What is prescribed for an adult after a tick bite? - briefly
Adults bitten by a tick should receive doxycycline 100 mg orally twice daily for 10–14 days if early Lyme disease is suspected, or a single 200 mg dose within 72 hours of removal for prophylaxis when the tick was attached ≥36 hours. If doxycycline is contraindicated, amoxicillin 500 mg three times daily for 10 days is an alternative.
What is prescribed for an adult after a tick bite? - in detail
An adult who has been bitten by a tick should receive a treatment plan based on the tick species, attachment time, and local disease prevalence. The primary goal is to prevent infection with tick‑borne pathogens, most notably Borrelia burgdorferi (Lyme disease) and Anaplasma phagocytophilum (anaplasmosis).
Antibiotic prophylaxis for Lyme disease
- Doxycycline 200 mg orally as a single dose, administered within 72 hours of removal, is the standard recommendation when the following conditions are met: the tick is identified as Ixodes species, it has been attached for ≥36 hours, and the local incidence of Lyme disease exceeds 20 cases per 100,000 population.
- For patients with a known doxycycline allergy, a single dose of amoxicillin 2 g orally may be used, provided the same time constraints apply.
- Cefuroxime axetil is an alternative for those who cannot tolerate either doxycycline or amoxicillin, though the evidence for a single‑dose regimen is less robust.
Therapeutic regimens for confirmed infection
- Early localized Lyme disease: Doxycycline 100 mg orally twice daily for 10–14 days; amoxicillin 500 mg three times daily for 14 days; or cefuroxime axetil 500 mg twice daily for 14 days.
- Early disseminated disease (e.g., multiple erythema migrans, neurologic involvement): Doxycycline 100 mg twice daily for 21 days, or intravenous ceftriaxone 2 g daily for 14–28 days if severe neurologic or cardiac manifestations are present.
- Anaplasmosis: Doxycycline 100 mg twice daily for 10 days; alternative regimens are not recommended due to superior efficacy of doxycycline.
Adjunctive measures
- Remove the tick promptly with fine‑tipped tweezers, grasping close to the skin and pulling upward with steady pressure.
- Inspect the bite site for erythema migrans or other rash development; document size and progression.
- Advise the patient to monitor for flu‑like symptoms, fever, headache, or joint pain for up to 30 days, and to seek immediate care if such signs appear.
Follow‑up
- Schedule a clinical review 2–4 weeks after initial treatment to assess resolution of symptoms and any lingering signs.
- In cases of persistent or recurrent manifestations, consider serologic testing and possible extended antibiotic therapy.
The outlined protocol reflects current consensus guidelines and should be adapted to individual patient factors, including comorbidities, pregnancy status, and medication tolerability.