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 completely using fine-tipped tweezers, grasping it as close to the skin as possible and pulling upward with steady pressure. The bite area should then be cleaned 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 if fever, headache, fatigue, muscle aches, joint pain, or an expanding rash develop within 3-30 days after the bite It is crucial to note that prompt removal is vital because many tick-borne diseases require the tick to be attached for 24-48 hours before transmission occurs, as stated in the guidelines by the Infectious Diseases Society of America 1. Additionally, if the tick bite cannot be classified with a high level of certainty as a high-risk bite, a wait-and-watch approach is recommended, according to the clinical practice guidelines by the Infectious Diseases Society of America, American Academy of Neurology, and American College of Rheumatology 1. In areas with high prevalence of tick-borne diseases like Lyme disease, Rocky Mountain spotted fever, or ehrlichiosis, consider saving the tick in a sealed container for identification if symptoms develop later. The dosage of doxycycline for chemoprophylaxis is 200 mg for adults and 4.4 mg/kg (up to a maximum dose of 200 mg) for children, as recommended by the guidelines 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
- Lyme disease is the most common tick-borne disease in the United States, with approximately 20,000 cases reported annually 3
- The disease is transmitted to humans through the bite of the Ixodes tick and can be prevented with measures such as avoiding wooded areas and using insect repellent
Treatment Options
- Doxycycline or amoxicillin are commonly used to treat Lyme disease, with cefuroxime axetil or erythromycin as alternative options 3, 4
- Intravenous ceftriaxone or penicillin G may be used to treat late or severe disease 3
- A network meta-analysis found that oral amoxicillin, oral azithromycin, injectable ceftriaxone, and injectable cefotaxime were effective for treating Lyme disease 5
- Oral doxycycline was found to be equally effective as intravenous ceftriaxone in the treatment of Lyme neuroborreliosis 6
Clinical Practice Guidelines
- The Infectious Diseases Society of America, American Academy of Neurology, and American College of Rheumatology have developed clinical practice guidelines for the prevention, diagnosis, and treatment of Lyme disease 7
- These guidelines provide recommendations for primary care physicians and specialists caring for patients with Lyme disease, including those with neurologic, cardiac, and rheumatologic manifestations.