Tick removal: Forceps or protected fingers are the preferred methods for removing ticks while ensuring successful removal of the mouthparts.
Two randomized trials of antibiotic prophylaxis showed no seroconversion of 869 treated patients with recent tick bites., Another study versus placebo showed an absolute risk reduction of 22 fewer cases per 1000 (reduction of developing disease from 2.2% to 0.2%. Prophylaxis is recommended for high-risk bites only. Bites not classified as high risk should follow a watch-and-wait approach. IDSA guidelines for prophylaxis are as follows31:
If criteria are met, adult patients should receive doxycycline 200 mg x1 and pediatric patients 4 mg/kg (max 200) x1. There is no data in children; the recommendation was extrapolated from adult data. Alternatively, patients can monitor the bite site for the development of EM and begin treatment for active disease. The IDSA does not recommend the use of any other prophylactic agent due to the paucity of data.