Treat The Bite!

Adult Treatment Recommendations 
Children's Treatment Recommendations 

Everyone Agrees- the sooner treatment begins after a bite by an infected tick the better! Ticks live in the dirt and consume blood from a number of wild and domesticated animals that can carry and transmit multiple disease causing organisms. Ticks are known to be infected with pathogens that can spread throughout the body quickly and cause a variety of mild to life-threatening symptoms. Waiting to see if the infections spread through your body, or if you get a rash, or if you get sick before treating does NOT make sense. Forget the old "wait and see" approach! Get it Right! Treat The Bite!

Important-  Less than 50% of adults get a rash after a tick bite and many do not notice any early symptoms.  Less than 10% of children get a rash.  Less than half of the people with reported cases of Lyme disease recall being bitten by a tick.  A tick does not have to be attached for more than 24, 48 or 72 hours to transmit Lyme and other diseases.   

Additional Information

Once tick borne disease organisms are entrenched in your body it is more costly to both your health and your wallet to get rid of them, if you can.  An ounce of prevention in this case can be worth a pound of cure!  

Save your money!  Forget the test!  Never depend on Lyme tests performed within a month of a tick bite!  Nearly everyone will test negative for Lyme disease within the first 1-4 weeks after being bitten by an infected tick (barring prior exposure).  It takes weeks for your body to produce enough antibodies to the Lyme bacterium to get a positive test result using the current tests and testing methods, if you ever get a positive test at all.  


Tests for Lyme disease miss 75% (or more) of people who are infected!

Tests for Lyme disease are only designed to detect a reaction to one strain.

There are over 300 known strains!

The CDC states for every case of Lyme disease reported, at least ten are missed.  Depending on unreliable tests to establish a "reported case" of Lyme disease allows even more cases to go undiagnosed, untreated and unreported, and results in more people suffering with chronic Lyme disease. 

According to a 1998 scientific study, treatment for early Lyme disease averaged $161 per patient. A patient with longstanding (chronic) Lyme disease spends an average of $61,243 per year, each year, with most insurers refusing to pay the bills.  Can you really afford to "wait and see"?  No, of course not!

NEW Lyme Disease Treatment Guidelines- 2014

(Very Limited Excerpts Only- To Provide A Basic Overview) 

Introduction- The IDSA Lyme disease treatment guidelines have not been updated since they were written in 2005.  There have been many scientific publications, clinical trials and another decade of observing and data collecting that is available now to potentially improve the outcome of those contracting Lyme disease.  Some of the conclusions, based on the most recent science and clinical observations, are:

“Clinicians should not use a single 200 mg dose of doxycycline for Lyme disease prophylaxis. Clinicians should promptly offer antibiotic prophylaxis for known Ixodes tick bites in which there is evidence of tick feeding, regardless of the degree of tick engorgement or the infection rate in the local tick population. The preferred regimen is 100–200 mg of doxycycline, twice daily for 20 days. Other treatment options may be appropriate on an individualized basis.  Most patients will place a high value on preventing chronic illness.   

Treatment regimens of 20 or fewer days of phenoxymethyl-penicillin, amoxicillin, cefuroxime or doxycycline and 10 or fewer days of azithromycin are not recommended for patients with EM [Lyme] rashes because failure rates in the clinical trials were unacceptably high.  Failure to fully eradicate the infection may result in the development of a chronic form of Lyme disease, exposing patients to its attendant morbidity and costs, which can be quite significant.

Clinicians should prescribe amoxicillin, cefuroxime or doxycycline as first-line agents for the treatment of EM [rash]. Azithromycin is also an acceptable agent, particularly in Europe, where trials demonstrated it either outperformed or was as effective as the other first-line agents [46–49]

Initial antibiotic therapy should employ 4–6 weeks of amoxicillin 1500–2000 mg daily in divided doses, cefuroxime 500 mg twice daily or doxycycline 100 mg twice daily or a minimum of 21 days of azithromycin 250–500 mg daily. 

Pediatric dosing for the individual agents is as follows: amoxicillin 50 mg/kg/day in three divided doses, with a maximal daily dose of 1500 mg; cefuroxime 20–30 mg/kg/day in two divided doses, with a maximal daily dose of 1000 mg and azithromycin 10 mg/kg on day 1 then 5–10 mg/kg daily, with a maximal daily dose of 500 mg. 

For children 8 years and older, doxycycline is an additional option. Doxycycline is dosed at 4 mg/kg/day in two divided doses, with a maximal daily dose of 200 mg. Higher daily doses of the individual agents may be appropriate in adolescents.

Selection of the antibiotic agent and dose for an individual patient should take several factors into account. In the absence of contraindications, doxycycline is preferred when concomitant Anaplasma or Ehrlichia infections are possibilities. Other considerations include the duration [27,32,50] and severity [50–53] of symptoms, medication tolerability, patient age, pregnancy status, co-morbidities, recent or current corticosteroid use [54,55] cost, the need for lifestyle adjustments to accommodate certain antibiotics and patient preferences. 

Variations in patient-specific details and the limitations of the evidence imply that clinicians may, in a variety of circumstances, need to select therapeutic regimens utilizing higher doses, longer durations or combinations of first-line agents.

Clinicians should continue antibiotic therapy for patients who have not fully recovered by the completion of active therapy. Ongoing symptoms at the completion of active therapy were associated with an increased risk of long-term failure in some trials and therefore clinicians should not assume that time alone will resolve symptoms. There is a wide range of options and choices must be individualized, based on the strength of the patient’s initial response.

