NEW TICK BITE? WHAT TO ASK YOUR DOCTOR.
Updated: Oct 20
This is the post to print and take to your doctor: what ILADS recommends for treatment after a tick bite, plus research to share. For the first steps right after a bite, see How to Handle a Tick Bite:
PRINT this for your doctor so you get enough antibiotics. (Always treat the bite!)
My personal opinion: even if I had no symptoms and no bull's-eye rash, I would still want 6 to 8 weeks of antibiotics. I'll admit I'm a little paranoid, but that comes from what Lyme did to my life and from watching people I love go through it too. Please talk with your doctor about what is right for you.
There is a quick-view graphic with the key points at the bottom of this post.
PRINT AND TAKE TO YOUR DOCTOR
ILADS - Lyme Disease Basics for Providers:
This gives antibiotic instructions too:
This one is from 2019, but I kept it in because it has been a great resource:
ILADS Treatment Guidelines:
My full doctor letter:
WHAT TO DO RIGHT AFTER A TICK BITE
These steps come from ILADEF, the education foundation of ILADS (the International Lyme and Associated Diseases Society):
- Remove the tick with fine-pointed tweezers. Grab it where it meets the skin and pull with steady, gentle pressure. Don't squeeze it, put Vaseline on it or burn it with a match, since that may raise the risk of infection.
- Put the tick in a sealed bag or small container. Your doctor can see what kind of tick it is and whether it had started feeding, and you can send it to a lab for testing.
- Clean the bite, your hands and the tweezers.
- Call your doctor right away. ILADS says not to wait for symptoms, because by the time symptoms show up, the infection may already be harder to treat.
- Ask your doctor about preventive antibiotics. ILADS says this should be discussed with everyone bitten by a black-legged (deer) tick.
How to get your tick tested:
Which tick was it? Different types of ticks:
Need a Lyme literate doctor?
WHAT ILADS RECOMMENDS
For a known black-legged tick bite with no symptoms:
- ILADS recommends 20 days of doxycycline when preventive treatment is used (as long as there is no reason you can't take it).
- ILADS recommends against the single 200 mg dose that many doctors still give. They explain that it is based on a flawed study that has never been repeated.
- Timing matters. Animal studies suggest preventive treatment works best when started within 48 hours of removing the tick.
If you have a Lyme rash OR symptoms:
- Longer treatment isn't only for a bull's-eye rash. ILADS says early Lyme without a rash is treated much the same way as early Lyme with a rash.
- Many people never get a rash. ILADS shares that fewer than 20% of Lyme rashes look like the classic bull's-eye.
- For a Lyme rash (erythema migrans), ILADS recommends 4 to 6 weeks of doxycycline, amoxicillin or cefuroxime. At least 21 days of azithromycin is also an option.
- ILADS explains that treating a rash for 20 days or less has had low success rates in studies, which is why they recommend 4 to 6 weeks.
- Your doctor should check on you at the end of treatment and keep going if you are still sick.
(I personally vote for 6 to 8 weeks, but that's between you and your doctor, who hopefully knows what he or she is doing.)
Good to know:
- ILADS calls doxycycline the treatment of choice for Ehrlichia, Anaplasma and Rocky Mountain spotted fever.
- ILADS notes that a preventive course of doxycycline won't treat Babesia, Bartonella or Powassan virus.
- One tick bite can pass on more than one germ. ILADS shares that 4% to 45% of Lyme patients in high-risk areas also have a co-infection.
- Taking antibiotics early can keep your body from making antibodies, so later blood tests may come back falsely negative.
- Even after preventive treatment, keep watching for fever, headache, muscle and joint pain, or fatigue, and call your doctor if any show up.
Most common symptoms of Lyme, Babesia and Bartonella:
Why tests can come back negative, and which tests to ask for:
WHAT OTHER TRUSTED SOURCES SHARE
Dr. Marty Ross (updated October 2026):
- For a black-legged tick bite with no symptoms, he treats with doxycycline for at least 20 days, no matter how long the tick was attached.
- For a tick bite with symptoms or a rash, he treats for at least 4 to 6 weeks and keeps going until all symptoms are gone.
- He strongly disagrees with the single dose. The study behind it only watched for a bull's-eye rash for six weeks, and more than 30% of Lyme patients never get a rash.
- If someone can't take doxycycline, amoxicillin, cefuroxime or azithromycin may be used instead.
