Lyme Disease Management

Diagnosis

Clinical diagnosis is recommended without laboratory testing if erythema migrans develops, which typically appears 7-14 days (range 3-30 days) after tick detachment and should be at least 5 cm in diameter for secure diagnosis 1, 2
The characteristic skin manifestation of early Lyme disease, erythema migrans (EM), should be diagnosed clinically, and laboratory testing is not necessary when typical EM is present 2, 1
Monitoring for symptoms of early Lyme disease, such as erythema migrans rash, is recommended for 30 days after tick removal, with testing only when symptoms develop, and two-tier serologic testing may be appropriate if non-specific symptoms develop without rash 1

Use EPA-registered repellents containing DEET, picaridin, IR3535, oil of lemon eucalyptus (OLE), p-methane-3,8-diol (PMD), 2-undecanone, or permethrin on clothing to prevent future tick bites 3, 4
Wear protective clothing (long-sleeved shirts, pants, socks, closed-toe shoes) to prevent future tick bites 4
Perform regular tick checks on yourself, children, and pets after outdoor activities 4
Limit exposure to tick-infested habitats when possible 4

Remove the tick if still attached using fine-tipped tweezers, grasping as close to the skin as possible and pulling upward with steady pressure, according to the American Heart Association guidelines 5
Proper tick removal using fine-tipped tweezers inserted between the tick body and skin is recommended, and the bite area should be cleaned thoroughly with soap and water, alcohol, or iodine scrub, with the tick submitted for species identification if possible 1, 3, 4, 5
To remove a tick, grasp it as close to the skin as possible with clean fine-tipped tweezers or a commercial tick removal device, and pull upward with steady, even pressure perpendicular to the skin 4, 5
Clean the bite area thoroughly with soap and water, alcohol, or an iodine scrub, and wash hands thoroughly after handling the tick 4
Don't delay tick removal, as the risk of disease transmission increases with attachment time 5
Don't use fingers to remove ticks if tweezers are available, as this may increase infection risk 4
Don't use alternative removal methods like burning or applying substances to the tick, as these may increase disease transmission risk by causing the tick to regurgitate 4

Prophylactic antibiotics should only be given if all three high-risk criteria are met: identified Ixodes species tick, attachment for ≥36 hours, and bite occurred in a highly endemic area, with treatment given within 72 hours of tick removal 1, 2
For high-risk bites meeting all criteria, a single dose of doxycycline (200 mg for adults, 4.4 mg/kg up to 200 mg for children) is recommended 1, 2
The following criteria determine the need for prophylaxis:
For pregnant women, breastfeeding women, and children <8 years, consider amoxicillin, though evidence for its prophylactic efficacy is less robust than for doxycycline 2
Asymptomatic patients should not be tested after tick removal, regardless of risk factors, and antibiotics should not be routinely prescribed for all tick bites, with tick removal not delayed as transmission risk increases with attachment time 1, 2
Don't test asymptomatic patients for tick-borne diseases after a tick bite 1
Don't routinely prescribe antibiotics for all tick bites, reserve for high-risk situations only 1

The preferred treatment for adults is Doxycycline 100 mg twice daily for 10 days, as recommended by the Infectious Diseases Society of America (IDSA) 1
Alternative treatments include Amoxicillin 500 mg three times daily for 14 days and Cefuroxime axetil 500 mg twice daily for 14 days, as recommended by the Infectious Diseases Society of America (IDSA) 1
For children ≥8 years, the American College of Rheumatology recommends doxycycline 4.4 mg/kg/day in 2 divided doses (maximum 100 mg per dose) for 10 days 1
For pregnant women, the Infectious Diseases Society of America recommends amoxicillin 500 mg three times daily for 14 days 2