Acute Tick Bite Clinic

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 adults, we generally recommend 100 mg 2 times a day. We recommend 2.2 mg/kg 2 times a day for a child of any age. We use this dose in children of any age for up to three weeks. In children under eight years of age, we use a different antibiotic at three weeks due to a concern of possible tooth staining. Recent studies show that using doxycycline for three weeks or less does not cause tooth staining.

If someone cannot take doxycycline, the alternative antibiotics include amoxicillin, cefuroxime, and azithromycin. However, no studies show these alternatives' proper dose or duration.
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 recommends a single course of 200 mg of doxycycline for adults and a similar dose based on weight in children. We strongly disagree with this recommendation. This recommendation is based on one small study that lasted six weeks only. The study aimed to prevent Lyme disease's development 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 bull’s 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 that 20 days of doxycycline prevents Lyme disease. So it seems appropriate to treat for at least this period of time. We do not have any human studies documenting 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.