Q: Is it true when you get a tick bite you need to bring the tick into the pharmacy with you for the pharmacist to prescribe antibiotics?
Pharmacists in New Brunswick can assess and prescribe prophylactic antibiotics if needed after a tick bite to reduce your risk of developing Lyme disease. Part of the prescribing criteria is we must be able to identify that it was a nymph or an adult female blacklegged tick that bit you as these are the only ticks in our province that carry the bacteria that causes Lyme disease. Although we can sometimes identify them with clear photos, it is easier when you bring in the tick so we can carefully look at the head, back and underbelly.
Each county in our province is assessed as being either low, moderate or high risk that the blacklegged ticks are infected by the bacteria Borrelia burgdorferi. Prophylactic antibiotics are recommended for bites that occur in high-risk areas as it is estimated that more than 20 per cent of the ticks are infected. Your overall risk of developing Lyme disease after a high-risk tick bite is approximately three per cent and the tick needs to be attached to your skin for more than 24 hours to transmit the bacteria. As ticks feed, they slowly fill with blood and become engorged. If you are unsure how long the tick has been attached, the pharmacist can estimate the attachment time based on the level of engorgement. When appropriate, pharmacists can prescribe you a single dose of the antibiotic doxycycline.
However, our best defense against Lyme disease is prevention. Blacklegged ticks become active in the spring when the temperature is consistently above freezing and remain active until the fall when the temperature drops again. Ticks prefer to stay in shaded areas that protect them from drying out such as wooded areas, tall grass, shrubs and leaf piles. When you are out walking or hiking it is important to stay in the middle of cleared trails and to avoid trails created by animals as ticks are often found on the plants along these paths. Wear long socks, pants and long sleeve shirts with your socks and shirt tucked into your pants to keep ticks on the outside of your clothing. Wearing light coloured clothing will help you to spot ticks more easily.
Bug sprays containing DEET or icaridin provide protection against ticks. Icaridin is my preferred choice as it is odorless, less irritating to the skin and less damaging to synthetic fabrics. It can be used on adults and children over six months of age.
When you return from outdoors be sure to check yourself, family members, pets and your gear for ticks. They are about the size of a poppy seed so take your time checking your scalp, eyebrows, behind your ears, chest, armpits, belly button, lower back, groin, lower buttocks, behind your knees and between your toes. Put your clothes in the dryer on high heat for at least 10 minutes and if washing use a hot cycle as ticks can survive cold and warm washes. Shower or bathe as soon as possible to help find ticks that may be crawling on you and haven’t attached yet.
If you do find an attached tick you will want to remove it with a pair of fine-tipped tweezers, forceps or a tick remover device. Grasp the tick’s head as close to your skin as possible and slowly pull upwards with steady, even pressure. Do not twist or crush the tick. Place the tick in a sealable plastic bag, pill bottle or jar. Record the date, time, location of the bite and the area of the body that was bitten. Wash the area of the bite with soap and water or disinfect with alcohol or an antiseptic solution.
You can see your pharmacist within 72 hours of tick removal for an assessment. The assessment is covered by the provincial government if you have a valid New Brunswick Medicare card, but patients are responsible for the cost of medication.
Monitor for early signs of Lyme disease which could start as soon as three days after a bite or as long as 30 days. See your doctor or nurse practitioner if you develop any flu-like symptoms or erythema migrans which is a rash that may or may not resemble a bullseye. It starts at the site of the bite and spreads to be larger than 5 cm over several days.
Erin Thompson (BSc, BScPharm) is a graduate of Dalhousie University and a community pharmacist practicing at Shoppers Drug Mart in Quispamsis N.B. Her opinions expressed in this column are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment.