From the Guidelines
The patient should receive a single dose of oral doxycycline, 200 mg, within 72 hours of tick removal as chemoprophylaxis for Lyme disease, as this is a high-risk tick bite. According to the clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) 1, a single dose of oral doxycycline is recommended for high-risk Ixodes spp. bites in all age groups. The guidelines suggest that doxycycline should be administered within 72 hours of tick removal, which is still possible in this case.
Key considerations for this recommendation include:
- The tick bite occurred in a high-risk setting (woods)
- The patient has already had the tick removed, but the head was initially left behind, which may increase the risk of infection
- The patient denies any symptoms of Lyme disease, such as joint pain, neck pain, fever, or rash, but it is still early in the course of potential infection
- The location of the tick bite and the geographic region are important factors in determining risk, but the guidelines recommend chemoprophylaxis for high-risk bites regardless of these factors 1
It is essential to note that the patient should still be monitored for symptoms of tick-borne illnesses, such as development of a rash, fever, headache, fatigue, muscle/joint pain, or neck stiffness, over the next 30 days. If such symptoms develop, she should seek immediate medical attention as these could indicate Lyme disease or other tick-borne illnesses.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Patient Presentation
The patient is a 43-year-old female who presents for evaluation in urgent care after sustaining a tick bite. She reports that the tick was removed, but the head was left behind and was later removed by her significant other. The patient denies any joint pain, neck pain, fever, or rash, and has no past medical history of Lyme disease.
Risk of Lyme Disease
- The patient is at risk of developing Lyme disease, which is the most common tick-borne disease in the United States 2.
- The disease is transmitted to humans through the bite of the Ixodes tick, and the tick must feed for at least 36 hours for transmission of the causative bacterium, Borrelia burgdorferi, to occur 2.
- The patient's symptoms, or lack thereof, do not necessarily rule out the possibility of Lyme disease, as the disease can present in different stages with varying clinical features 2.
Antibiotic Prophylaxis
- There is evidence to suggest that antibiotic prophylaxis can be effective in preventing Lyme disease in patients who have been bitten by a tick 2.
- A single dose of doxycycline (200 mg orally) can be used as prophylaxis in selected patients 2.
- However, the use of antibiotic prophylaxis is not without controversy, and the risk of antibiotic resistance must be considered 3, 4, 5, 6.
- The decision to use antibiotic prophylaxis should be made on a case-by-case basis, taking into account the patient's individual risk factors and medical history 2.