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Volume 345:79-84 July 12, 2001 Number 2 Next

	Full Text PDF Editorial by Shapiro, E. D. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background It is unclear whether antimicrobial treatment after an Ixodes scapularis tick bite will prevent Lyme disease.

Methods In an area of New York where Lyme disease is hyperendemic, we conducted a randomized, double-blind, placebo-controlled trial of treatment with a single 200-mg dose of doxycycline in 482 subjects who had removed attached I. scapularis ticks from their bodies within the previous 72 hours. At base line, three weeks, and six weeks, subjects were interviewed and examined, and serum antibody tests were performed, along with blood cultures for Borrelia burgdorferi.

Results Erythema migrans developed at the site of the tick bite in a significantly smaller proportion of the subjects in the doxycycline group than of those in the placebo group (1 of 235 subjects [0.4 percent] vs. 8 of 247 subjects [3.2 percent], P<0.04). The efficacy of treatment was 87 percent (95 percent confidence interval, 25 to 98 percent). Objective extracutaneous signs of Lyme disease did not develop in any subject, and there were no asymptomatic seroconversions. Treatment with doxycycline was associated with more frequent adverse effects (in 30.1 percent of subjects, as compared with 11.1 percent of those assigned to placebo; P<0.001), primarily nausea (15.4 percent vs. 2.6 percent) and vomiting (5.8 percent vs. 1.3 percent). Erythema migrans developed more frequently after untreated bites from nymphal ticks than after bites from adult female ticks (8 of 142 bites [5.6 percent] vs. 0 of 97 bites [0 percent], P=0.02).

Conclusions A single 200-mg dose of doxycycline given within 72 hours after an I. scapularis tick bite can prevent the development of Lyme disease.

Source Information

From the Department of Medicine, Division of Infectious Diseases (R.B.N., J.N., R.C.F., D.M., G.P.W.), and the Department of Pathology (M.E.A.-R.), New York Medical College; and the Lyme Disease Diagnostic Center, Westchester Medical Center (R.B.N., J.N., D.M., G.P.W.) — both in Valhalla, N.Y.; the Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn. (D.F.); the Vector Ecology Laboratory, Louis Calder Center, Fordham University, Armonk, N.Y. (R.C.F.); the Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, N.Y. (K.F.); Northern Westchester Hospital Center, Mt. Kisco, N.Y. (P.W., R.M.); and the Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colo. (D.T.D.).

Because of its potential importance in the treatment of Lyme disease, this article was published at www.nejm.org on June 12, 2001.

Address reprint requests to Dr. Nadelman at the Division of Infectious Diseases, Westchester Medical Center, Macy Pavilion 209 Southeast, Valhalla, NY 10595.

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