Treatment for a 2-Year-Old with Tick Bite and Positive Exposure to Lyme Disease
For a 2-year-old with a tick bite and positive exposure to Lyme disease, amoxicillin at 50 mg/kg per day divided into 3 doses (maximum 500 mg per dose) for 14 days is the recommended treatment. 1
Initial Assessment and Treatment Decision
- For children under 8 years of age, doxycycline is relatively contraindicated due to potential dental staining concerns, despite some recent evidence suggesting it may be safe 1, 2
- Amoxicillin is the first-line treatment for children under 8 years with Lyme disease 1, 3
- The treatment duration should be 14 days (range 14-21 days) for early Lyme disease 1
Treatment Options Based on Clinical Presentation
If the child has erythema migrans (bullseye rash):
- Immediate treatment with amoxicillin at 50 mg/kg per day in 3 divided doses (maximum 500 mg per dose) for 14 days 1
- Cefuroxime axetil is an alternative at 30 mg/kg per day in 2 divided doses (maximum 500 mg per dose) 1
If the child has neurological involvement:
- Ceftriaxone (50-75 mg/kg per day) in a single daily dose (maximum 2 g) is recommended 1
- Alternative options include cefotaxime (150-200 mg/kg per day) divided into 3-4 doses (maximum 6 g per day) or penicillin G (200,000-400,000 units/kg per day) 1
Post-Exposure Monitoring
- Monitor the child for signs and symptoms of tick-borne diseases for up to 30 days 1, 4
- Pay particular attention to the development of:
Important Considerations and Pitfalls
- Prophylactic treatment is generally not recommended for children under 8 years due to doxycycline contraindication 1, 4
- Do not use macrolide antibiotics (azithromycin, clarithromycin, erythromycin) as first-line therapy as they are less effective than amoxicillin 1
- The 72-hour window for prophylaxis has passed in this case, making full treatment necessary if infection is suspected 5, 4
- Children generally have excellent prognosis with appropriate treatment, even with late manifestations like Lyme arthritis 3