My 8-yr. old nephew lives in southern North Carolina. My sister-in-law called yesterday to say her husband picked a tick off their son's armpit area two days ago. The tick was attached but not terribly engorged. He now has a red bite spot but no ring.
My brother-in-law threw the tick away in the grass and doesn't know what kind of tick it was.
Anyway, they called me for advice because I'm the "Lyme expert" in the family.
I recommended they get 28 days of prophylactic amoxicillin following Dr. B.'s guidelines. So, armed with information, my sister-in-law took their son to the pediatrician this morning.
The doctor told them "no antibiotics" until and unless symptoms develop. She said Rocky Mountain Spotted Fever was more of a concern in their region and that if she gave "10 days" of amoxicillin to my nephew it would mask the symptoms of this often fatal disease.
She said that Lyme and Rocky Mountain need different antibiotics and she wasn't willing to treat Lyme when RMSF could be in the picture.
She said "all" children develop Lyme symptoms within a week and a half if they have the disease. She said there is a 99% chance my nephew will be "fine".
My sister-in-law is in tears not knowing what to do. Because I know nothing about Rocky Mountain Spotted Fever I felt I could not argue either way regarding the pediatrician's decision.
Does anyone have experience, advice to offer on this? I am asking before doing any research on my own. I will do that now.
Thanks in advance. - Lymelady
Posted by sixgoofykids (Member # 11141) on :
My LLMD treats prophylactically if it's an endemic area (all areas are, right?!).
I don't know how to deal with docs who won't treat, I never had any luck there.
Posted by kimmie (Member # 25547) on :
RMSF is treated with doxy. I think the risk of lyme is greater than RMSF...if he gets ill with a fever and spotted rash he needs doxy asap for RMSF.
As you know with lyme, it can be a delayed response 4-6 weeks after the bite before symptoms devop in some. It was 6 weeks for my daughter and 3 days for me.
They dont believe in lyme in the south. Personally, I would treat with 28 days amox if possible.
I went through this and promised myself, I will ALWAYS keep meds available in case of another bite. Why wait till symptoms?
Posted by bcb1200 (Member # 25745) on :
I know how you feel. In April we pulled an attached tick off the inside of my 2 year old daughter's ear. It had been there for days.
This was pre my Dx so I had no idea about lyme at the time. I flushed the tick and called the pediatrician who said watch for symptoms in the next 6 weeks.
3 weeks later she got a fever of 102 and was ill for a week. By this time I was diagnosed and had a lyme crash course. We took her to her Pediatrician and I demanded antibiotics. He refused. It ended up being croup, luckily.
As a precaution, I took her 1 month later to see Dr. M in CT who worked for the famous pediatrician Dr. J. Dr M felt she was fine and called / conferred with Dr. J on the phone who agreed.
So we were lucky. BUt I know how infuriating it is when the docs won't prescribe prophylactically.
Posted by janet thomas (Member # 7122) on :
8 yrs old is old enough for doxy
if it was her kid I bet she'd treat!
I sent you a pm.
Posted by janet thomas (Member # 7122) on :
Empiric treatment Doxycycline 100 mg po or iv bid 5 to 7 days
a.Because the clinical picture of a patient with Rocky Mountain spotted fever can be variable, and the disease can be fulminant, empiric therapy is essential. b. The recommended treatment regimen is 100 mg oral or intravenous doxycycline twice daily for five to seven days. c.The clinical response to treatment can be dramatic and supports the diagnosis of Rocky Mountain spotted fever before results of serologic testing are available. Prognosis. a. Early initiation of antibiotic therapy usually results in prompt clinical remission. b. Diagnostic or therapeutic delays substantially increase morbidity and mortality.
Posted by lymeladyinNY (Member # 10235) on :
Thank you, all. I will tell my sister-in-law what you've told me here.
I was thinking that maybe they should wait the 7-10 days to see if RMSF symptoms develop. If no symptoms develop, then have them insist on the full course of amoxicillin to get any Lyme disease that may have been transmitted.
Do you think this is good advice to give my in-laws?
Posted by janet thomas (Member # 7122) on :
Personally I think doxy should have been started already.
Children younger than 8 years old should not take doxycycline. Doxycycline can cause permanent tooth discoloration and can also affect a child's growth.
I didn't have a bullseye rash either, but I did hav a round, red rash where the tick was embedded. I got a basketfull of diseases wtith that bite.
I agree with the others. 4-8 weks of abx is called for immediatly in this case, IMO.
Posted by lymeladyinNY (Member # 10235) on :
I guess they're taking a wait-and-see position. My brother-in-law is not worried about this situation.
My husband sent his sister a lot of information this morning. She is doing research on her own. I know she wants to do the right thing. We've given her as much advice as possible.
Thanks so much to all of you. - Lymelady
Posted by JT's Mom (Member # 24553) on :
I would strongly caution your in-laws not to brush this off and take the 'wait and see' approach. It can take many months for symptoms to develop and by then the disease is widely disseminated and much more difficult to treat.
My son (age 3 when bit) had virtually no symptoms in the first 6 months after his tick bite other than a small red spot (NOT a bulls-eye) at the site of the bite. No flu-like symptoms, no aching joints (other than 1 day mentioning his knee hurt... never again... wasn't swollen).
Six months later he developed a motor tic that we didn't connect to Lyme disease. We have no family history of tic disorders or Tourettes.
Fast forward 2 years, and I come across information about Lyme causing motor and vocal tis in children. I decide to have my son tested through IGeneX and he is IGG positive (5 bands), and positive on the 31 kda epitope test. He has been diagnosed with neuroborreliosis.
Please make them aware of the potentional long-term consequences of the "wait and see" approach.
Posted by lymeladyinNY (Member # 10235) on :
I'm sorry to learn of your son. Yes, I am very discouraged that they have decided on this approach and my husband and I have explained the risks to them.
My sister-in-law is unable to convey to her husband or the pediatrician the potential seriousness of the situation. However, the doctor did tell her that she would put her son on antibiotics if ANY symptom arises.
Hmmm, as we all know, that's not good enough. What else can I do from NY state when they are in No. Carolina? I will be following the situation closely but I don't know what to do to help them beyond what we've already told them.
![[Frown]](frown.gif)