Which medications should be used to treat children after a tick bite? - briefly
For prophylaxis after a confirmed tick bite, give a single dose of amoxicillin (50 mg/kg, max 200 mg) within 72 hours for children under 8 years, and a single dose of doxycycline (4 mg/kg, max 200 mg) for those 8 years and older. If early Lyme disease symptoms develop, treat with a 10‑day course of amoxicillin (or doxycycline for older children).
Which medications should be used to treat children after a tick bite? - in detail
A tick bite on a child requires prompt assessment and, when indicated, medication to prevent or treat infection. The choice of drug depends on the species of tick, the geographic region, the duration of attachment, and the presence of symptoms.
Prophylactic antibiotics
- Indicated when a nymphal or adult tick has been attached for ≥36 hours in an area where Lyme disease is endemic, and the bite occurred ≤72 hours ago.
- Doxycycline, 4 mg/kg once daily (maximum 200 mg), is the preferred agent for children ≥8 years and for younger children when the benefit outweighs the risk; recent guidelines accept its use in children of any age for Lyme prophylaxis.
- If doxycycline is contraindicated, amoxicillin 50 mg/kg/day divided twice daily for 10 days may be used, though it is less effective for early Lyme disease.
Treatment of confirmed Lyme disease
- Early localized disease (single erythema migrans lesion) – doxycycline 4 mg/kg once daily (max 200 mg) for 10 days; alternatives are amoxicillin 50 mg/kg/day in two doses or cefuroxime axetil 30 mg/kg/day in two doses.
- Disseminated disease (multiple lesions, neurologic involvement, arthritis) – same regimens extended to 21 days; for neurologic manifestations, doxycycline may be given for 14 days followed by oral therapy.
Other tick‑borne infections
- Ehrlichiosis and Anaplasmosis – doxycycline 4–5 mg/kg twice daily (max 200 mg per dose) for 7–14 days.
- Rocky Mountain spotted fever – doxycycline 2.2 mg/kg every 12 hours (max 100 mg per dose) for 7–10 days; early treatment is critical.
- Babesiosis – atovaquone 20 mg/kg three times daily plus azithromycin 10 mg/kg once daily for 7–10 days; pediatric dosing adjusted by weight.
- Tularemia – streptomycin 20 mg/kg intramuscularly every 8 hours for 7–10 days, or gentamicin 5 mg/kg once daily for the same duration.
Supportive and symptomatic care
- Local inflammation may be managed with a short course of ibuprofen 10 mg/kg every 6‑8 hours.
- Antihistamines (e.g., cetirizine 0.25 mg/kg once daily) can alleviate itching from a bite site.
- Monitor for fever, rash, joint swelling, or neurologic signs; seek immediate medical attention if they develop.
Follow‑up
- Re‑examine the child 2–4 weeks after therapy completion to confirm resolution of lesions and absence of new symptoms.
- Serologic testing for Borrelia burgdorferi is recommended only after the initial 4‑week period to avoid false‑negative results.
Adhering to these medication protocols minimizes complications and ensures effective management of tick‑related illnesses in pediatric patients.