Doxycycline Prescription For Lyme Disease

Can Lyme Disease Be Prevented Or Avoided

The best way to prevent Lyme disease is to avoid being bitten by ticks. When you are outdoors, follow these guidelines:

• Avoid areas that are wooded, brushy, or have tall grass.
• Walk in the center of trails.
• Use an insect repellent with at least 20% DEET. It can be put on clothing or sparingly on the skin. Dont apply it to the face or hands of children.
• Treat clothing, tents, or other gear with repellents containing 0.5% permethrin.
• Wear light-colored clothing. This makes it easier to see and remove ticks from your clothes.
• Wear a long-sleeved shirt and long pants. Tuck your pant legs into your socks or boots for added protection.

After you get home, check everything and everyone for ticks.

• Bathe or shower as soon as you can to wash off any ticks that have not attached to you.
• Check your entire body for ticks. Use a mirror for places you cant see. Check your children and your pets. Common tick locations include the back of the knees, groin area, underarms, ears, scalp, and the back of the neck.
• Check any gear you used, including coats, backpacks, or tents.

Tumble dry clothes or blankets on high heat in the dryer for 10 to 15 minutes. This should kill any ticks. If clothes are dirty, wash them in hot water and dry on high heat for 60 minutes.

Strengths And Limitations Of This Study

• The trial has a double-blinded design.

• The inclusion criteria for Lyme neuroborreliosis are according to the EFNS guidelines.

• The endpoints of the trial are well-defined.

• The follow-up period of the included patients is long with registered symptoms, signs and potential side effects.

• A weakness of the study is that the primary scoring tool, the composite clinical score, is not validated.

Doxycycline For Tick Bite

Tessa Chatham Registered Nurse

Tessa Chatham Registered Nurse

Tessa is a MSN prepared Registered Nurse with 10 years of critical care experience in healthcare. When not practicing clinical nursing, she enjoys academic writing and is passionate about helping those affected by medical aliments live healthy lives.

Linda Anegawa MD, FACP

Linda Anegawa MD, FACP

Dr. Anegawa graduated from the Univ. of Pennsylvania School of Medicine and completed residency at Stanford. She has over 20 years of practice experience and specializes in Internal Medicine and Obesity Medicine.

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What Are The Risk Factors For Post Treatment Lyme Disease

Risk factors for Post Treatment Lyme Disease include:

• Delay in diagnosis
• Increased severity of initial illness
• Presence of neurologic symptoms

Increased severity of initial illness, the presence of neurologic symptoms, and initial misdiagnosis increase the risk of Post Treatment Lyme Disease. PTLD is especially common in people that have had neurologic involvement. The rates of Post Treatment Lyme Disease after neurologic involvement may be as high as 20% or even higher. Other risk factors being investigated are genetic predispositions and immunologic variables.

In addition to Borrelia burgdorferi, the bacteria that causes Lyme disease, there are several other tick-borne co-infections that may also contribute to more prolonged and complicated illness.

How Soon Do You Need Antibiotics After A Tick Bite

If you have a known tick bite without symptoms, preventative doxycycline can be considered within 72 hours of tick removal. Otherwise, you can simply watch and wait, as oftentimes antibiotic treatment is not necessary. Your doctor can decide if doxycycline treatment is necessary for your tick bite.

Signs of illness after a tick bite include:

• Rash particularly if in the shape of a âbulls eyeâ
• Altered mental status
• Infection at tick site

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What Is Post Treatment Lyme Disease

Post Treatment Lyme Disease represents a research subset of patients who remain significantly ill 6 months or more following standard antibiotic therapy for Lyme disease. PTLD is characterized by a constellation of symptoms that includes severe fatigue, musculoskeletal pain, sleep disturbance, depression, and cognitive problems such as difficulty with short-term memory, speed of thinking, or multi-tasking. In the absence of a direct diagnostic biomarker blood test, PTLD has been difficult to define by physicians, and its existence has been controversial. However, our clinical research shows that meticulous patient evaluation when used alongside appropriate diagnostic testing can reliably identify patients with a history of previously treated Lyme disease who display the typical symptom patterns of PTLD.

