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!