What is the recommended prophylaxis for tick-borne disease after a tick bite in Edinburgh?

Prophylaxis for Tick-Borne Disease After Tick Bite in Edinburgh

For tick bites in Edinburgh, prophylactic antibiotic therapy with a single 200 mg dose of oral doxycycline is recommended only if all three high-risk criteria are met: (1) identified Ixodes species tick, (2) tick attached for ≥36 hours, and (3) treatment can be given within 72 hours of tick removal. 1

Initial Management of Tick Bite

1. Immediate tick removal

   • Remove the tick as soon as possible using fine-tipped tweezers or a commercial tick removal device 1
   • Grasp the head of the tick as close to the skin as possible and pull upward with steady, even pressure 1
   • Do NOT burn the tick or apply chemicals to remove it 1

2. Tick identification

   • Submit the removed tick for species identification 1
   • This is crucial as prophylaxis is only indicated for Ixodes species ticks 1

Risk Assessment for Prophylaxis

Assess the following three criteria to determine if prophylactic antibiotics are warranted:

1. Tick species: Must be an identified Ixodes species (I. ricinus is the main vector in Europe) 1
2. Attachment duration: Must be attached for ≥36 hours (can be estimated by degree of engorgement) 1
3. Timing: Antibiotics must be administered within 72 hours of tick removal 1

Prophylactic Treatment Protocol

If ALL three high-risk criteria are met:

• Adults: Single oral dose of doxycycline 200 mg 1, 2
• Children ≥8 years: Single oral dose of doxycycline 4.4 mg/kg (maximum 200 mg) 1, 2

When Prophylaxis is NOT Recommended

• Tick species cannot be identified as Ixodes 1
• Tick attached for <36 hours 1
• More than 72 hours have passed since tick removal 1
• For these cases, adopt a "wait-and-watch" approach 1

Monitoring After Tick Bite

• Do NOT test asymptomatic patients for B. burgdorferi exposure after tick bite 1
• Monitor for symptoms of early Lyme disease, particularly erythema migrans (bull's-eye rash) 1
• If symptoms develop, treat according to Lyme disease protocols:
  • Doxycycline 100 mg twice daily for 10 days, OR
  • Amoxicillin or cefuroxime for 14 days 1

Evidence and Efficacy

• Single-dose doxycycline prophylaxis has shown a 67% relative risk reduction in European studies with Ixodes ricinus ticks 3
• The number needed to treat is approximately 51 patients to prevent one case of Lyme disease 3
• Prophylactic efficacy decreases dramatically when treatment is delayed beyond 24 hours after tick removal 4

Important Caveats

• Prophylaxis is only effective against Lyme disease, not other tick-borne diseases 1
• For areas where Rocky Mountain Spotted Fever is endemic, prophylaxis is not recommended, but treatment should begin at first sign of fever or rash 1
• The window for effective prophylaxis is narrow—treatment must be given promptly after tick removal 4
• Recent data suggests Lyme disease prophylaxis may be underprescribed, particularly in children 5

Remember that prophylactic treatment is only warranted when all three high-risk criteria are met. Otherwise, careful monitoring for symptoms is the recommended approach.