Lyme Disease Prophylaxis — Medical Practice MCQ

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EasyInfectious DiseasesLyme Disease Prophylaxis

A 38-year-old man presents 10 hours after a deer tick bite in an endemic area. The engorged tick was removed intact; estimated attachment time 48 hours. He is asymptomatic. Best next step?

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Correct answer: D — No prophylaxis; provide routine wound care only

The correct next step is no antibiotic prophylaxis and no Lyme serology: provide local tick-bite wound care and safety-net advice. In UK practice, an asymptomatic person should not be diagnosed or treated for Lyme disease simply because a tick was attached, even if engorged or attached for a prolonged period. Advise cleaning the bite site, checking for retained mouthparts or secondary skin infection, and returning urgently if erythema migrans or systemic features develop, such as fever, malaise, headache, facial palsy, neuropathic symptoms, palpitations, or joint swelling. Lyme serology immediately after a bite is not useful and is not recommended in people without symptoms. Doxycycline 200 mg once within 72 hours is a US-style post-exposure prophylaxis approach for selected high-risk Ixodes bites, but it is not the routine UK/NICE approach for an asymptomatic tick bite. Amoxicillin or a treatment course of doxycycline is reserved for clinically suspected or diagnosed Lyme disease, not for prophylaxis in this scenario.

Reference: NICE guideline NG95: Lyme disease, published 2018 and last updated 17 October 2018. https://www.nice.org.uk/guidance/ng95/chapter/Recommendations