Lyme disease secondary prevention

The secondary prevention of Lyme disease may include post exposure prophylaxis with doxycycline in select cases meeting criteria for chemoprophylaxis.

• After a tick bite, routine use of antibiotic prophylaxis is not recommended.
• The secondary prevention of Lyme disease may include post exposure prophylaxis with doxycycline in selected cases meeting criteria for chemoprophylaxis.
• The criteria for chemoprophylaxis includes:^[1]
• A single dose of doxycycline (avoid in pregnancy and children <8 years) may be offered to adults (200mg) and children (4mg/kg, maximum 200mg) if all of the following criteria are fulfilled:
  • The tick is identified as I. scapularis (adult or nymph).
  • The tick has been attached for > 36 hours. Attachment time is estimated by the degree of engorgement of the tick with blood or approximating the time of exposure to the tick.
  • Prophylaxis should be stated within 72 hours of tick removal.
  • Local infection rate of ticks with B. burgdorferi is > 20%.
  • There is no contraindication to use of doxycycline.

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