Treatment For Erythema Migrans

People treated with appropriate antibiotics in the early stages of Lyme disease usually recover rapidly and completely. Early diagnosis and proper antibiotic treatment of Lyme disease can help prevent late Lyme disease.

Treatment regimens listed in the following table are for the erythema migrans rash, the most common manifestation of early Lyme disease. These regimens may need to be adjusted depending on a persons age, medical history, underlying health conditions, pregnancy status, or allergies. Consult an infectious disease specialist regarding individual patient treatment decisions.

*When different durations of antibiotics are shown to be effective for the treatment of Lyme disease, the shorter duration is preferred to minimize unnecessary antibiotics that might result in adverse effects, including infectious diarrhea and antimicrobial resistance.

NOTE:For people intolerant of amoxicillin, doxycycline, and cefuroxime, the macrolide azithromycin may be used, although it is less effective. People treated with azithromycin should be closely monitored to ensure that symptoms resolve.

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How Is Doxycycline Given To Dogs

Doxycycline is available on the market in the form of a capsule, tablet, and oral suspension. It is advised to give doxycycline with food to avoid stomach upset, diarrhea, and vomiting. Never give another dose of doxycycline if your dog vomits in the next hour after getting the antibiotic.

The capsule and the tablet can be mixed with food. Never open the capsule to pour the powder onto the food. Removing the capsule will make the drug ineffective. If your dog does not want to eat the capsule or the tablet with the food, put it in a little piece of butter and put it directly in the throat behind the tongue. This way, the dog wont be able to spit the antibiotic, and the butter will help ease the way down the throat to the stomach.

Patient And Public Involvement

Representatives from the Norwegian patient organisation for Lyme borreliosis were invited and participated in the early stages of planning of the BorrSci projects design and gave feedback on the drafts of the application for funding. They were also invited to continue work with the project. Inclusion to the study, implications of the intervention and time required to participate is discussed with each individual patient. Local newspapers and other media have been involved in making the project known to the public in different parts of Norway.

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Why Doxycycline Alone Isn’t Enough

Because Lyme Disease is a result of the spreading of the bacterium Borrelia burgdorferi, it makes sense that a common response is antibiotics. Antibiotics like doxycycline, amoxicillin, and cefuroxime axetil are some of the most commonly used antibiotic treatments for the spread of Lyme Disease.

Antibiotics can be effectively used as a prophylactic dose to reduce the risk of acquiring Lyme Disease immediately after a high-risk tick bite. However, antibiotic treatment helps such a fraction of individuals living with Lyme Disease that it doesn’t make sense for this to be the primary treatment. When it comes to treating Chronic Lyme Disease, doxycycline, and other antibiotics, just aren’t enough and that’s because of the nature of Borrelia.

Dealing With Lyme Disease

One of the reasons Lyme is so difficult to diagnose is because it mimics other illnesses. Often, patients are diagnosed with a whole host of illnesses in an attempt to explain the symptoms of what is actually Lyme. Common misdiagnoses are fibromyalgia, multiple sclerosis, and chronic fatigue syndrome.

The easiest way to diagnose Lyme Disease is via a bullseye-shaped rash. However, doctors who aren’t familiar with Lyme often overlook this rash. And while this rash is a clear indicator of Lyme, it doesn’t show up on everyone who has Lyme. Practitioners may be trained to look for this rash as an indicator of Lyme, and when they don’t see it, they move on to other possible illnesses.

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Does Doxycycline Kill Ticks

Doxycycline does not kill ticks but treats illnesses caused by tick bites. Doxycycline is an antibiotic that kills a wide variety of bacteria and parasites but does not kill ticks directly.

Chemicals that kill ticks directly are not safe for human consumption. Pesticides and insecticides can kill ticks instantly but are not safe to put on skin or handle without gloves. Usually, these chemicals are sprinkled along the yard to kill ticks and other insects.

