Preventative antibiotics for Lyme?

April 7, 2013 6:36 AM

I removed a deer tick from the back of my head. I called my MD (and left a message with the nurse ) to see if I should get preventive antibiotics against Lyme disease. Without speaking to me, the doctor called in a script to the pharmacy. Now I have a question about the dose.

I have been bitten by deer ticks before without taking meds, but this time was a little different: It clearly been stuck on my head for a while, based on its size, and I couldn't do the normal thing of checking to make sure there was no rash. So after tweezing that horrid thing out, I called the doc and inquired about a preventative dose of antibiotics.

He ordered a 2 week supply of doxycycline. It is a pain, because it is really, really nauseating. You have to take it on an empty stomach, and it makes me feel like dry heaving for hours.

My question: I thought that this was the standard treatment for actual diagnosed early Lyme, not the preventative dose. I thought the preventative dose was more like a single pill or two. Have you ever gotten a preventative treatment of antibiotics after a tick bite? If so, was it for a full 2 weeks, or was it a quick dose?

Also: because of calling the doctor and waiting for him to call in the prescription, I did not take the meds for 3 days after getting the tick out. Is this too late anyway for a preventative treatment? Googling looks like it could work if you start up to 72 hours after tick bite, but I don't know if that means 72 hours after it attaches or comes off.

I am not able to go to the doctor this week because I am too busy, and even though he is much better at responding than most doctors are in my experience these days, I will still be playing telephone with the nurse who gave him the message to begin with. So, I am not looking to change doctors or even go to the doctor; rather I would like to know whether, in other people's experience, this dose is atypical or standard for prophylactic Lyme care, before maybe calling the office again.

Thanks!

posted by third rail to Health & Fitness (10 answers total)

I'm not a doctor but I do have personal experience with Lyme prophylaxis. My understanding is that the preventive dose is just for a day. It also should be taken within 1-3 days of the initial bite (not when you remove the tick). You might be outside the window where a prophylactic dose would be appropriate.
posted by medusa at 7:15 AM on April 7, 2013

No-one here is going to tell you what I think you want to hear. If you think the dose is wrong, you need to speak to your doctor before diverging from his instructions. I really don't think there's anything more to be said.
posted by howfar at 7:24 AM on April 7, 2013

Call the pharmacist.
posted by Specklet at 7:33 AM on April 7, 2013

Yes, talk to yor pharmacist, whom you can also ask about the side effects and how best to mitigate them.
posted by lulu68 at 7:54 AM on April 7, 2013

No-one here is going to tell you what I think you want to hear. If you think the dose is wrong, you need to speak to your doctor before diverging from his instructions. I really don't think there's anything more to be said.

I totally appreciate this, it's a responsible position to take. To be more clear: I would not change my dose myself based on what someone says here, I am just wondering if there is even a reason to call the doctor. If other people have had different experiences, I would call. I don't want to question him for no reason, especially because you have to go through the nurse, so he gets a very abbreviated, non-nuanced form of the question.
posted by third rail at 8:28 AM on April 7, 2013

Since you have no idea when you were bit, and the tick was engorged, and you waited three days after removal to begin the antibiotics, you're well outside the window for a preventive dose; your doc is operating on the better-safe-than-sorry principle. I empathize, because I did the full two-week course myself after a tick bite. Hang in there.
posted by Johnny Wallflower at 9:03 AM on April 7, 2013

Maybe talk to the dr and pharmacist about having something minimal to eat. I take doxycycline and was originally told not to eat with it. My new dr said having a little food is fine - especially if it makes me nauseous. Better than not taking it. Dairy is still a big no-no.
posted by crankyrogalsky at 9:11 AM on April 7, 2013

It's definitely worth asking. Especially in these days where we can send electronic prescriptions, it can be easy to click on the script right next to the one you actually wanted. Not to mention that tired/overworked docs may get confused or mis-speak when calling something in. If calling your doctor to confirm this is a pain, just ask the pharmacist as noted above.
posted by treehorn+bunny at 10:53 AM on April 7, 2013

In a similar situation, I took doxycycline for 21 days because of minor maybe-Lyme-maybe-a-cold symptoms and good tolerance for the doxy. My NP had indicated she'd be fine with stopping the antibiotic at 14 days if I had major nausea or photosensitivity problems, and that without extenuating symptoms it would have been a much shorter prescription.
posted by teremala at 11:26 AM on April 7, 2013

Too many unknowns not to treat as if you are already infected.
posted by Miko at 7:48 PM on April 7, 2013