Q: Last fall I started working for a landscaping company and had a few tick encounters while working outdoors. On one occasion, my pharmacist prescribed an antibiotic after I found an engorged tick attached behind my knee. Now that I’ll be landscaping for the full season, I’m expecting even more tick bites. Is it possible to get a larger supply of antibiotics to keep on hand for future bites, or take antibiotics as a weekly dose during tick season to help prevent Lyme disease?
Lyme disease is a very real concern in New Brunswick, particularly in high-risk areas for infected blacklegged ticks. For people who regularly work or spend time outdoors, repeated tick exposure can understandably create significant anxiety. Pharmacists can assess tick bites and prescribe preventative antibiotics in certain situations, but each bite needs to be assessed individually.
These assessments are publicly funded for patients with a valid New Brunswick Medicare card, with coverage available for up to two assessments within a 12-month period. Pharmacists can still assess additional tick bites and provide assessments for patients without a Medicare card, although a fee is charged to the patient, which may be reimbursable through private insurance plans.
The blacklegged tick, also known as the deer tick, is the only tick species in New Brunswick that carries the bacteria Borrelia burgdorferi that causes Lyme disease. Lyme disease can become serious if it is not recognized and treated early. While many people think only of the classic bullseye rash, symptoms can also include fever, chills, severe fatigue, headaches, muscle and joint pain, swollen lymph nodes, facial paralysis, heart complications, and neurological symptoms.
Because Lyme disease can have serious consequences, it is important to take every tick bite seriously. However, taking antibiotics weekly, seasonally, or keeping a supply at home for self treatment is not recommended and is not considered safe or effective prevention.
This is where antibiotic stewardship becomes important. Unnecessary antibiotic use increases antibiotic resistance and exposes people to avoidable side effects such as diarrhea, severe sun sensitivity, allergic reactions, and yeast infections. Repeated antibiotic use can also disrupt the body’s normal bacteria and may make future infections harder to treat.
Every tick bite carries a different level of risk. Pharmacists assess several factors before deciding whether preventative antibiotics are appropriate, including the type of tick, where the exposure occurred, and how long the tick was attached. In most cases, the tick must be attached for at least 24 to 36 hours before Lyme disease transmission becomes likely. As ticks feed, they gradually become engorged with blood, which can help estimate attachment time.
If possible, take clear photos of the tick before removal in case it becomes damaged, then place it in a sealed container or plastic bag and bring it to the pharmacy for assessment. When the risk factors are met, it has been less than 72 hours since the tick was removed, and there are no symptoms suggesting early Lyme disease, a single dose of doxycycline is generally recommended.
For people who spend time outdoors regularly, prevention and early detection remain the best defense. Ticks thrive in wooded areas, tall grass, shrubs, and leaf litter. Wearing long sleeves, long pants, and socks pulled over pant legs can help reduce exposure. Light coloured clothing makes ticks easier to spot, and insect repellents containing DEET or icaridin can help deter them.
Daily tick checks are extremely important because removing ticks early significantly lowers the risk of Lyme disease transmission. Nymph ticks can be as small as a poppy seed, so carefully inspect the scalp, behind the ears, armpits, groin, behind the knees, waistband, and between the toes. Clothing should also be placed in the dryer on high heat for at least 10 minutes after coming indoors to help kill any hidden ticks.
If you find an attached tick, remove it promptly using fine tipped tweezers or a tick removal device. Grasp the tick as close to the skin as possible and pull upward slowly with steady pressure. It may take a few seconds for the tick to release. Avoid twisting or crushing the tick. Clean the bite area afterward with soap and water or an antiseptic.
After any tick bite, monitor for symptoms of Lyme disease for 30 days. Seek medical attention promptly if you develop an expanding rash, fever, chills, fatigue, headaches, muscle aches, or joint pain, even if preventative antibiotics were prescribed.