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Lyme Post Exposure Prophylaxis

This document provides guidance on when post-exposure prophylaxis (PEP) with doxycycline may be appropriate after a tick bite to prevent Lyme disease. It consists of a decision tree with 5 questions about factors like the location of the bite, timing of tick removal, and tick characteristics to help determine the risk of transmission and appropriateness of PEP.

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Kel Zhang
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131 views1 page

Lyme Post Exposure Prophylaxis

This document provides guidance on when post-exposure prophylaxis (PEP) with doxycycline may be appropriate after a tick bite to prevent Lyme disease. It consists of a decision tree with 5 questions about factors like the location of the bite, timing of tick removal, and tick characteristics to help determine the risk of transmission and appropriateness of PEP.

Uploaded by

Kel Zhang
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Lyme Disease Prophylaxis After Tick Bite

START HERE

1 Where the tick bite occurred, are ticks likely to be infected with Borrelia burgdorferi? No

When a tick bite occurs in a state or county where Lyme disease is


Yes common, (cdc.gov/lyme/datasurveillance), PEP might be beneficial.
If Lyme disease is not common in your area, ask your patient if they Areas with HIGH INCIDENCE
of Lyme disease
have recently traveled to an area where Lyme disease is common.
Some local transmission
of Lyme disease

2 Was the tick removed within the last 72 hours? No

Yes The Lyme disease incubation period is at least three days, so PEP is most
effective within the 72-hour window after tick removal.

3 Was the tick’s body flat, or was it engorged with blood? Flat

Flat Engorged
If the tick is engorged with blood, the risk of Lyme disease is higher,
Engorged
and PEP should be considered. A flat, or unfed tick, is unlikely to
have transmitted the pathogen that causes Lyme disease.

4 Was the tick an Ixodes (blacklegged) tick? Definitely NOT

Nymph Adult

Yes / Possibly / In the United States, the only ticks that transmit the bacteria that cause Lyme
Tick Unavailable disease are the small, teardrop-shaped Ixodes ticks. Tick identification can be
challenging, and PEP can still be considered when the tick cannot be identified.

5 Is doxycycline safe for the patient? No

A single dose of doxycycline has been shown to reduce the frequency of Lyme disease
after a high-risk tick bite and is safe for people of all ages, including young children. Before
Yes recommending doxycycline prophylaxis, make sure that it is a safe medication for your patient.
Considerations include allergy to doxycycline, pregnancy, and lactation.

Consider Prescribing PEP* PEP Not Indicated


*Single dose of doxycycline (200 mg for adults or 4.4 mg/kg
for children of any age weighing less than 45 kg)

REFERENCES:
Nadelman RB, et al. Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite. N Engl J Med. 2001 Jul 12;345(2):79-84.
Harms MG, et al. A single dose of doxycycline after an Ixodes ricinus tick bite to prevent Lyme borreliosis: An open-label randomized controlled trial. J Infect. 2021
Jan;82(1):98-104.

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