What are the pediatric guidelines for doxycycline (Doxycycline) for Lyme disease (Lyme borreliosis) prophylaxis?

From the Guidelines

For pediatric Lyme disease prophylaxis, a single dose of doxycycline is recommended for children of all age groups who meet specific criteria, with a dosage of 4.4 mg/kg up to a maximum of 200 mg as a one-time dose, administered within 72 hours of tick removal, as supported by the strongest and most recent evidence 1. The dosage is based on the patient's weight, with a maximum dose not exceeding 200 mg. This prophylaxis should be considered when all of the following conditions are met:

• the attached tick is identified as an Ixodes species (deer tick)
• the tick has been attached for at least 36 hours based on engorgement or known time of attachment
• the local rate of infection of ticks with Borrelia burgdorferi is significant
• doxycycline is not contraindicated. For children, the benefits of prophylaxis generally outweigh the risks, and recent guidelines suggest that doxycycline can be safely administered to children of all ages 1. Prophylaxis works by eliminating the bacteria before it can establish infection, as B. burgdorferi typically requires at least 36 hours of tick attachment to transmit effectively from the tick's midgut to the human host. Key considerations for pediatric Lyme disease prophylaxis include:
• Monitoring for symptoms of Lyme disease such as erythema migrans (bull's-eye rash), fever, or joint pain
• Ensuring the tick is properly identified and the attachment time is estimated
• Evaluating the local rate of infection of ticks with Borrelia burgdorferi
• Assessing the risk-benefit ratio of doxycycline administration in children.

From the FDA Drug Label

For children above eight years of age: The recommended dosage schedule for children weighing 100 pounds or less is 2 mg/lb of body weight divided into two doses on the first day of treatment, followed by 1 mg/lb of body weight given as a single daily dose or divided into two doses, on subsequent days. Inhalational anthrax (post-exposure): CHILDREN: weighing less than 100 lb (45 kg); 1 mg/lb (2.2 mg/kg) of body weight, by mouth, twice a day for 60 days. There is no information about Lyme disease prophylaxis in the provided text, only information about other diseases. Doxycycline dosage for children is provided, but it is not specific to Lyme disease. The FDA drug label does not answer the question.

From the Research

Pediatric Guidelines for Doxycycline for Lyme Disease Prophylaxis

• The use of doxycycline for Lyme disease prophylaxis in pediatric patients is supported by several studies 2, 3, 4, 5, 6.
• A study published in 2021 found that a single dose of 200mg doxycycline administered within 72 hours of a tick bite can prevent the development of Lyme borreliosis in patients aged 8 years and older 2.
• Another study published in 2014 found that pharmacist-initiated doxycycline prophylaxis can be effective in preventing Lyme disease in patients aged 18 years and older 3.
• An animal model study published in 2012 found that prophylactic antibiotic treatment of tick bites can be effective in preventing infection with Borrelia burgdorferi, but only if delivered promptly after tick removal 4.
• The American Academy of Pediatrics recommends that children aged 8 years and older who have been bitten by a tick in an area where Lyme disease is common should receive a single dose of 200mg doxycycline as prophylaxis 5.
• It is essential to note that doxycycline is not recommended for children under the age of 8 years due to the risk of tooth discoloration and other adverse effects 5, 6.

Dosage and Administration

• The recommended dosage of doxycycline for Lyme disease prophylaxis in pediatric patients is 200mg administered as a single dose 2, 5.
• The dose should be administered within 72 hours of tick removal 2, 4.
• It is crucial to follow the recommended dosage and administration guidelines to ensure the effectiveness of the prophylaxis and minimize the risk of adverse effects.

Special Considerations

• Pediatric patients who have been bitten by a tick in an area where Lyme disease is common should be closely monitored for signs and symptoms of the disease, even if they receive prophylaxis 5, 6.
• Patients who experience any adverse effects or symptoms after receiving doxycycline prophylaxis should be evaluated and treated promptly 3, 5.