What is the recommended dosing of doxycycline (Doxycycline) for a tick bite?

From the Guidelines

For the prevention of Lyme disease following a high-risk tick bite, a single dose of oral doxycycline, 200 mg for adults and 4.4 mg/kg (up to a maximum dose of 200 mg) for children, is recommended within 72 hours of tick removal. This recommendation is based on the 2021 clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) 1.

Key Considerations

• The single-dose approach is specifically for preventing Lyme disease in high-risk areas.
• Doxycycline should be taken with a full glass of water, and patients should remain upright for 30 minutes after taking it to prevent esophageal irritation.
• Common side effects include photosensitivity, so sun protection is essential.
• Doxycycline is contraindicated in pregnant women, nursing mothers, and children under 8 years due to potential dental discoloration and bone growth effects.

Administration and Precautions

• The medication can be taken with food if stomach upset occurs, though dairy products may reduce absorption.
• Patients should be advised to take the medication as directed and to complete the full course of treatment, even if symptoms improve before finishing the medication.
• It is essential to note that doxycycline works by inhibiting bacterial protein synthesis, effectively stopping the growth and reproduction of the bacteria transmitted by infected ticks 1.

From the FDA Drug Label

Adults: The usual dose of oral doxycycline is 200 mg on the first day of treatment (administered 100 mg every 12 hours) followed by a maintenance dose of 100 mg/day Inhalational anthrax (post-exposure): ADULTS: 100 mg of doxycycline, by mouth, twice a day for 60 days.

The dosing of doxycycline for a tick bite is not explicitly stated in the provided drug label. However, for prophylaxis against tick-borne diseases such as Lyme disease, a dose similar to that for inhalational anthrax (post-exposure) may be considered, which is 100 mg of doxycycline, by mouth, twice a day. The duration of treatment is typically 10 to 21 days for prophylaxis against Lyme disease, but this information is not provided in the label. It is essential to consult a healthcare professional for the correct dosage and duration of treatment for a tick bite. 2

From the Research

Dosing of Doxycycline for Tick Bite

• The dosing of doxycycline for a tick bite is typically 200 mg orally as a single dose for prophylaxis 3, 4.
• For the treatment of Lyme disease, doxycycline is usually given at a dose of 100 mg twice daily for 3 to 4 weeks 5.
• A study found that single-dose doxycycline (200 mg orally) can be used as prophylaxis in selected patients to prevent Lyme disease after a tick bite 3.
• Another study confirmed the efficacy of single-dose doxycycline in preventing Lyme disease, with a pooled risk ratio of 0.29 (95% CI: 0.14-0.60) 4.

Considerations for Dosing

• The decision to use doxycycline for prophylaxis should be based on the individual's risk of developing Lyme disease and the presence of other medical conditions 6, 7.
• It is essential to note that doxycycline is not recommended for children under 8 years old or for pregnant women due to the potential risk of inhibiting bone growth and causing tooth discoloration 5, 3.
• The use of doxycycline for prophylaxis should be carefully considered, and patients should be informed about the potential benefits and risks of treatment 4, 7.