Tick Bite Treatment

You have a tick bite. Now what? First we recommend making sure you remove the tick safely, save it and send it to a lab such as tickreport.com or ticknology.com 

• We suggest treating with antibiotics for at least 20 days for a tick bite with no symptoms and no bullseye rash. 
• If a person has a bullseye rash or symptoms such as increased temperature, flu-like symptoms or neurologic symptoms then they should be treated for a minimum of four to six weeks and  then reassessed. 
• If there are any remaining symptoms, then treatment should continue with antibiotics until the symptoms are gone. This would be addressed during a subsequent visit. 

Our position is similar to the ILADS position.

Antibiotic Treatment. The antibiotic most used is Doxycycline because it treats Lyme and most of the co-infections should they be present. For an adult we generally recommend 100 mg 2 times a day. For a child of any age we recommend 2.2 mg/kg 2 times a day. We use this dose in children of any age for up to three weeks. In children under 8 years of age, we use a different antibiotic at 3 weeks due to a concern of possible tooth staining. Recent studies show that using doxycycline for 3 weeks or less does not cause tooth staining.

If someone cannot take doxycycline, the alternative antibiotics include amoxicillin, cefuroxime, and azithromycin. However, there are no studies showing the proper dose or duration of these alternatives.
We do not generally recommend herbal antibiotics on their own for an acute tick bite because there is no research evidence showing they work for an acute tick bite.

CDC/IDSA recommend a single course of 200 mg of doxycycline for an adult and similar dose based on weight in children. We strongly disagree with this recommendation. This recommendation is based on one small study which lasted six weeks only. The goal in the study was to prevent the development of Lyme disease by measuring whether or not a bullseye rash developed. No other Lyme symptoms or signs were followed. Remember that 30 percent of people who develop Lyme never have a bulls eye rash. So this is not an accurate way to determine if Lyme develops. In addition, six weeks is not enough time to determine if Lyme disease will develop.

Mice studies that looked for Lyme tissue damage show 20 days of doxycycline prevent Lyme disease. So it seems appropriate to treat for at least this period of time. The truth is we do not have any human studies that document the best length of time to treat asymptomatic tick bites or the proper length of antibiotics to use. My recommendations for treatment duration are based on my clinical experience of what works and the one mouse study showing 20 days prevents Lyme disease in infected mice.