What is prescribed for a subcutaneous tick? - briefly
A short course of doxycycline (200 mg once daily for 10–14 days) is the primary prescription after a subcutaneous tick bite lasting over 36 hours, serving as prophylaxis against tick‑borne disease. If signs of infection appear, clinicians may add a topical antiseptic or replace doxycycline with an appropriate alternative such as amoxicillin‑clavulanate.
What is prescribed for a subcutaneous tick? - in detail
A tick that has penetrated the dermis and lies beneath the skin surface requires immediate medical management to reduce the risk of infection and systemic complications.
Removal
- Use sterile fine‑point tweezers or a dedicated tick‑removal device.
- Grip the tick as close to the skin as possible, applying steady, gentle traction without twisting.
- Extract the whole organism; any remaining mouthparts can provoke localized inflammation.
Antibiotic prophylaxis
- If the tick is identified as a carrier of Borrelia burgdorferi (Lyme disease) or other pathogenic agents, a single dose of doxycycline (200 mg for adults, 4 mg/kg for children ≥8 years) is recommended within 72 hours of removal.
- For patients with contraindications to doxycycline (pregnancy, severe hepatic impairment), azithromycin (500 mg once) or amoxicillin (2 g single dose) may be used.
Tetanus considerations
- Verify tetanus immunization status. If the patient’s last booster was >10 years ago (or >5 years for dirty wounds), administer tetanus toxoid (Td) or combined tetanus‑diphtheria‑pertussis (Tdap) vaccine.
Anti‑inflammatory and analgesic support
- Non‑steroidal anti‑inflammatory drugs (e.g., ibuprofen 400 mg every 6 hours) reduce swelling and pain.
- Topical corticosteroid cream (hydrocortisone 1 %) may be applied to the site for localized erythema.
Monitoring and follow‑up
- Inspect the bite area daily for signs of erythema migrans, necrosis, or purulent discharge.
- Advise the patient to seek urgent care if fever, headache, joint pain, or a rash develops, as these may indicate systemic infection.
Patient education
- Instruct on proper tick avoidance: use of permethrin‑treated clothing, DEET‑based repellents, and thorough body checks after outdoor exposure.
- Emphasize the importance of prompt removal and adherence to the prescribed medication regimen.
The outlined protocol addresses immediate extraction, prophylactic antimicrobial therapy, tetanus protection, symptom control, and preventive measures, providing comprehensive care for a subdermal tick bite.