What to Do if There is a New Tick Bite

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Here is a summary of what I think. Keep in mind, that catching the illness, Lyme Disease, in the first few weeks, or even a month is probably as good as catching it in the first few days. But, there are other Tick Borne Illnesses to consider, too. I believe the key is monitoring for the onset of symptoms and keeping your treating clinicians informed of any symptoms, for their evaluation.

IMPROVE ON YOUR SYSTEM OF TICK PRECAUTIONS!!!
YOU HAVE  A FAILED SYSTEM THAT NEEDS TO BE FIXED!!!

Preventtickbites.org

CDC Preventing Tick Bites

CDC Preventing Ticks on Your Pets

CDC Preventing Ticks in Your Yard

Tick Precautions Handout


A. Make sure the bite area is not locally infected. Properly remove the tick.

B. Inform your primary doctor, in order to get it documented and, perhaps for further recommendations.

C. Fevers, Chills, Sweats, or a Rash is an automatic trip to the Emergency Room, to be evaluated for a severe Tick Borne Illness.

D. A Flu Like Illness, meaning... achy, fatigue, feverish, or headache, esp. with joint or other pain, should be presumed to be early Lyme Disease.

     Treatment should be initiated with 3 - 4 weeks of antibiotic, and then the response assessed.

     Choice of antibiotic can depend on whether or not other infections are also suspected, but if just suspecting Lyme Disease then, Children Amoxicillin and Adults Doxycycline Monohydrate.
    
     A follow up appt. should be scheduled with the treating clinician or primary clinician, at the time treatment is started, to correspond to when the course of antibiotic is to end, in order to assess the response to the course of antibiotic. 

     If not perfectly well at the end of the course, the patient should be evaluated for continuing the same antibiotic treatment and the diagnosis should be reassessed. They should also make an appointment with a doctor that believes in the use of long-term antibiotics for “Lyme Disease”.

E. I believe it is wisest Not to Use a preventative course of antibiotics (two pill or 3 - 4 week prophylaxis). I use “watchful waiting”, but I keep close track of my patients. I am suspicious that a small amount of antibiotic or using only one, just delays the onset of Symptoms, and then the onset of symptoms is not recognized as being associated with a tick bite.

F. The development of a rash, that could be an EM rash, means treatment should be initiated, for the diagnosis of Lyme Disease.

G. Follow Up is Key.

Factors that I consider if I am treating “New Lyme Disease”:
Most patients in New England already had a “Lyme or Lyme Like Infection” at the time of the tick bite.  So, if they are given “a good dose of a good form from a good company generic antibiotic”, they will initially have a Jarsch-Herxheimer reaction, causing a worsening of their symptoms, before they will improve. That means different generics will work better or worse than others. That means that 3 - 4 weeks of one antibiotic is not likely to result in “wellness”, as defined as, the absence of symptoms. And, I start with a low dose of antibiotic, speaking to them on the phone soon after starting to assess the response and to slowly work up to the therapeutic dose, as the worsening allows.

B. Age and status of the development of adult teeth will make a difference in drug choice and outcome/prognosis. Many young people are behind in the development of adult teeth. I choose to not give courses of Doxycycline or Tetracycline, unless I know, from dental examination (x-ray) by a dentist or parent history, that the adult teeth are formed sufficiently to avoid worry about the medication affecting the teeth.

C. My drug of choice, for a patient with formed adult teeth, is Doxycycline Monohydrate Capsules, manufactured by Lupin Pharmaceuticals. I start with a 50mg Dose, building up to One Three Times per Day, after Food. Once they are doing well with that, I build up to One of the 100mg Capsules Three Times per Day, after Food. Generally, after food means after Breakfast, Lunch, and Supper. I may stop at 100mg Twice per Day, if the response is adequate. My goal is to give at least 3 weeks, of at least One 100mg Dose Twice per Day.

D. My drug of choice, for a patient that does not have their adult teeth adequately formed is Amoxicillin. I use as much Amoxicillin as I think is safe for age and size, relative to the adult dose of 500mg Three Times per Day. I will, again, start low and work up, as I can, based on clinical response. I believe that Generic Augmentin MANUFACTURED BY SANDOZ, NOT JUST SOLD BY SANDOZ, works best and will plan to use that if I am not happy with the response to the plain Amoxicillin.

E. Follow up and the assessment of the response to treatment is essential. Not responding well… meaning, still having symptoms, should cause a rethinking of the diagnosis and treatment.
Rex G. Carr, MD FAAPMR
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