Prevention Of Tick Bites

The best currently available method for preventing infection with B. burgdorferi and other Ixodes-transmitted infections is to avoid tick-infested areas . If exposure to I. scapularis or I. pacificus ticks is unavoidable, a number of measures may help to decrease the risk that ticks will attach and subsequently transmit infection. The use of protective clothing may interfere with attachment by ticks by increasing the time required for ticks to find exposed skin, thus facilitating their recognition and removal. By wearing light-colored clothing , persons in areas of endemicity may also be more likely to see ticks before they have attached.

Daily inspections of the entire body to locate ticks also provide an opportunity to prevent transmission of tick-borne infections . Attached ticks should be removed promptly with fine-toothed forceps, if possible . Tick and insect repellents applied to the skin and clothing provide additional protection .

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Study Design And Interventions

The study is a randomised, double-blinded, placebo-controlled, multicentre trial with a non-inferiority design. We plan to recruit 120 patients diagnosed with definite or probable LNB according to EFNS guidelines at six different hospitals in the southern part of Norway as shown in . The study is coordinated from Sørlandet Hospital in Kristiansand, Agder County by neurologists connected to the large BorrSci study . The inclusion and exclusion criteria are shown in . Inclusion started in 2015 and will continue through December 2019 or until the necessary sample size is obtained. Eligibility before inclusion is assessed by, or discussed with, a physician connected to the study and accustomed to evaluating patients with neurological symptoms. The patients are randomised into two treatment arms: doxycycline 200mg daily for 2 weeks, followed by 4weeks of placebo doxycycline 200mg daily for 6weeks .

Single Dose Doxycycline For Treatment Of Tick Bite Only Prevents Lyme Disease Rash

In a review entitled Lyme Disease: Emergency Department Considerations, Applegren et al. recommend using a one-time, single dose of doxycycline for the prophylactic treatment of a tick bite, despite the fact that there has been only one study exploring the effectiveness of such a limited dosage. The article also neglects to mention that there are doctors who take a different approach and advise against a one-time, single dose.

In the article, the authors reference the 2006 Infectious Diseases Society of America guidelines when making their recommendation that individuals be treated with a single dose of doxycycline .

Their recommendation applies only to patients meeting the following criteria, the attached tick is clearly identified as a nymph or adult I. scapularis the tick has been attached 36 hours local infection rates of ticks with B.burgdorferi is 20% and there are no contraindications to doxycycline.

The authors fail to mention that the IDSA single dose of doxycycline approach is based on one study, which only found a reduction in the number of erythema migrans rashes.

A study by Nadelman et al. found that patients treated with a single dose of doxycycline developed EM manifestation at a lower rate than the placebo group , according to Applegren.

The IDSA guidelines adopted the single, 200 mg dose of doxycycline despite the fact that 3 previous prophylactic antibiotic trials for a tick bite had failed.

References:

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Lyme Disease Prophylaxis After Tick Bite

In areas that are highly endemic for Lyme disease, a single prophylactic dose of doxycycline may be used to reduce the risk of acquiring Lyme disease after a high-risk tick bite.

Benefits of prophylaxis may outweigh risks when all of the following circumstances are present:

Flat

Nymph

Adult

Antibiotic treatment following a tick bite is not recommended as a means to prevent anaplasmosis, babesiosis, ehrlichiosis, Rocky Mountain spotted fever, or other rickettsial diseases. Instead, persons who experience a tick bite should be alert for symptoms suggestive of tickborne illness and consult a physician if fever, rash, or other symptoms of concern develop.

What Causes Lyme Disease

People get Lyme disease when they are bitten by an infected tick. Ticks live in areas with a lot of plant life, such as wooded areas or fields. They sit near the top of grassy plants and low bushes. They wait there for people or animals to brush up against them. Ticks can crawl on your clothes or body for up to several hours or more before attaching to the skin.

