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Need for treatment — The clinician will review the description of the tick along with any physical symptoms to decide upon a course of action. The Infectious Disease Society of America recommends preventive treatment with antibiotics only in patients who meet all of the following circumstances [3] :
Attached tick identified as an adult or nymphal I. scapularis (deer) tick
Tick is estimated to have been attached for ≥36 hours (by degree of engorgement or time of exposure)
Prophylaxis should begin within 72 hours of tick removal
Local rate of infection of ticks with B. burgdorferi is ≥20 percent (these rates of infection have been shown to occur in parts of New England, parts of the mid-Atlantic States, parts of Minnesota and Wisconsin)
Doxycycline is not contraindicated (ie, the patient is not pregnant or lactating or a child <8 years of age)
If the patient meets the guidelines, the recommended dose of doxycycline is a single dose of 200 mg for adults and 4 mg/kg up to a maximum dose of 200 mg in children ≥ 8 years
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