Guidance for Clinicians Recommendations for Patients after a Tick Bite When a patient seeks care after a tick bite, topics to discuss should include: Tick removal Lyme disease prophylaxis How to Remove a Tick Use fine-tipped tweezers to grasp the tick as close to the skin's surface as possible. Pull upward with steady, even pressure. Don't twist or jerk the tick. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol or soap and water. Kill a live tick by putting it in rubbing alcohol or placing it in a sealed bag/container. Save the tick for species identification and degree of tick engorgement (important when determining eligibility for Lyme disease prophylaxis). Symptom watch Table 1. Recommended Lyme disease* post-exposure prophylaxis. Age Category Drug Adults Children weighing less than 45 kg Doxycycline Doxycycline 200 mg orally N/A 4.4 mg/kg orally Once 200 mg Once * Antibiotic treatment following a tick bite is not recommended as a means to prevent tickborne diseases other than Lyme disease (such as anaplasmosis, babesiosis, ehrlichiosis, Rocky Mountain spotted fever). There is no evidence this practice is effective, and it may simply delay onset of disease. Dosage Maximum Duration Post-exposure prophylaxis for Lyme disease Antimicrobial prophylaxis for the prevention of Lyme disease (Table 1) following tick bite may be beneficial in certain circumstances. A single dose of doxycycline can lower the risk of Lyme disease when: * The tick bite occurred in a state where Lyme disease incidence is high (Figure 1) or in an area where >20% of ticks are infected with Borrelia burgdorferi. Contact your local health department for information about tick infection rates in your area. * The attached tick can be identified as an adult or nymphal blacklegged tick (Figure 2). * The estimated time of attachment is ≥36 hours based on the degree of tick engorgement with blood or likely time of exposure to the tick (Figure 3). * Prophylaxis can be started within 72 hours of tick removal. * The patient has no contraindication to doxycycline. C304282-A September 29, 2019 Diagnostics I Pharmaceuticals I DxRx Solutions I Continuing Education I News 19 A Henry Schein Publication