What are the current treatment recommendations for new deer tick bites?
There are several schools of thought as
to how new tick bites should be handled. One school takes a watch and wait ap- proach. You should circle the date the tick was discovered on your calendar and keep a close eye out for any symptoms to develop. Unfortunately symptoms may take 4-6 weeks from the time of infection to develop at which time Lyme has had an opportunity to spread throughout the body. Another school of thought suggests a one time dose of an antibiotic to prevent Lyme infection. This approach is based upon a small study that showed a decrease in development of the classic EM rash with a one time dose of an antibiotic; however this study did not look at prevention of Lyme dis- ease. It only looked at preventing the rash. I would propose that this approach is flawed because the goal in prophylactic treatment is to prevent the entire disease, not merely a rash.
A third school of thought suggests
that Lyme disease is extremely prevalent, especially in CT, and that any deer tick bite
is very high risk. Given the high risk of a deer tick bite prophylactic antibiotics should be given at a standard treatment dose for 3-4 weeks. If no symptoms develop by the end of this time period antibiotics would be discontinued. If symptoms developed treat- ment would be continued. It is important to remember that several of the drugs that are commonly used to treat Lyme disease are used safely for years at a time to treat acne. Given the high prevalence of Borrelia burgdorferi infection in deer ticks in the state of Connecticut for most patients, the risk on an untreated deer tick bite is likely much higher than the potential risks of short term antibiotic use.
What are the current recommendations for acute Lyme disease?
There are two general approaches to the treatment of acute Lyme disease. One approach is treatment with one antibiotic for 3-4 weeks and, in specific situations, up to 6 weeks. If symptoms persist past this time, the patient is then diagnosed with a post-Lyme syndrome. Their Lyme infection is
considered 100% eradicated. Any persistent symptoms are not due to active infection. Another approach involves treatment with one or more antibiotics as well as sup- portive therapies for as long as the patient has symptoms. Borrelia has a long reproduc- tive cycle and several strategies for persis- tence so treatment should be continued 2 months past the time when the patient is symptom-free prior to being discontinued. In the monkey study mentioned earlier,
it was also noted that Borrelia burgdor- feri persisted in 100% of monkeys who were treated with 28 days of the antibiotic doxycycline when it was started 4 months after they were initially infected; suggesting this duration of therapy may be insufficient to eradicate infection when initiation of treatment is delayed. Additionally, 73% of monkeys treated for 90 days with intrave- nous and then oral antibiotics had persistent infection. The findings of this study support the notion that longer-term treatments for Lyme disease are likely necessary. This study did not look at the response to treatment initiated a couple of weeks after infection, however common sense dictates that early diagnosis and treatment will likely lead to better long-term outcomes.
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