- He chooses doxycycline first because he feels it covers Lyme along with Ehrlichia, Anaplasma, Babesia, Bartonella and Rocky Mountain spotted fever.
- He does not recommend herbal antibiotics for a new tick bite, since they haven't been researched for this.
Doxycycline, Babesia and Bartonella:
- Doxycycline has some activity against Babesia and Bartonella, but research so far suggests it usually isn't enough on its own.
- Bartonella: Tulane lab studies by Monica Embers (2021 and 2026) found doxycycline slowed Bartonella's growth but didn't kill it, and by itself it didn't clear Bartonella hiding inside cells or in biofilms. Some antibiotic combinations worked better. These were lab studies, so studies in people are still needed. Dr. Richard Horowitz also shares that long-term (chronic) Bartonella often needs two antibiotics together.
- Babesia: Babesia is a parasite and is usually treated with antiparasitic medicines. A 2023 case report from China described one patient whose Babesia venatorum infection cleared with doxycycline alone. The authors say more studies are needed before it becomes a standard treatment.
Global Lyme Alliance tips:
- Take a photo of the bite and draw a circle around it with a pen, so you can tell if a rash spreads.
- A Lyme rash can show up somewhere other than the bite, and it may not look like a bull's-eye.
- Write down any symptoms (GLA has a Lyme Symptom Tracker app) and call your doctor right away if they appear.
- Many people with Lyme never even notice the tick bite.
RESEARCH TO SHARE WITH YOUR DOCTOR
I would also suggest emailing or walking in with this list of education if you want to take it one step further. The more education, the better!
2026 study (Infectious Disease Reports): In one Wisconsin health system, more than 2,400 single-dose doxycycline prescriptions were given after tick bites from 2022 to 2024. In the charts reviewed, the kind of tick was written down less than half the time.
Dr. Richard Horowitz lists the evidence that Lyme bacteria can survive antibiotics, and why guidelines need to catch up. LymeDisease.org suggests saving it for future talks with doctors (2022):
Tulane University, Monica Embers (2023): In mice, a single antibiotic given for 28 days did not fully clear a lasting Lyme infection, while some combinations of approved antibiotics did. This was a lab study in mice, so human studies are still needed.
Tulane University, Monica Embers (2021): Lyme bacteria were found in the brain and spinal cord of a woman who had been treated with antibiotics many times.
Tulane University, Monica Embers (2017): In monkeys infected by ticks, living Lyme bacteria were still found 7 to 12 months after a full 28-day course of doxycycline. This was an animal study, so results may not apply directly to people.
RELATED POSTS
Tick Bite Education
How to Handle a Tick Bite
Tick Attachment Time
Tick Repellent for Body and Yard
SOURCES
ILADEF - How to Handle a Tick Bite
ILADS - Lyme Disease Basics for Providers (updated 2026)
ILADS Treatment Guidelines
ILADS - Tick-Borne Diseases Other Than Lyme (brochure)
Tulane University (Olsen and Embers) - Combination antibiotic therapy is required to eliminate Bartonella henselae, Frontiers in Microbiology (2026)
Tulane University (Gadila and Embers) - Antibiotic Susceptibility of Bartonella Grown in Different Culture Conditions, Pathogens (2021)
Infectious Diseases of Poverty - Doxycycline treatment for human Babesia venatorum infection, case report (2023)
LymeDisease.org - Dr. Horowitz, Effective treatments for Bartonella (2025)
Get It Right! Treat the Bite! (2019)
Infectious Disease Reports - Post-Exposure Prophylaxis Prescribing Practices in a Lyme Disease-Endemic Area (2026)
Global Lyme Alliance - I Found a Tick on Me, Now What? (2023)
Tulane University - Combined antibiotics more effective against Lyme (2023)
LymeDisease.org - Horowitz on Lyme persistence (2022)
Tulane University - Persistent Lyme infection in the brain (2021)
Tulane University - Lyme bacteria survive antibiotic treatment (2017)
Dr. Marty Ross, Antibiotics for Acute Tick Bites (updated October 2026)
Disclaimer: Rise Above Lyme makes no claims about any possible benefit of using any product mentioned within this site. Always consult with your doctor before adding anything. The information shared is based on personal experience, years of accumulated researched resources from Lyme Literate doctors and polls conducted within Lyme groups from actual patient experience using these solution ideas.
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