Disease progression or recurrence suggests that the iv. antibiotics or injectable penicillin G benzathine, as discussed previously, may be required. For patients requiring antibiotic therapy beyond the initial treatment period, subsequent decisions regarding the modification or discontinuation of treatment should be based on the therapeutic response and treatment goals.

Clinicians should retreat patients who were successfully treated initially but subsequently relapse or have evidence of disease progression. Therapeutic options include repeating the initial agent, changing to another oral agent or instituting injectable penicillin G benzathine or iv. ceftriaxone therapy. Choices must be individualized and based on several factors, including: the initial response to treatment; the time to relapse or progression; the current disease severity and the level of QoL impairments.

Disease relapse or progression with mild manifestations or QoL impairments occurring within a few months of treatment suggests a need for longer regimens using either tetracycline, a combination of oral first-line agents, injectable penicillin G benzathine or iv. ceftriaxone. 

Regardless of the duration of disease latency, when disease manifestations or QoL impairments are significant or rapidly progressive, injectable penicillin G benzathine or iv. ceftriaxone may be required.”


Evidence assessments and guideline recommendations in Lyme disease: the

clinical management of known tick bites, erythema migrans rashes and

persistent disease.    September 2014, Vol. 12, No. 9 , Pages 1103-1135 (doi:10.1586/ 14787210.2014.940900) Daniel J CameronLorraine B Johnson, and Elizabeth L Maloney  PDF (633 KB)   PDF Plus (639 KB) 1 International Lyme and Associated Diseases Society, PO Box 341461, Bethesda MD, 20827-1461,  USA 2, PO Box 1352, Chico, CA 95927, USA  3 Partnership for Healing and Health Ltd, PO Box 84, Wyoming, MN 55092, USA  *Author forcorrespondence: +1 914 666 4665



A printable version of  NEW Lyme Disease Treatment Guidelines 


Tick Bite 
Treatment Recommendations
Advanced Topics In Lyme Disease  
Dr. Joseph Burrascano, Jr.

Embedded Deer Tick With No Signs or Symptoms of Lyme 

Decide to treat based on the type of tick, whether it came from an endemic area, how it was removed, and length of attachment (anecdotally, as little as four hours of attachment can transmit pathogens).  

The risk of transmission is greater if the tick is engorged, or of it was removed improperly allowing the tick's contents to spill into the bite wound.  High-risk bites are treated as follows (remember the possibility of co-infection!): 


1) Adults:  Oral therapy for 28 days.


2) Pregnancy:  Amoxicillin 1000 mg q6h for 6 weeks.  Test for Babesia, Bartonella and Ehrlichia.  
  Alternative: Cefuroxime axetil 1000 mg q12h for 6 weeks.


3) Young Children:  Oral therapy for 28 days. 



Single erythema migrans [Lyme rash] with no constitutional symptoms: 

1) Adults:  oral therapy- must continue until symptom and sign free for at least one month, with a 6 week minimum.


2) Pregnancy:  1st and 2nd trimesters:  I.V.  X 30 days then oral X 6 weeks 3rd trimester:  Oral therapy X 6+ weeks as above. Any trimester- test for Babesia and Ehrlichia. 

3) Children:  oral therapy for 6+ weeks.


ORAL THERAPY: Always check blood levels when using agents marked with an *, and adjust dose to achieve a peak level above ten and a trough greater than three. Because of this, the doses listed below may have to be raised. Consider Doxycycline first in early Lyme due to concern for Ehrlichia co-infections.

*Amoxicillin- Adults: 1g q8h plus probenecid 500mg q8h; doses up to 6 grams daily are often needed

Pregnancy: 1g q6h and adjust.

Children: 50 mg/kg/day divided into q8h doses.

*Doxycycline- Adults: 200 mg bid with food; doses of up to 600 mg daily are often needed, as doxycycline is only effective at high blood levels. Not for children or in pregnancy. If levels are too low at tolerated doses, give parenterally or change to another drug.

SOURCE:  ADVANCED TOPICS IN LYME DISEASEDIAGNOSTIC HINTS AND TREATMENT GUIDELINES FOR LYME AND OTHER TICK BORNE ILLNESSES  Sixteenth Edition.  Copyright October, 2008.  JOSEPH J. BURRASCANO JR., M.D.  Board Member, International Lyme and Associated Diseases Society [MANAGING LYME DISEASE, 16h  edition, October, 2008  Page 18 of 37]   

About the Author-  Dr. Joseph Burrascano lives and worked in one of the most endemic areas of the country.  He treated over 11,000 people for Lyme and tick borne diseases.  He has over 25 years experience in the therapeutic areas of Internal Medicine and Infectious Diseases.  Dr. Burrascano also has a wide range of experience with clinical trials and has been a contributing author to numerous scientific articles for both the lay and peer-reviewed press.

 Dr. Joseph Burrascano's Advanced Topics in Lyme Disease

Full Guidelines

Click Here

For a one page PRINTABLE document of 
Dr. Burrascano's treatment recommendations 
To take with you to your doctor
Or use as a handout to educate others 
Please click on the PDF link below.

                        Treating Tick Bites & Rashes- June 2014.pdf 

See Dr. Burrascano's Study

Effectiveness of Vancomycin in Treatment-Resistant Lyme

On PDF Below- Titled JoeVanco.pdf

Last Updated: September 2016
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