From the Guidelines
For a 6-year-old male with a recently removed deer tick and no symptoms, prophylactic treatment with doxycycline is not recommended due to the child's age and the lack of specific criteria being met, as outlined in the guidelines by the Infectious Diseases Society of America 1. The guidelines suggest that a single dose of doxycycline may be offered to children 8 years of age or older, but it is relatively contraindicated in children under 8 years old 1. Key considerations for prophylactic treatment include:
- The attached tick must be reliably identified as an adult or nymphal I. scapularis tick that is estimated to have been attached for 36 hours or more 1.
- Prophylaxis must be started within 72 hours of tick removal 1.
- The local rate of infection of these ticks with B. burgdorferi must be 20% or higher 1.
- Doxycycline treatment must not be contraindicated 1. Given that the child is under 8 years old and doxycycline is relatively contraindicated in this age group, the best course of action is to monitor the child closely for signs and symptoms of tickborne diseases, including Lyme disease, for up to 30 days 1. The father should be advised to watch for symptoms such as:
- Erythema migrans (bull's-eye rash)
- Fever
- Fatigue
- Headache
- Joint pain If symptoms develop, the child should be evaluated promptly for full treatment 1. Preventive measures for future tick exposure should also be discussed, including:
- Wearing protective clothing
- Using insect repellents containing DEET
- Checking for ticks daily
- Promptly removing any attached ticks 1.
From the Research
Patient Presentation and History
- A 6-year-old male presents for evaluation in urgent care with his father.
- The father reports removing a deer tick from the patient's neck after being in the woods for 3 days.
- The patient denies any symptoms, but the father is concerned about Lyme disease and requests preventative treatment.
Lyme Disease Treatment and Prevention
- According to 2, amoxicillin, doxycycline, and cefuroxim axetil are equally efficacious for early-localized Lyme disease, with azithromycin as an alternative.
- The study 3 recommends treating adults with amoxicillin or doxycycline for 14-21 days, but notes that doxycycline should not be used in children under 8 years old due to the risk of tooth and bone disorders.
- 4 suggests that successful treatment of erythema migrans can be accomplished with 20 days of oral doxycycline, amoxicillin, or cefuroxime axetil.
- Routine antibiotic prophylaxis is not justified after a tick bite, even in an endemic area, as the risk of infection is low 3.
Treatment Options for Children
- 2 recommends amoxicillin (50 mg/kg/day in 3 intakes) for children, but does not specify a dose for children under 8 years old.
- 3 notes that doxycycline should not be used in children under 8 years old, and recommends monitoring the skin around the bite and prescribing an antibiotic only if erythema migrans develops.
- There is limited information available on the efficacy and safety of amoxicillin in children with erythema migrans, and further studies are needed to determine the optimal treatment approach for this age group.
Efficacy of Antibiotic Treatment
- 5 found that doxycycline and tetracycline have similar efficacy in treating Lyme disease associated with erythema migrans.
- 6 demonstrated that a 14-day course of amoxicillin is highly effective in resolving erythema migrans and preventing the development of objective neurologic, cardiac, or rheumatologic manifestations in adult patients.