From the Guidelines
Recommendation for Prophylactic Antibiotic Treatment
A 200 mg dose of doxycycline followed by a 5-day course of cephalexin is not recommended for a 78-year-old female with a partially removed tick (Ixodes species) embedding in her neck, in a non-endemic area for Lyme disease, as the guidelines suggest a single dose of doxycycline is sufficient for prophylaxis and cephalexin is ineffective against Lyme disease 1.
Key Considerations
- The tick bite does not meet the high-risk criteria since it occurred in a non-endemic area, despite being an Ixodes species tick 1.
- A single dose of 200 mg doxycycline is recommended for prophylaxis in high-risk tick bites, but this case does not qualify as high-risk due to the non-endemic location 1.
- Cephalexin is not effective for the treatment or prevention of Lyme disease and should not be used for this purpose 1.
- The patient's age and the fact that the tick was only partially removed do not change the recommendation for prophylactic antibiotic treatment in this scenario.
Prophylaxis and Treatment Guidelines
- For high-risk Ixodes spp. bites, a single dose of oral doxycycline within 72 hours of tick removal is recommended over observation 1.
- Doxycycline is given as a single oral dose of 200 mg for adults 1.
- Cephalexin and other first-generation cephalosporins are ineffective against Lyme disease and should not be used for prophylaxis or treatment 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) When used in streptococcal infections, therapy should be continued for 10 days
The FDA drug label does not answer the question.
From the Research
Treatment Recommendations
- There is no direct evidence to support the use of a 200 mg dose of doxycycline followed by a 5-day course of cephalexin for a 78-year-old female with a partially removed tick embedding in her neck, in a non-endemic area for Lyme disease 2, 3, 4, 5, 6.
- The provided studies focus on the epidemiology, management, and prevention of Lyme disease in non-endemic areas, but do not specifically address the recommended treatment for a partially removed tick embedding in the neck.
Lyme Disease in Non-Endemic Areas
- Lyme disease can occur in non-endemic areas, and its incidence has increased over the last decades 4.
- A study in a non-endemic area in Northern Italy reported a high percentage of Lyme disease infection (19%) 4.
- Another study in a non-endemic area in Germany found that the estimated cumulative lifetime incidence of Lyme borreliosis was 5.1% 5.
Diagnostic Testing
- Lyme serology testing should only be performed when there is a realistic possibility of exposure to infected ticks, particularly in patients who have had untreated erythema migrans or those with a history of a tick bite presenting with unexplained joint or neurological symptoms 6.
- Unnecessary Lyme serology testing in non-endemic areas may lead to false-positive results and unnecessary follow-up testing 6.