Preventing Lyme Disease: Antibiotic Prophylaxis After Tick Bites Can Help

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Summary and Comment

Preventing Lyme Disease: Antibiotic Prophylaxis After Tick Bites Can Help

A common clinical question in the northeastern U.S. is whether prophylactic antibiotic therapy after a tick bite can prevent Lyme disease. Although prior studies have found no benefit to this approach (JWID 2000, p. 76, accession number 000921004, and Clin Infect Dis 2000; 31:1), a report newly released by the New England Journal of Medicine indicates that a single 200-mg dose of doxycycline provides effective prophylaxis.

Four hundred eighty-two people, at least 12 years old, were enrolled in a randomized, controlled trial of doxycyline therapy after presenting within 72 hours of removing an Ixodes scapularis tick acquired in Westchester County, New York. Erythema migrans occurred at the site of tick attachment in 8 of 247 placebo recipients (3.2 percent), but in only 1 of 235 doxycycline recipients (P < 0.04 percent; efficacy rate 87 percent; 95 percent confidence interval, 25 percent -98 percent). Bites from nymphal ticks were significantly more likely to transmit Borrelia burgdorferi than bites from adult ticks, particularly bites from nymphs apparently attached longer than 72 hours. Adverse events, noted in 30 percent of treated subjects (compared with 11 percent of controls), consisted principally of nausea and vomiting (15 percent and 6 percent, respectively).

Comment: As emphasized by the authors and in the accompanying editorial, these results should not be extended to other populations or to the use of other therapeutic agents. It is important to note that ticks attached less than 48 hours are unlikely to transmit Lyme disease. Additionally, although this study was performed in a community where Lyme disease is hyperendemic, only 3 percent of placebo recipients developed Lyme disease; thus the benefit of prophylaxis will be much less in other U.S. regions.

— R Ellison

Published in Journal Watch Infectious Diseases June 22, 2001

Citation(s):

Nadelman RB et al. Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite. N Engl J Med 2001 Jul 12 345 79-84.

Medline abstract (Free)

Shapiro ED. Doxycycline for tick bites - not for everyone. N Engl J Med 2001 Jul 12 345 133-134.

Medline abstract (Free)

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