What is prescribed for a Lyme disease tick bite? - briefly
Doxycycline, taken for 10–21 days, is the standard oral treatment for an early Lyme disease tick bite; alternatives include amoxicillin or cefuroxime for patients who cannot tolerate doxycycline.
What is prescribed for a Lyme disease tick bite? - in detail
A tick bite that raises suspicion for Lyme disease is typically managed with antimicrobial therapy aimed at eradicating Borrelia burgdorferi before dissemination. The first‑line oral agent for most adults and children over eight years is doxycycline, administered at 100 mg twice daily for 10–21 days, depending on the stage of infection and local resistance patterns. When doxycycline is contraindicated—such as in pregnancy, lactation, or in children younger than eight—amoxicillin (500 mg three times daily) or cefuroxime axetil (500 mg twice daily) are appropriate alternatives, also for a 10–21‑day course.
For patients presenting with early localized disease (erythema migrans) without neurologic involvement, a single 200 mg dose of doxycycline within 72 hours of the bite can serve as prophylaxis, provided the tick was attached for ≥36 hours and the local infection rate exceeds 20 %. In cases of early disseminated disease—manifested by multiple erythema migrans lesions, facial palsy, or meningitis—intravenous ceftriaxone (2 g daily) for 14–28 days is recommended. Intravenous therapy may also be indicated for severe cardiac involvement (e.g., atrioventricular block).
Adjunctive measures include:
- Removal of the tick with fine‑tipped tweezers, grasping as close to the skin as possible, and pulling straight out without crushing the mouthparts.
- Documentation of the bite date, location, and duration of attachment.
- Baseline serologic testing (ELISA followed by Western blot) when the diagnosis is uncertain; repeat testing may be needed after 4–6 weeks if initial results are negative.
- Monitoring for signs of treatment failure, such as persistent rash, new neurologic symptoms, or joint swelling, which may necessitate a longer antibiotic course or a switch to an alternative agent.
Dosage adjustments are required for patients with renal impairment (e.g., reducing cefuroxime to 250 mg twice daily) and for those with hepatic dysfunction (modifying doxycycline dosing). All patients should be advised to complete the full prescribed regimen, even if symptoms improve early, to minimize the risk of relapse or chronic infection.