When it comes to preventing Lyme disease, doctors disagree on the amount of antibiotics to prescribe — and the advice you get can change completely depending on who you see. You might walk out with a prescription, a single pill, or just instructions to “watch for symptoms.” For patients, that uncertainty can feel like a gamble with their health.

Two Different Playbooks for Tick Bite Antibiotics

The Infectious Diseases Society of America (IDSA) guidelines recommend prescribing a single 200 mg dose of doxycycline after a tick bite only under strict criteria:

1. The tick is a deer tick (Ixodes scapularis)
2. It was attached for ≥36 hours
3. You live in or visited a high-risk area
4. Antibiotics can be started within 72 hours of removal

Many physicians interpret these rules narrowly, denying prophylaxis if any box is unchecked.

The International Lyme and Associated Diseases Society (ILADS) guidelines, however, recommend a longer antibiotic course — often 10–20 days — after a high-risk bite, especially in endemic regions, arguing that early treatment may prevent serious illness.

Evidence Gaps Fuel the Antibiotics Debate

Those who favor single-dose prophylaxis cite limited studies suggesting it reduces—but doesn’t eliminate—risk.

Those who favor longer treatment point to:

• The possibility of other tick-borne infections (Babesia, Anaplasma, Bartonella)

• Reports of patients developing Lyme disease despite single-dose therapy

• The difficulty of knowing exactly how long the tick was attached

Different Antibiotic Approaches, Different Patient Outcomes

Because the medical community is split, patients face very different outcomes depending on which doctor they see. Some walk out with a prescription for a full 10–20 day course of doxycycline; others receive a single 200 mg dose; and some are told to “watch for symptoms” and return if they develop a rash or fever—by which time the infection could be harder to treat. In every case, I advise follow-up to monitor for new or ongoing symptoms so treatment can be adjusted promptly if needed.

“The difference between early prevention and delayed treatment can be the difference between full recovery and years of illness.”

Shared Decision-Making for Post-Tick Bite Treatment

Until more robust studies settle the debate, the safest path is an informed discussion between patient and clinician, considering:

1. Geographic risk
2. Tick identification and removal time
3. Patient health history and tolerance for antibiotics
4. Co-infection risk in the local tick population

Whatever approach is chosen—watchful waiting, a single dose, or a 10–20 day course of antibiotics—close follow-up ensures that emerging symptoms are addressed early, and treatment can be escalated if needed.

In tick-borne illness, an ounce of prevention is worth far more than a pound of cure. The key is making sure prevention isn’t lost in medical disagreement — and that patients are never left without a plan for monitoring and response.

After a tick bite, did your doctor recommend antibiotics — or a wait-and-see approach? Share your experience below.

Additional Articles:

1. CDC Lyme Disease Overview
2. Lyme Science blog –Only a minority of children with Lyme disease recall a tick bite
3. Lyme Science blog – Tick Bite Treatment Options: Wait or Treat?
4. Lyme Science blog –Tick Bite Ethical Concerns: Rethinking the single dose of doxycycline