Prophylactic Actions After Seed Tick Nest Bites
Immediate Actions
- Remove all ticks as soon as possible using fine-tipped tweezers or a commercial tick removal device by grasping the head of the tick as close to the skin as possible and pulling upward with steady, even pressure 1, 4
- Do not burn the attached ticks or apply noxious chemicals or petroleum products to remove them 3
- Submit the removed ticks for species identification if possible 3
- Wash the bite area with soap and water after tick removal 1
Risk Assessment for Prophylactic Antibiotics
- The American College of Cardiology and Arthritis and Rheumatology recommend antibiotic prophylaxis when the tick can be identified as an Ixodes scapularis (blacklegged tick) and the tick was attached for ≥36 hours (based on degree of engorgement or known time of exposure) 1, 3, 5
- Prophylaxis can be started within 72 hours of tick removal in areas where the local rate of tick infection with Borrelia burgdorferi is ≥20% (parts of New England, mid-Atlantic states, Minnesota, and Wisconsin) 3, 6
Prophylactic Antibiotic Regimen
- For adults and children ≥8 years, a single 200 mg dose of oral doxycycline is recommended 3
- For children <8 years and pregnant women, doxycycline is relatively contraindicated; a single-dose prophylactic regimen with amoxicillin has not been established and is not recommended 3, 7
Monitoring After Tick Bite
- Monitor for signs and symptoms of tick-borne diseases for 30 days after tick removal, particularly for the development of erythema migrans (expanding rash) at the bite site 6, 8
- Be aware that antibiotic prophylaxis may not prevent other tick-borne diseases such as babesiosis 9