Brush Up on Tick Bites and Preventing Lyme Disease

Top Takeaways

• Point to product labels on insect repellents to ensure they protect against ticks.
• Listen for patients reporting a tick bite and gather key details for the pharmacist.
• Watch doxycycline orders closely, especially days’ supply and alerts related to age or pregnancy.

People commonly ask about tick bites and Lyme disease.

How can tick bites be prevented? People should wear protective clothing (long sleeves, etc) and use tick repellent (DEET, etc).

Point to product labels to ensure the repellent covers ticks.

People should also check for ticks on themselves and their pets after being outdoors in wooded, brushy, or grassy areas.

Stay tuned...a new Lyme disease vaccine looks promising.

How should ticks be removed? Expect your pharmacist to advise using fine-tipped tweezers to grab the tick close to the skin and pull it straight out...and cleaning the bite with soap and water after removal.

Don’t be surprised if patients are also told to take a picture of the tick...or save it in a sealed bag. Websites, such as TickEncounter or CDC’s Tick Bite Guide, can help identify the species and guide next steps.

For example, only Ixodes ticks (deer, western) are at risk of carrying Borrelia burgdorferi, the bacteria that cause Lyme disease.

What are symptoms of Lyme disease? Stay alert for patients reporting a red, ring-like rash (with or without a bull’s-eye)...or feeling like they have the flu (fever, muscle aches, headache, etc) after a tick bite.

If needed, gather key details for the pharmacist...including when the bite occurred, when the tick was removed, and where the patient was.

Who should get antibiotics? Patients may get one dose of doxycycline to PREVENT infection...if an Ixodes tick in a high-risk area (Northeast, mid-Atlantic, MN, WI, etc) has been attached for at least 36 hours. This dose should be given within 72 hours of tick removal.

Some experts may give prophylaxis if an Ixodes tick is attached for 24 hours or more, but risk of transmission is very low before 36 hours.

Anticipate dispensing antibiotics to TREAT “early” Lyme disease when patients develop symptoms within 30 days of a tick bite...or for “late” Lyme disease (arthritis, etc), which can happen even years after a bite.

Update allergy info and pregnancy status with all antibiotic Rxs.

For example, pregnant patients may get amoxicillin or cefuroxime for Lyme treatment...since doxycycline may be risky during pregnancy.

Double-check days’ supply. Early Lyme is usually treated for 10 days with doxycycline or 14 days with amoxicillin or cefuroxime...but late Lyme may require up to 28 days with any of these antibiotics.

Alert your pharmacist to computer warnings. Doxycycline may prompt an age alert in kids under 8...due to concern about tooth staining. But the short courses for early Lyme don’t seem to be an issue.

See our resource, Treatment of Lyme Disease, to review antibiotic options for late disease and complications (arthritis, etc).

• Chart: Treatment of Lyme Disease