From the Guidelines
For a tick bite with erythema migrans present for 12+ hours, the recommended treatment is doxycycline 100 mg taken orally twice daily for 10 days, as this duration has been shown to be effective in treating Borrelia burgdorferi, the bacterium causing Lyme disease, with moderate-quality evidence 1.
Key Considerations
- Doxycycline is the preferred antibiotic for adults, while amoxicillin is preferred for children under 8 years old due to potential teeth staining effects of doxycycline.
- The treatment duration for doxycycline is 10 days, while amoxicillin or cefuroxime axetil should be taken for 14 days.
- Patients should avoid sun exposure while taking doxycycline as it increases photosensitivity.
- Doxycycline should be taken with a full glass of water and can be taken with food if stomach upset occurs, though dairy products may reduce absorption.
Important Notes
- Early treatment with appropriate antibiotics is highly effective at preventing progression to later stages of Lyme disease.
- If the patient experiences severe headache, neck stiffness, heart palpitations, or joint pain, they should seek immediate medical attention as these could indicate disseminated infection requiring more intensive treatment.
- The recommended treatment is based on the most recent guidelines from the Infectious Diseases Society of America, American Academy of Neurology, and American College of Rheumatology, which provide strong recommendations with moderate-quality evidence 1.
From the FDA Drug Label
Adults: The usual dose of oral doxycycline is 200 mg on the first day of treatment (administered 100 mg every 12 hours) followed by a maintenance dose of 100 mg/day
- Doxycycline dosing for a tick bite with erythema migrans is not explicitly stated in the provided drug label. The FDA drug label does not answer the question.
From the Research
Tick Bite and Erythema Migrans Treatment
- A tick bite with erythema migrans is typically treated with antibiotics, such as doxycycline, to prevent the progression of Lyme disease 2, 3.
- The recommended dosage and duration of doxycycline treatment may vary depending on the patient's age, weight, and other factors.
Doxycycline Dosing for Erythema Migrans
- A study published in The Lancet. Infectious diseases found that 7 days of oral doxycycline (100 mg twice a day) was non-inferior to 14 days of treatment in adults with solitary erythema migrans 2.
- Another study published in Clinical infectious diseases found that 10 days of doxycycline treatment was not inferior to 15 days of treatment in adult European patients with erythema migrans 4.
- The typical dosage of doxycycline for adults is 100 mg twice a day, but the duration of treatment may vary from 7 to 14 days or more, depending on the severity of the infection and the patient's response to treatment 2, 3, 4.