From the Guidelines
Tick bite prophylaxis with a single dose of doxycycline is recommended only in specific high-risk situations, as outlined in the most recent guidelines from 2021 1.
Key Criteria for Prophylaxis
The following criteria must be met for prophylaxis to be considered:
- The attached tick is identified as an adult or nymphal Ixodes scapularis (deer tick)
- The tick has been attached for at least 36 hours (based on engorgement or known time of attachment)
- Prophylaxis can be started within 72 hours of tick removal
- The local rate of infection of ticks with Borrelia burgdorferi is at least 20%
Recommended Prophylaxis Regimen
A single dose of oral doxycycline is recommended, with the following dosages:
- 200 mg for adults
- 4.4 mg/kg (up to a maximum dose of 200 mg) for children This approach is supported by high-quality evidence from the 2021 guidelines 1, which recommend prophylactic antibiotic therapy only for adults and children within 72 hours of removal of an identified high-risk tick bite.
Special Considerations
Doxycycline should be avoided in pregnant women and children under 8 years old due to potential side effects, as noted in the 2006 guidelines 1.
Monitoring for Symptoms
For those who don't meet criteria for prophylaxis, careful monitoring for symptoms of Lyme disease (especially the characteristic erythema migrans rash) for 30 days after tick removal is recommended, as outlined in the 2021 guidelines 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Tick Bite Prophylaxis
- Tick bite prophylaxis is required in areas where Lyme disease is endemic, as no vaccine is currently available against Lyme disease for humans 2.
- The use of antibiotic prophylaxis to prevent Lyme disease after a tick bite is worth further exploration, particularly in high-risk individuals such as residents of the coastal Northeast, northwest California, and the Great Lakes region 3.
- Single-dose doxycycline (200 mg orally) can be used as prophylaxis in selected patients, especially those who have been bitten by a tick in an area where Lyme disease is common 3, 2.
High-Risk Individuals
- Children and those spending extended time outdoors in wooded areas are at increased risk of contracting Lyme disease 3.
- Individuals who have been bitten by a tick that has fed for at least 36 hours are at higher risk of transmission of the causative bacterium, Borrelia burgdorferi 3.