Lyme and When to Treat
Tick season is in full swing and I am getting lots of calls and seeing patients with new tick bites. Many of the calls are about children who are at day camp. Please check your children for ticks everyday when they come home if they have been playing outside. If you do find one that is embedded, the following is the protocol that I recommend. First, save the tick and send it to a lab that can analyze the tick and see what organisms it is carrying. I happen to like the lab at the University of Massachusetts (tickreport.com) and they guarantee a 3 day turn around. Igenex (igenex.com) in Palo Alto, California also provides this service.
If the tick is carrying Lyme disease, I recommend a full 2 week course of antibiotic treatment no matter how long the tick was embedded. This goes against the Center For Disease Control (CDC ) recommendations which are that a tick must be attached for 48 hours to transmit the disease. This recommendation was based upon study that was done with laboratory ticks in a controlled setting, which is not what happens in real life.
The other CDC recommendation that I disagree with is that a single high dose of an appropriate antibiotic after a tick bite is enough to prevent infection. Once again, this is based upon very old and questionable evidence. I have seen many patients treated like this go on to develop full-blown Lyme disease. At least 2 weeks and sometimes up to 4 weeks of antibiotics are appropriate for a tick bite.
Because a laboratory diagnosis of the infection through analysis of the offending tick is a relatively new phenomenon, there are no current official guidelines about how to manage this situation. I have heard from some patients that their physician is recommending to wait and see if the disease develops before initiating treatment. I would respectfully disagree with this approach and find someone who can prescribe an appropriate course of antibiotics. The best and most effective time to treat Lyme disease is early on. My recommendation is never to wait.