Embedded Deer Tick With No Signs or Symptoms of Lyme (see appendix): 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.
ANTIBIOTIC CHOICES AND DOSES
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.
ADVANCED TOPICS IN LYME DISEASE. DIAGNOSTIC 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 19 of 37 MANAGING LYME DISEASE, 16h edition, October, 2008- Page 18 of 37