From the Guidelines
The management of a child with a recent tick bite in New Mexico involves careful observation for signs of tick-borne illnesses, such as Rocky Mountain spotted fever, tularemia, and anaplasmosis, and doxycycline is the recommended treatment for all ages 1.
Key Considerations
- Doxycycline dosage: 2.2 mg/kg body weight twice daily (orally or intravenously) for children weighing <100 lbs (45 kg), with a maximum dose of 100 mg per dose 1.
- Treatment duration: at least 3 days after subsidence of fever and until evidence of clinical improvement is noted, with a minimum treatment course of 5–7 days 1.
- Monitoring: parents should be advised to monitor for fever, rash, or other symptoms and seek medical attention if they occur, as delay in treatment can lead to severe disease and death 1.
Special Considerations
- Children under 8 years old: doxycycline is recommended for all ages, including children under 8 years old, as the risk of tooth staining is low 1.
- Pregnancy and lactation: doxycycline is recommended, but alternative treatments may be considered in cases of severe allergy or pregnancy 1.
Prevention
- Prophylactic use of doxycycline: not recommended after a tick bite for the prevention of tickborne rickettsial diseases 1.
From the Research
Appropriate Management for a Child with a Recent Tick Bite in New Mexico
- The management of a child with a recent tick bite in New Mexico depends on the specific tick-borne disease suspected, as different diseases require different treatments 2, 3, 4.
- For rickettsial infections such as Rocky Mountain spotted fever, ehrlichiosis, and anaplasmosis, doxycycline is the antimicrobial treatment of choice for all patients, regardless of age 2, 3, 4.
- For Lyme disease, the treatment depends on the age of the child and the stage of the disease, with amoxicillin recommended for children under 8 years old and doxycycline recommended for children 8 years old and older 2, 4.
- It is essential to maintain a high index of suspicion for tick-borne infections and to diagnose these illnesses presumptively, without waiting for confirmatory laboratory test results, to promptly start therapy with doxycycline, even in young children, when rickettsial infections are suspected 3.
- Counseling patients on the use of protective clothing and tick repellents during outdoor activities can help minimize the risk of infection, and prophylactic treatment after tick exposure in patients without symptoms is generally not recommended but may be considered within 72 hours of tick removal in specific patients at high risk of Lyme disease 4.
Specific Considerations for New Mexico
- Rocky Mountain spotted fever has been reported in Arizona, and the common brown dog tick (Rhipicephalus sanguineus) has been implicated as a vector of R. rickettsii, which raises concern about its potential to transmit R. rickettsii in other settings, including New Mexico 5.
- The management of tick-borne diseases in children should be guided by the specific disease suspected, the age of the child, and the stage of the disease, with doxycycline being the antimicrobial treatment of choice for rickettsial infections and amoxicillin or doxycycline recommended for Lyme disease, depending on the age of the child and the stage of the disease 2, 3, 4.
Diagnosis and Treatment
- The diagnosis of tick-borne diseases can be complex, and clinicians should maintain a high index of suspicion for these illnesses, especially in children who have recently been bitten by a tick 3, 4, 6.
- The treatment of tick-borne diseases should be guided by the specific disease suspected, with doxycycline being the antimicrobial treatment of choice for rickettsial infections and amoxicillin or doxycycline recommended for Lyme disease, depending on the age of the child and the stage of the disease 2, 3, 4.