From the Guidelines
If you have a symptomatic tick bite with a bullseye rash (erythema migrans), you should seek immediate medical attention and start treatment with oral antibiotics, typically doxycycline 100mg twice daily for 10-14 days for adults, as recommended by the most recent guidelines 1. The bullseye rash is a classic sign of Lyme disease, and early intervention with antibiotics can prevent progression to more serious complications.
- The recommended treatment duration is 10-14 days for adults, but it may vary depending on the patient's condition and response to treatment.
- Alternative options include amoxicillin 500mg three times daily for 14-21 days (preferred for children and pregnant women) or cefuroxime axetil 500mg twice daily for 14-21 days.
- While taking antibiotics, you may experience a Jarisch-Herxheimer reaction (temporary worsening of symptoms) as bacteria die off.
- Complete the full course of antibiotics even if symptoms improve.
- The bullseye rash appears because Borrelia burgdorferi bacteria, transmitted through the tick bite, trigger an inflammatory response as they spread outward through the skin.
- Document the rash with photos if possible, remove any attached tick properly using fine-tipped tweezers, and monitor for additional symptoms like fever, fatigue, headache, or joint pain which may indicate disease progression.
- It is essential to note that the treatment guidelines may vary depending on the patient's age, condition, and other factors, and it is always best to consult with a healthcare professional for personalized advice 1.
From the FDA Drug Label
Doxycycline is indicated for the treatment of the following infections: Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers caused by Rickettsiae. Relapsing fever due to Borrelia recurrentis.
The treatment for a symptomatic tick bite and bullseye rash is doxycycline. The bullseye rash is a characteristic symptom of Lyme disease, which is caused by the bacterium Borrelia burgdorferi, but the drug label mentions Relapsing fever due to Borrelia recurrentis as an indication for doxycycline treatment. Although Borrelia recurrentis is a different species, doxycycline is commonly used to treat Lyme disease. Key points:
- Doxycycline is the recommended treatment
- The drug label does not explicitly mention Lyme disease, but Borrelia is mentioned as a treated infection 2
From the Research
Symptomatic Tick Bite and Bullseye Rash Treatment
- The treatment for symptomatic tick bite and bullseye rash, which are common manifestations of Lyme disease, typically involves the use of antibiotics 3, 4.
- According to a network meta-analysis, oral amoxicillin (1.5 g/day), oral azithromycin (0.5 g/day), injectable ceftriaxone, and injectable cefotaxime were found to be effective for treating Lyme disease 3.
- Another study suggests that short-term antibiotic therapy (≤ 10 days for erythema migrans and ≤ 21 days for disseminated Lyme borreliosis) may be as effective as long-term therapy, but more research is needed to confirm this 5.
- First-line treatment options for erythema migrans include oral amoxicillin and doxycycline, while alternative second-line options include phenoxymethylpenicillin, cefuroxime axetil, and azithromycin 4.
- Ceftriaxone and doxycycline have been shown to be effective in treating Lyme arthritis and neuroborreliosis, but their efficacy in late Lyme borreliosis is less clear 4.