From the Guidelines
The primary treatment for tick-borne illnesses is antibiotics, with doxycycline being the first-line medication for most infections, including Lyme disease, ehrlichiosis, anaplasmosis, and Rocky Mountain spotted fever. For adults, the typical doxycycline regimen is 100mg twice daily for 10-21 days, depending on the specific infection and severity 1. Children under 8 years old may receive amoxicillin (50mg/kg/day divided into three doses) instead of doxycycline due to concerns about dental staining, though doxycycline is increasingly used for short courses even in younger children when necessary 1. Alternative antibiotics include azithromycin, cefuroxime, or amoxicillin for those who cannot take doxycycline. Early treatment is crucial for preventing complications, so therapy should begin promptly when tick-borne illness is suspected, often before laboratory confirmation 1. Supportive care including rest, adequate hydration, and antipyretics for fever may also be necessary. Some patients may experience a Jarisch-Herxheimer reaction (temporary worsening of symptoms) when treatment begins as bacteria die off. For severe cases, especially those involving neurological symptoms, intravenous antibiotics may be required. After treatment, most symptoms resolve within weeks, though fatigue and other symptoms may persist longer in some patients.
Key considerations in the treatment of tick-borne illnesses include:
- The use of doxycycline as the first-line treatment for most infections
- The importance of early treatment to prevent complications
- The need for supportive care, including rest, hydration, and antipyretics
- The potential for Jarisch-Herxheimer reactions and the need for close monitoring
- The consideration of alternative antibiotics for patients who cannot take doxycycline
It is essential to note that the treatment of tick-borne illnesses should be guided by the most recent and highest-quality evidence, and that the specific treatment regimen may vary depending on the individual patient's needs and circumstances 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. Relapsing fever due to Borrelia recurrentis.
The treatment for tick-borne illness includes doxycycline for certain infections such as:
- Rocky Mountain spotted fever
- Tick fevers caused by Rickettsiae
- Relapsing fever due to Borrelia recurrentis 2
From the Research
Treatment for Tick-Borne Illness
The treatment for tick-borne illness varies depending on the specific disease and stage of infection.
- For Rocky Mountain spotted fever, human monocytic ehrlichiosis, or human granulocytic ehrlichiosis, doxycycline is the antimicrobial treatment of choice for all patients, regardless of age 3.
- For Mediterranean spotted fever, doxycycline, chloramphenicol, and newer macrolides all appear to be effective therapies 3.
- For Lyme disease, therapy depends on the age of the child and stage of the disease.
- For tick-borne relapsing fever, doxycycline, penicillin V, and erythromycin are all effective treatments 3.
- For tularemia, hospitalized patients should receive gentamicin or streptomycin, while doxycycline and ciprofloxacin may be used for outpatients 3.
- For babesiosis, combination therapy with clindamycin and quinine is preferred, although the combination of azithromycin and atovaquone also appears promising 3.
General Treatment Guidelines
- Prompt diagnosis and treatment can prevent complications and death 6, 7.
- Treatment should not be delayed for laboratory confirmation if clinical findings suggest tick-borne disease 7.
- Empiric treatment is not indicated if no symptoms follow exposure to tick bites 7.
- Counseling patients on the use of protective clothing and tick repellents during outdoor activities can help minimize the risk of infection 6.