What is the proper procedure after a tick bite to prevent tick-borne illnesses, such as Lyme disease?

Proper Management After a Tick Bite

Immediately remove the tick using fine-tipped tweezers by grasping as close to the skin as possible and pulling upward with steady pressure, then clean the area thoroughly—antibiotic prophylaxis is only indicated for high-risk bites meeting specific criteria within 72 hours of removal. 1

Immediate Tick Removal

• Remove the tick as soon as possible using clean fine-tipped tweezers or a comparable device inserted between the tick body and the skin, pulling upward with steady, constant pressure perpendicular to the skin. 1, 2

• Do NOT use burning methods (matches or heat devices), petroleum jelly, nail polish, gasoline, kerosene, or other noxious chemicals to remove the tick—these methods are ineffective and potentially harmful. 1, 3, 2

• Avoid crushing the tick or handling it with bare fingers, as fluids from the tick's body may contain infectious organisms. 2, 4

• If mouthparts remain embedded after removal, clean the site with soap and water, alcohol, or iodine scrub and leave the retained parts alone—attempting further removal causes unnecessary tissue damage and does not increase infection risk, as the body will naturally expel them over time. 3

Post-Removal Care

• Clean the bite area thoroughly with soap and water, alcohol, or an iodine scrub immediately after tick removal. 1, 3, 2

• Wash your hands thoroughly after handling the tick, especially before touching your face or eyes. 3, 2

• Consider submitting the tick for species identification to help determine disease risk. 1

Antibiotic Prophylaxis Decision Algorithm

Prophylactic antibiotics should ONLY be given if ALL three high-risk criteria are met AND within 72 hours of tick removal: 1, 3, 2

High-Risk Criteria (ALL must be present):

1. Tick species: Identified as Ixodes species (deer tick/black-legged tick) 1, 3
2. Geographic location: Bite occurred in a highly endemic area for Lyme disease 1, 3
3. Attachment duration: Tick was attached for ≥36 hours (can be estimated by degree of engorgement) 1, 3, 5

If ALL Three Criteria Are Met:

• Give a single dose of oral doxycycline within 72 hours of tick removal: 1, 3, 2
  • Adults: 200 mg orally once 1, 3, 2
  • Children ≥8 years: 4.4 mg/kg (maximum 200 mg) orally once 1, 3, 2
  • Pregnant women and children <8 years: Doxycycline is relatively contraindicated; use observation approach instead 3

If Criteria Are NOT All Met:

• Use a "wait-and-watch" approach rather than prophylactic antibiotics. 1
• Do NOT test asymptomatic patients for Borrelia burgdorferi exposure following a tick bite. 1

Post-Bite Monitoring (Critical for All Tick Bites)

• Monitor the bite site for 30 days for development of erythema migrans (expanding "bullseye" rash), which indicates Lyme disease. 3, 2, 6, 5

• Watch for symptoms of tick-borne diseases including fever, headache, muscle pain, joint pain, or fatigue. 3, 2, 6

• Seek immediate medical attention if erythema migrans develops at any bite site—this requires treatment regardless of prophylaxis status. 3, 6

• Be alert for petechial rash starting on wrists, forearms, and ankles, which may indicate Rocky Mountain Spotted Fever. 3

If Outside the 72-Hour Window

• Prophylaxis is no longer indicated after 72 hours from tick removal. 6

• Continue monitoring for 30 days for symptoms as described above. 6

• If Lyme disease develops, treat with a 10-day course of doxycycline OR a 14-day course of amoxicillin or cefuroxime axetil. 1, 6

Prevention of Future Tick Bites

• Use EPA-registered repellents containing DEET, picaridin, IR3535, oil of lemon eucalyptus (OLE), p-methane-3,8-diol (PMD), 2-undecanone, or permethrin on exposed skin. 1, 2, 6

• Apply permethrin to clothing for additional protection—this is highly effective and nontoxic to humans of all ages. 1, 2, 7, 8

• Wear protective clothing including long-sleeved shirts, long pants tucked into boots or socks, and closed-toe shoes when in tick-infested areas. 2, 6, 7

• Perform regular tick checks on yourself, children, and pets after spending time outdoors in endemic areas. 2, 6, 7

Common Pitfalls to Avoid

• Delaying tick removal increases disease transmission risk—the risk of Borrelia burgdorferi transmission increases significantly after 36 hours of attachment. 2, 7, 5

• Not all tick bites require antibiotics—prophylaxis is only indicated for high-risk bites meeting ALL three specific criteria. 1, 3, 2

• A single dose of doxycycline prophylaxis prevents Lyme disease but may not prevent other tick-borne diseases such as anaplasmosis, ehrlichiosis, or babesiosis. 3, 2

• Do not assume the tick species or attachment duration—if you cannot classify the bite with high certainty as meeting all three high-risk criteria, use the wait-and-watch approach. 1