What is the post-exposure prophylaxis (PEP) for a tick bite?

From the Guidelines

For individuals who have experienced a high-risk tick bite, a single dose of oral doxycycline within 72 hours of tick removal is recommended to prevent Lyme disease, with a dose of 200 mg for adults and 4.4 mg/kg (up to a maximum dose of 200 mg) for children 1. This approach is based on the latest guidelines from the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR), which emphasize the importance of prompt prophylactic antibiotic therapy in high-risk cases 1. The decision to provide prophylactic antibiotics depends on several factors, including:

• The type of tick, with Ixodes spp. being the primary vector for Lyme disease
• Geographic location, with areas of high endemicity posing a greater risk
• Duration of attachment, with ticks attached for 36 hours or more considered high-risk
• Local disease prevalence, with areas having a high rate of Borrelia burgdorferi infection in ticks posing a greater risk Key considerations for post-exposure prophylaxis include:
• The tick bite must be identified as high-risk, meeting specific criteria such as being from an Ixodes spp. vector species, occurring in a highly endemic area, and having an attachment duration of 36 hours or more
• Prophylaxis should be initiated within 72 hours of tick removal
• Careful observation for symptoms is preferred for pregnant women, children under 8 years old, and individuals with equivocal or low-risk tick bites
• Patients should monitor for symptoms like fever, rash, headache, or muscle pain for 30 days after a tick bite and seek medical attention if these develop
• Proper tick removal technique using fine-tipped tweezers is crucial to minimize disease transmission risk.

From the FDA Drug Label

Doxycycline is indicated for the treatment of the following infections: Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers caused by Rickettsiae. Relapsing fever due to Borrelia recurrentis. The answer is: No specific post-exposure prophylactic indication for tick bite is mentioned, however, doxycycline is indicated for the treatment of certain tick-borne diseases, such as Rocky Mountain spotted fever and relapsing fever due to Borrelia recurrentis 2.

From the Research

Post Exposure Prophylactic for Tick Bite

• The use of antibiotic prophylaxis to prevent Lyme disease after a tick bite has been explored in several studies 3, 4, 5, 6, 7.
• A study published in the Mayo Clinic proceedings in 2008 found that single-dose doxycycline (200 mg orally) can be used as prophylaxis in selected patients 3.
• Another study published in the Journal of the American Pharmacists Association in 2014 found that pharmacist-initiated antibiotic therapy can enhance public access to prophylaxis for Lyme disease following an identified Ixodes scapularis tick bite 4.
• A systematic review and meta-analysis published in BMC infectious diseases in 2021 found that the available evidence supports the use of antibiotics for the prevention of Lyme disease, and reveals advantages of using single-dose doxycycline 5.
• A study published in The Journal of antimicrobial chemotherapy in 2018 found that community pharmacies can play a role in improving access to appropriate post-exposure doxycycline for Lyme disease prophylaxis 6.
• The treatment and prevention of Lyme disease were also discussed in a study published in Current problems in dermatology in 2009, which found that oral amoxicillin and doxycycline are first-line treatment options for early stage Lyme borreliosis 7.

Antibiotic Prophylaxis

• The use of antibiotic prophylaxis to prevent Lyme disease after a tick bite is a topic of ongoing research 3, 4, 5, 6, 7.
• Doxycycline is the most commonly used antibiotic for prophylaxis, and a single dose of 200 mg orally has been shown to be effective in preventing Lyme disease 3, 5.
• Other antibiotics, such as amoxicillin and cefuroxime axetil, may also be used as alternatives 7.

Prevention and Treatment

• Prevention of Lyme disease is crucial, and individuals can reduce their risk by taking measures such as using insect repellent, wearing protective clothing, and conducting regular tick checks 3, 6.
• Treatment of Lyme disease typically involves the use of antibiotics, and early treatment is essential to prevent the development of late-stage disease 3, 7.