However, accurate determinations of tick species and degree of engorgement are not routinely possible, and data are insufficient to demonstrate efficacy of antimicrobials in this setting. Furthermore, doxycycline is relatively contraindicated for women who are either pregnant or breast-feeding, as well as for children aged 48 h (on the basis of the degree of engorgement of the tick with blood), in conjunction with epidemiological information regarding the prevalence of tick-transmitted diseases (C-III). Many experts, however, disagree with key assumptions in the model. burgdorferi after a tick bite is ⩾.036 and should be considered when the theoretical probability ranges from. One cost-effectiveness analysis concluded that a 2-week course of doxycycline is indicated when the probability of infection with B. In 2 studies of prophylaxis for tick bites in which adverse effects of the antimicrobials used for prophylaxis were reported, the risk of acquiring Lyme disease after a tick bite was no different than the risk of developing adverse effects from the prophylactic antibiotics. In addition, 3 cases of minor amoxicillin-related adverse effects (e.g., diarrhea) would occur for every case of Lyme disease that was prevented. The authors of the meta-analysis estimated that if amoxicillin rather than doxycycline were used (to enable small children and pregnant or lactating women to receive prophylaxis), 8 cases of drug-associated rash, including 1 severe life-threatening reaction, would occur for every 10 cases of early Lyme disease that were prevented. Doxycycline is relatively contraindicated during pregnancy or lactation and for children aged 600 persons were enrolled) did not indicate that antimicrobial prophylaxis is effective (pooled OR, 0.0 95% CI, 0.0–1.5 P =. Doxycycline has the advantage of being efficacious for treatment of HGE, which may occur simultaneously with early Lyme disease. In prospective studies, these agents have been shown to be effective in treating erythema migrans and associated symptoms. Administration of doxycycline (100 mg twice daily) or amoxicillin (500 mg 3 times daily) for 14–21 days is recommended for treatment of early localized or early disseminated Lyme disease associated with erythema migrans, in the absence of neurological involvement or third-degree atrioventricular heart block (A-I). Prior vaccination with the recently licensed recombinant outer-surface protein A (OspA) vaccine preparation reduces the risk of developing Lyme disease associated with tick bites but should not alter the above recommendations (A-I).Įarly Lyme disease. Testing of ticks for tick-borne infectious organisms is not recommended, except in research studies (D-III). Health care practitioners, particularly those in areas where Lyme disease is endemic, should become familiar with its clinical manifestations, recommended practices for testing for it, and therapy for the disease, as well as for HGE and babesiosis (A-III). Persons who develop a skin lesion or other illness within 1 month after removing an attached tick should promptly seek medical attention for assessment of the possibility of having acquired a tick-borne disease (A-II). Persons who remove attached ticks should be monitored closely for signs and symptoms of tick-borne diseases for up to 30 days and specifically for the occurrence of a skin lesion at the site of the tick bite (which may suggest Lyme disease) or a temperature >38☌ (which may suggest human granulocytic ehrlichiosis or babesiosis). However, accurate determinations of species of tick and degree of engorgement are not routinely possible, and data are insufficient to demonstrate efficacy of antimicrobial therapy in this setting. scapularis ticks that are estimated to have been attached for >48 h (on the basis of the degree of engorgement of the tick with blood), in conjunction with epidemiological information regarding the prevalence of tick-transmitted infection (C-III). Some experts recommend antibiotic therapy for patients bitten by I. Routine use of either antimicrobial prophylaxis (E-I) or serological tests (D-III) after a tick bite is not recommended. Grades indicating the quality of evidence on which recommendations are based.
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