Did you know that ticks can’t jump or fly? They simply lie and wait on the top edge of plants with their front legs stretched out. As soon as a warm-bodied being passes, they simply walk onboard. The practice is called “questing,” and it is the kind of knowledge that is perfect for your next water cooler conversation.
As the weather warms up and these tiny bugs start their summer quest, they start causing big problems for patients and clinicians. As clinicians, we know that almost all patients want prophylactic medications, but who actually needs them? Spoiler alert: not every patient who experiences a tick bite needs post-exposure prophylactic (PEP) treatment.
Let's start with the basics:
Start with a post-bite risk assessment. When faced with a high-risk Ixodes tick bite, we must look to the PEP treatment criteria:
✅ Was the bite from an adult Ixodes tick?
✅ Was the bite acquired in a highly endemic area?
✅ Was the tick attached for at least 36 hours or more, or was the tick engorged?
✅ Was the tick removed within the last 72 hours?
✅ Lastly, is doxycycline safe for the patient to take?
If all of these criteria are met, the adult or pediatric patient may be eligible for PEP treatment for Lyme disease with doxycycline.
Okay, so you run through all of the criteria with your patient and deem them eligible for the single-dose doxycycline PEP treatment. You’re ready to discharge the patient, right?
Not quite; let’s talk about patient education.
Post-exposure prophylactic treatment is effective in reducing the risk of developing Lyme disease, but is not 100% effective in preventing it. As astute clinicians, we still need to educate our patients to monitor for signs and symptoms of Lyme disease and to return for re-evaluation if any of those symptoms do develop. Remember, symptoms and signs of early localized Lyme disease (stage 1) typically develop 3 to 30 days after the initial tick bite.
High-risk Ixodes tick bites may be cause for concern, but with the power of tick bite PEP treatment, criteria knowledge, and doxycycline PEP on our side, we can face them with confidence.
To learn more about tick bites and Lyme Disease, check out our newest product, Urgent Care Peds Bootcamp.
