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Rapid Response is an online forum for ongoing peer review. To submit a Rapid Response please go to the article you wish to respond to and click on the link that reads "Rapid Responses: Submit a Response." Submission of Rapid Responses are open to all health care professionals and experts in related fields.

Rapid Response to:

Articles:
Jacob J. Rosenberg, Vivek Prasad, John Gaebler, Naomi Dreisinger, and Shai Manzuri
Index of Suspicion
Pediatrics in Review 2008; 29: 131-136 [Full text] [PDF]
*Rapid Responses: Submit a response to this article

Rapid Responses published:

[Read Rapid Response] Dr. Rosenberg's Response to Dr. Sampang
jacob j rosenberg   (16 June 2008)
[Read Rapid Response] Formal recommendations for prophylaxis
Heidi L Sampang   (16 June 2008)

Dr. Rosenberg's Response to Dr. Sampang 16 June 2008
Previous Rapid Response Top
jacob j rosenberg,
physician
Nausau Univ Med Center, East Meadow, NY

Send letter to journal:
Re: Dr. Rosenberg's Response to Dr. Sampang

sydney_sutherland{at}urmc.rochester.edu jacob j rosenberg

Thank you very much for the inquiry regarding the prophylaxis recommendation. The information came mainly from the two articles listed below. Although no formal recommendation by the CDC has been made, these are recommendations that “should be strongly considered” based on the findings in the paper by Nadelman et al.

Also, the American Academy of Pediatrics’ Red Book states: “On the basis of a study of doxycycline for prevention of Lyme disease after a deer tick bite, some experts recommend a single 200-mg dose (4.4 mg/kg for body weight < 45 kg) of doxycycline for people 12 years of age (the lower limit of age studied) and older who have been bitten in an area with hyperendemic infection who have found an engorged deer tick, especially if the suspected duration of attachment is 72 hours or longer; gastrointestinal tract adverse effects occur commonly. Data are insufficient to recommend amoxicillin prophylaxis.”

Readers should note this discrepancy: The “Index of Suspicion” case recommends prophylaxis if the attachment has been for 36 to 72 hours but the Red Book recommends prophylaxis for attachment of 72 hours or more. The latter recommendation should be followed.

Nadelman RB, Nowakowski J, Fishe D, Falco RC, Freeman K, McKenna D, Welch P, Marcus R, Aguero-Rosenfeld ME, Dennis Dt, Wormser GF for the Tick Bite Study Group. Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite. New Engl Jour Med. 2001;345:79-84

Hayes Eb, Piesman J. How can we prevent Lyme disease? New Engl Jour Med 2003;348:2424-2430

Red Book: 2006 Report of the Committee on Infectious Diseases. Elk Grove Village, IL: American Academy of Pediatrics. Pp 432-433

Conflict of Interest:

None declared
Formal recommendations for prophylaxis 16 June 2008
Next Rapid Response Top
Heidi L Sampang,
pediatrician
Town Pediatrics

Send letter to journal:
Re: Formal recommendations for prophylaxis

hsampang{at}hotmail.com Heidi L Sampang

I enjoyed reading the article especially since I practice in the Northern VA area and we see a lot of these cases. We have not been giving prophylaxis for tick bites and has been treating them only when symptoms are present. But Dr. Rosenberg is recommending prophylaxis for certain cases and I just want to know where did he get the recommendations? Has the CDC released a formal statement about prophylaxis?

Conflict of Interest:

None declared

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