Ticks can attach to any part of your body. They are usually found in hard-to-see areas, including the armpits, groin, or scalp. An infected tick needs to be attached to your skin for 36 to 48 hours before it passes the bacteria on to you.

People who spend time in outdoor areas where ticks are common are at higher risk of getting tick-borne diseases.

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Borrelia: A Stealthy Bacteria

The bacteria Borrelia clears the blood quickly, and it uses its unique corkscrew shape to deeply penetrate the tissues of the joints, cartilage, brain, and nerves. Once it’s hidden inside these tissues, the antibiotics and immune system can’t reach it. It can even roll up into a dormant cyst and wait until the antibiotics are gone to reappear.

Slow Growing

Antibiotics are most effective on bacterium and microbes that grow rapidly and are densely concentrated in localized areas of the body. For instance, pneumonia is concentrated in the lungs, and this is part of the reason that it responds well to antibiotics. Borrelia, however, is very slow-growing and exists throughout the body in low concentrations.

Borrelia in the Microbiome

The microbiome is the congregate of all the microbes in the body, and Borrelia is great at blending in with them, becoming a part of the microbiome. Unlike other bacteria, it doesn’t want to overwhelm the human hos it just needs enough resources to survive. This makes it very difficult to both diagnose and treat.

Antibiotics Can Disrupt the Microbiome

Antibiotics Can Disrupt the Immune System

Up to 70% of our immune system functions are actually located in the gut, meaning that disruption of the microbiome can have huge effects on our immune system. When your body and immune system are already being run down by Lyme, causing even more harm to them with antibiotics is the wrong move.

Antibiotics Can Damage Mitochondria

How Quickly Will Doxycycline Work

Once taken orally, doxycycline peaks within 1.5 to 4 hours with immediate release and 2.8 to 3 hours with extended-release capsules. Treatment guidelines suggest that doxycycline works better if you take it on an empty stomach, therefore it is suggested that doxycycline be administered on an empty stomach 1-2 hours before meals.

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Consult Your Healthcare Provider Before Using Natural Remedies

If youre curious about banderol, samento, or other herbal treatments, talk with your healthcare provider about whether to incorporate any of these remedies into your Lyme disease treatment plan. While it may be tempting to want to try it, improper treatment of Lyme disease can lead to serious complications such as joint problems and nervous system disorders, so self-treating with herbs isnt recommended.

Also, its important to keep in mind that the side effects and risks of these herbs in regular or high doses arent known, nor is their safety in children, pregnant or nursing women, or people with other health conditions. Your healthcare provider can help you weigh the risks with the benefits.

Lyme Disease Doctor Discussion Guide

Get our printable guide for your next healthcare providers appointment to help you ask the right questions.

If Bitten By A Tick Should I Consider Immediate Antibiotics To Prevent Lyme Disease

ILADS recommends that prophylaxis be discussed with all who have had a blacklegged tick bite.An appropriate course of antibiotics has been shown to prevent the onset of infection.

When the decision is made to use antibiotic prophylaxis, ILADS recommends 20 days of doxycycline . The decision to treat a blacklegged tick bite with antibiotics often depends on where in the country the bite occurred, whether there was evidence that the tick had begun feeding, and the age of the person who was bitten. Based on the available evidence, and provided that it is safe to do so, ILADS recommends a 20-day course of doxycycline.

Patients should also know that although doxycycline can prevent cases of Lyme disease, ticks in some areas carry multiple pathogens, some of which, including Babesia, Powassan virus, and Bartonella, are not responsive to doxycycline. This means a person could contract a tick-borne illness despite receiving antibiotic prophylaxis for their known tick bite.

ILADS recommends against single-dose doxycycline. Some doctors prescribe a single 200 mg dose of doxycycline for a known bite. However, as discussed in detail in the guidelines, this practice is based on a flawed study that has never been replicated. Read more in the ILADS treatment guidelines.

The bottom line: If you have been bitten by a blacklegged tick, you should discuss immediate antibiotic treatment with your provider as a possible course of action.

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