Use of repellents

Avoidance and early removal of ticks are the first steps in prevention of Lyme disease. In highly endemic areas, when an engorged Ixodes scapularis tick is attached for at least 48 hours, prophylaxis with a single dose of doxycycline would be reasonable in adults and children at least 8 years old. With a less com- pelling indication, it would be reasonable not to prescribe antibiotics unless erythema migrans develops. Recommended doses of antibiotics cure almost all patients with erythema migrans without complications. Antibiotic therapy is not recommended for patients with a history of appropriately treated Lyme disease and persistent subjective symptoms.