First-Line Treatment for Tick Bites
Remove the tick immediately using fine-tipped tweezers by grasping the head as close to the skin as possible and pulling upward with steady, even pressure. 1
Immediate Tick Removal
Grasp the tick's head as close to the skin as possible with fine-tipped tweezers or a commercial tick removal device and pull upward with steady, even pressure. 1, 2
Remove the tick as quickly as possible because disease transmission risk increases significantly after 24-48 hours of attachment. 1, 3
The speed of removal matters more than the technique—in honeybee sting studies (similar principle), the area of reaction corresponded directly to the time the stinger remained in the skin. 1
What NOT to Do
Never use burning methods, petroleum jelly, nail polish, gasoline, kerosene, or other chemicals to remove ticks—these methods are ineffective and potentially harmful. 2
Do not crush the tick with your fingers or remove it with bare hands when possible. 2
Post-Removal Care
Clean the bite area thoroughly with soap and water, alcohol, or iodine scrub immediately after removal. 1, 2
Wash your hands thoroughly after handling the tick to prevent potential infection transmission. 2
If tick mouthparts remain embedded, clean the site and leave them alone—attempting further removal causes unnecessary tissue damage and does not increase infection risk. 2
Antibiotic Prophylaxis Decision Algorithm
Prophylactic antibiotics are NOT routinely recommended for all tick bites. 4 Consider prophylaxis ONLY if ALL three high-risk criteria are met:
High-Risk Criteria (All Must Be Present)
The tick is identified as an Ixodes scapularis (blacklegged tick) 1, 2, 4
The bite occurred in a highly endemic Lyme disease area (parts of New England, mid-Atlantic states, Minnesota, Wisconsin with ≥20% tick infection rates) 2, 4
The tick was attached for ≥36 hours (estimated by degree of engorgement with blood or known time of exposure) 1, 2, 4
Additional Requirements for Prophylaxis
Prophylactic Antibiotic Regimen
If all criteria are met, give a single dose of oral doxycycline: 4
Children ≥8 years: 4.4 mg/kg (maximum 200 mg) orally once 2, 4
Children <8 years and pregnant women: Doxycycline is relatively contraindicated; single-dose prophylaxis with amoxicillin has not been established and is not recommended. 5, 4
Important Caveats About Prophylaxis
A single dose of doxycycline may prevent Lyme disease but not necessarily other tick-borne diseases like babesiosis, anaplasmosis, or Rocky Mountain spotted fever. 2, 5
Even with prophylactic treatment, some people may still develop Lyme disease requiring additional treatment. 5
If the tick bite cannot be classified with high certainty as high-risk, use a wait-and-watch approach rather than empiric antibiotics. 4
Post-Bite Monitoring (Critical for All Patients)
Monitor all bite areas for 30 days for signs of infection or development of erythema migrans (expanding "bullseye" rash). 2, 4
Watch for symptoms of tick-borne diseases including fever, headache, muscle pain, joint pain, and rash. 2
For Rocky Mountain spotted fever specifically, watch for petechial rash starting on wrists, forearms, and ankles. 2
When to Seek Immediate Medical Attention
Prompt consultation with a healthcare professional is recommended within 72 hours after removal of an engorged tick in regions with high Lyme disease prevalence. 1
Seek immediate care if erythema migrans (expanding rash) develops at any bite site. 2
In Rocky Mountain spotted fever endemic areas, doxycycline treatment is recommended at the first sign of fever or rash—do not wait for laboratory confirmation. 1, 6
Common Pitfalls to Avoid
Delaying tick removal increases disease transmission risk—remove immediately upon discovery. 2
Not all tick bites require antibiotics—prophylaxis is only indicated for high-risk bites meeting all specific criteria. 2, 4
Do not test the tick for infections—finding Borrelia burgdorferi DNA in a tick does not prove the patient will develop Lyme disease. 7, 6
Do not give routine antibiotic prophylaxis if no symptoms follow tick exposure. 8, 3