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Clinician’s Corner: Prevention of Lyme disease

Let’s assume you didn’t adequately follow last week’s prevention tips.  We can cover two scenarios.  The first we will discuss when you find a tick on your skin, and remove it. Then we can discuss treatment when the characteristic rash appears.

Pharmacological Prevention of Lyme disease:

The Infectious Disease Society of America recommends antibiotics for prevention of a tick bite only when:

  • Attached tick identified as an adult or nymphal deer tick (Ixodes scapularis)
  • Tick is estimated to have been attached for 36 + hours
  • The antibiotic can be given within 72 hours of tick removal
  • The local rate of tick infection with B. burgdorferi is ≥20 percent. (we certainly have that in Central Pennsylvania)
  • Doxycycline is safe to be given. Not for patients that are pregnant, nursing or a pediatric patient.

Recommended dose:  Doxycycline 100mg (2) tablets daily as a single dose with food.

 

Pharmacological Treatment of Lyme disease

The first sign of infection is usually a circular rash called erythema migrans (bullseye rash).  This rash occurs in approximately 70-80% of infected persons and begins at the site of a tick bite after a delay of 3-30 days. (So, 20-30% of the time is does NOT occur)

A distinctive feature of the rash is that it gradually expands over a period of several days, reaching up to 12 inches across. The center of the rash may clear as it enlarges, resulting in a bull’s-eye appearance.  It may be warm but is not usually painful.

Drug treatment for early erythema migrans: (appearance of red “bulls-eye” rash)

  • Doxycycline (Vibra-tab) 100mg twice daily for 14-21 days. Avoid doxy if pregnant or under age 8. Be sure to use sunscreen when outdoors.
  • Amoxicillin (Amoxil) 500mg three times daily for 14-21 days
  • Cefuroxime (Ceftin) 500mg twice daily for 14-21 days
  • Erythromycin (Ery-tab) 250mg four times daily for 14-21 days. (Very expensive!)

Note: 10 days of treatment may be as effective as 20 days.

Since your Thompson Pharmacist is indeed the “drug expert” as well as the “cost expert” consider the following.

  • Amoxicillin is equally effective as doxycycline, but it needs to be dosed three times a day. Best option for pediatrics and pregnant women.
  • Amoxicillin is still the least expensive treatment for Lyme erythema migrans. Amoxicillin should NOT be used for prophylaxis (as doxycycline is).
  • Amoxicillin might also be a better choice for patients who experience increased sun burning on previous doxycycline therapy.

Your Thompson Pharmacist is the drug expert; feel free to ask us about prevention and treatment of Lyme disease.  Central Pennsylvania is a beautiful place to be in the great outdoors, we can make sure you have a safe time!  At Thompson Pharmacy, it’s all for YOU!