#EMConf: Management of Tick Borne Illnesses

Consider tick borne illness when:

  • Influenza-like illness presentations, especially during the summer months. 
  • Fever of unknown origin
  • When viral meningitis is on your differential diagnosis. 


  • PO: Atovaquone + Azithromycin
  • IV: Clindamycin + Quinine
  • Exchange transfusion indications (would need Hematology/Oncology consult): 1. Asplenia       2. Parasite Load > 10%

Lyme's Disease:

  • Doxycycline for early localized or early disseminated disease
  • If under 8 years old or allergy, can do Amoxicillin
  • if high degree AV Block or Meningitis - IV Ceftriaxone 
  • Lyme prophylaxis with 200 mg Doxy x 1 dose; Amoxicillin not effective
    • Attached x 36h; based on engorgement size
    • Lyme endemic area (local infection rate > 20%)
    • Treatment within 72h of tick removal
    • No Doxycycline contraindication 

Erhlichiosis and Anaplasmosis:

  • Doxycycline regardless of age. 
  • Rifampin if life-threatening allergy or pregnant

Tularemia (not always tickborne): 

  • Streptomycin or Gentamycin.