How to treat Lyme disease in an adult after a tick bite?

How to treat Lyme disease in an adult after a tick bite? - briefly

Administer a 10‑ to 21‑day course of doxycycline (100 mg orally twice daily) as first‑line therapy, switching to amoxicillin or cefuroxime if doxycycline is contraindicated. Remove the tick promptly, then monitor for early manifestations such as erythema migrans and systemic symptoms.

How to treat Lyme disease in an adult after a tick bite? - in detail

Effective management of Lyme disease after a tick bite in an adult begins with prompt assessment. Confirm exposure by identifying a recent bite, noting the presence of an erythema migrans lesion, and evaluating for systemic symptoms such as fever, headache, fatigue, or joint pain. Laboratory testing (ELISA followed by Western blot) is recommended when the rash is atypical or symptoms are disseminated; it is not required for classic early skin manifestations.

Antibiotic therapy is the cornerstone of treatment. First‑line oral regimens include:

  • Doxycycline 100 mg twice daily for 10–21 days; preferred for most adults, also effective against co‑infecting agents.
  • Amoxicillin 500 mg three times daily for 14–21 days; alternative for patients with doxycycline contraindications (pregnancy, allergy, severe gastrointestinal intolerance).
  • Cefuroxime axetil 500 mg twice daily for 14–21 days; another option when doxycycline is unsuitable.

For severe or late manifestations (neurologic involvement, cardiac disease, arthritis), intravenous therapy is indicated:

  • Ceftriaxone 2 g once daily for 14–28 days.
  • Alternatively, cefotaxime 2 g three times daily for the same duration.

Adjunctive measures:

  • Analgesics (acetaminophen or NSAIDs) for pain and fever.
  • Anti-inflammatory medication for arthritis flares, with consideration of corticosteroids only in refractory cases.
  • Monitoring of liver and kidney function when prolonged courses or intravenous agents are used.

Follow‑up includes clinical reassessment at 2–4 weeks to verify resolution of rash and systemic symptoms. Persistent joint swelling after 3 months warrants repeat serology and possible referral to rheumatology. Neurologic symptoms persisting beyond 6 weeks may require additional imaging and specialist evaluation.

Prevention of recurrence emphasizes tick avoidance: use of repellents containing DEET or picaridin, wearing long sleeves and trousers, performing thorough body checks after outdoor exposure, and prompt removal of attached ticks with fine‑tipped tweezers, leaving the mouthparts intact. Early removal within 24 hours reduces transmission risk dramatically.

In summary, adult Lyme disease following a tick bite is treated with a defined oral antibiotic course for early disease, escalated to intravenous therapy for disseminated involvement, supported by symptomatic care, systematic follow‑up, and preventive practices to minimize future exposure.