From the Guidelines
To treat a tick bite, a single dose of oral doxycycline within 72 hours of tick removal is recommended for high-risk Ixodes spp. bites in all age groups, as it has been shown to be effective in preventing Lyme disease 1. When dealing with a tick bite, it is essential to remove the tick promptly using fine-tipped tweezers, grasping it as close to the skin as possible and pulling upward with steady pressure. After removal, clean the bite area with soap and water, rubbing alcohol, or an iodine scrub. Some key points to consider when treating a tick bite include:
- Applying an over-the-counter antibiotic ointment like Neosporin to prevent infection
- Using hydrocortisone cream (1%) or taking an oral antihistamine like Benadryl (diphenhydramine) following package directions for pain and itching
- Monitoring the bite site for signs of infection or rash, particularly a bull's-eye pattern which could indicate Lyme disease
- Seeking medical attention immediately if fever, rash, severe headache, muscle or joint pain, or flu-like symptoms develop within several weeks of a tick bite, as these symptoms could indicate tick-borne illnesses like Lyme disease, Rocky Mountain spotted fever, or ehrlichiosis, which require prescription antibiotics like doxycycline 1. It is crucial to note that prophylactic antibiotic therapy should only be given to adults and children within 72 hours of removal of an identified high-risk tick bite, but not for bites that are equivocal risk or low risk 1. The dosage of doxycycline recommended is 200 mg for adults and 4.4 mg/kg (up to a maximum dose of 200 mg) for children 1. In terms of prevention, the best currently available method for preventing infection with *B. burgdorferi and other Ixodes species–transmitted pathogens is to avoid exposure to vector ticks, and if exposure is unavoidable, measures such as using protective clothing and tick repellents, checking the entire body for ticks daily, and prompt removal of attached ticks can reduce the risk of infection 1.
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.
- Tick bite treatment may involve the use of doxycycline, specifically for the treatment of tick fevers caused by Rickettsiae, such as Rocky Mountain spotted fever.
- The decision to use doxycycline for tick bite treatment should be based on the suspicion of a Rickettsial infection. 2
From the Research
Tick Bite Treatment Overview
- The most common tick-borne disease in the United States is Lyme disease, with approximately 20,000 cases reported annually 3.
- Residents of the coastal Northeast, northwest California, and the Great Lakes region are at highest risk, as well as children and those spending extended time outdoors in wooded areas 3.
Treatment Options
- Doxycycline or amoxicillin are commonly used to treat Lyme disease, with cefuroxime axetil or erythromycin as alternative options 3, 4.
- For late or severe disease, intravenous ceftriaxone or penicillin G may be necessary 3.
- A network meta-analysis found that oral amoxicillin, oral azithromycin, injectable ceftriaxone, and injectable cefotaxime were effective for treating Lyme disease 5.
- Cefuroxime and penicillin were found to be safe for treating Lyme disease, while amoxicillin was effective for treating erythema migrans 5.
Treatment Duration
- A study comparing 14-day and 28-day courses of ceftriaxone found that the shorter course was effective in eradicating signs and symptoms of late Lyme disease in the majority of patients 6.
- However, there were more treatment failures in the 14-day group, and the study did not have the power to determine if a subset of patients may benefit from the longer course of therapy 6.