swelling after treatment may require a repeat course of antibiotics or referral to rheumatology. Neurologic deficits should be reassessed with lumbar puncture; CSF pleocytosis warrants extended intravenous therapy.
Special populations:
- Pregnant or lactating women: oral amoxicillin 500 mg three times daily for 14–21 days.
- Patients with renal impairment: adjust ceftriaxone dosage according to creatinine clearance.
- Co‑infection with Anaplasma or Babesia: add doxycycline for anaplasmosis; consider atovaquone plus azithromycin for babesiosis.
Follow‑up serology is not required for early disease but may be useful in late manifestations to confirm seroconversion. Document all treatment decisions, adverse reactions, and patient education on tick avoidance and prompt removal.