The rainy East coast spring has increased tick populations in endemic areas such as Maryland resulting in more tick bites.
ED visits for known tick bites present acutely, often with parents bringing in the tick to be identified/tested.
Routine serologic testing and antibiotic prophylaxis is not recommended after every tick bite.
If an attached tick is engorged, identified as I. scapularis, and has been attached for >36 hours, then antibiotic prophylaxis for Lyme can be prescribed if started within 72 hours of tick removal in those patients > 8 years of age
Prophylaxis: Single dose of doxycycline 4 mg/kg or 200mg max
If early Lyme Disese is present in the form of the classic rash of Erythema migrans, then treatment is doxycycline, 4 mg/kg or 100mg max BID for patients > 8 years of age or amoxicillin 50 mg/kg per day divided TID with 500 mg max TID in those < 8 years of age for 14 days
Serologic testing is false negative in the first month of testing, and unnecessary in the ED for acute presentations.
