How to treat Lyme disease in children after a tick bite? - briefly
Give a 10‑21‑day course of age‑appropriate antibiotics—doxycycline for children ≥ 8 years or amoxicillin for younger patients—starting promptly after the bite, and monitor for rash or systemic symptoms. If the tick was removed within 72 hours, a single dose of doxycycline can be used for prophylaxis.
How to treat Lyme disease in children after a tick bite? - in detail
When a child is bitten by a tick in an area where Lyme disease is endemic, immediate assessment should focus on the duration of attachment and the appearance of the erythema migrans rash. If the tick has been attached for 36 hours or more, a single dose of doxycycline (10 mg/kg, not exceeding 200 mg) administered within 72 hours of removal reduces the risk of infection. In children younger than eight years, amoxicillin (50 mg/kg per day divided twice daily) is an alternative for prophylaxis, especially when doxycycline is contraindicated.
If infection is confirmed or strongly suspected—evidenced by rash, flu‑like symptoms, or positive serology—antibiotic therapy is required. Recommended regimens include:
- Oral doxycycline: 10 mg/kg per dose, twice daily for 10 days (maximum 200 mg per dose). Suitable for children ≥8 years and for those without contraindications.
- Oral amoxicillin: 50 mg/kg per day, divided into three doses for 14 days. Preferred for children <8 years or when doxycycline is unsuitable.
- Cefuroxime axetil: 30 mg/kg per day, divided twice daily for 14 days. An option for patients unable to tolerate amoxicillin.
Intravenous therapy is reserved for severe manifestations such as meningitis, carditis, or arthritis unresponsive to oral agents. The typical IV regimen is ceftriaxone 50 mg/kg once daily (maximum 2 g) for 14–21 days.
Monitoring during treatment should include:
- Resolution of rash and systemic symptoms within a few days.
- Assessment of joint swelling or neurological signs weekly.
- Repeat serologic testing only if symptoms persist beyond the treatment course.
If symptoms recur after completion of therapy, a second course of a different oral antibiotic for 28 days is advised. Persistent arthritis may require a short course of oral steroids or intra‑articular corticosteroid injection, under specialist supervision.
Preventive measures for future exposures involve:
- Regular tick checks after outdoor activities.
- Use of EPA‑registered repellents containing 20 %–30 % DEET on exposed skin.
- Dressing children in long sleeves and trousers, tucking pants into socks.
- Prompt removal of attached ticks with fine‑tipped tweezers, grasping close to the skin and pulling steadily upward.
Adhering to these protocols minimizes complications and promotes full recovery in pediatric patients following tick exposure.