Prevention of Lyme Disease after Tick Bites

Criteria for Prophylactic Treatment

The American College of Cardiology and other guideline societies recommend prophylactic antibiotic treatment only when the tick is identified as an Ixodes scapularis, the tick was attached for ≥36 hours, the bite occurred in a highly endemic area, doxycycline can be administered within 72 hours of tick removal, and doxycycline is not contraindicated for the patient 1, 3, 4, 5
The tick bite should occur in regions with high prevalence of Lyme disease, such as parts of New England, mid-Atlantic states, Minnesota, Wisconsin with ≥20% tick infection rates 5, 6

The Infectious Diseases Society of America recommends a single dose of 200 mg for adults and 4.4 mg/kg (up to maximum 200 mg) for children ≥8 years 4, 5

Clinical trials demonstrate that a single dose of prophylactic doxycycline given within 72 hours after an Ixodes scapularis tick bite can prevent Lyme disease, with a strength of evidence supporting this recommendation 3, 4

The Arthritis and Rheumatology society recommends a wait-and-watch approach if a tick bite cannot be classified with high certainty as high-risk 4
Routine prophylaxis is not recommended for all tick bites, only those meeting all high-risk criteria, as stated by the Clinical Infectious Diseases society 4, 5

Doxycycline is relatively contraindicated in pregnant women and children <8 years old, according to the Clinical Infectious Diseases society 5, 6

Patients should monitor for signs and symptoms of tick-borne diseases for 30 days, including development of erythema migrans, flu-like symptoms, and swollen lymph nodes 7

The use of protective clothing and EPA-registered tick repellents, such as DEET, picaridin, IR3535, oil of lemon eucalyptus, PMD, 2-undecanone, or permethrin, is recommended by the Arthritis and Rheumatology society 4, 7
Daily full-body tick checks and prompt removal of attached ticks using fine-tipped tweezers are also recommended 1, 3, 4, 7