Re: OB: Lyme disease/tick bite
From: Anna Meenan, MD (annam@uic.edu)
Thu Jun 1 23:48:51 2006
I knew that. Doxy 200 mg X1 is the only prophylactic regimen I've ever
seen, but I got curious about what WOULD one do for prophylaxis in a
pregnant woman if the issue ever arose (since prenatal care is the only
medicine I do these days and "'tis the season" here in Illinois). All I
could find in a brief search was Amoxicillin 250 TID X 10d (as opposed
to 500 TID X 21d for treatment). Don't know what one would do with a
PCN-allergic pt. Now that I've said that, I fully expect to have one of
my ladies show up tomorrow in clinic with a deer tick bite and a hx of
PCN allergy. That's just how my life goes these days. LOL
--
Anna Meenan, MD
At Thu, 1 Jun 2006, Garry E. Siegel, M.D. wrote:
>
>You're not being nitpicky, but accurate--thanks. No doxy since
>pregnant, however.
>
>Garry
>
>At Thu, 1 Jun 2006, Meenan, Anna wrote:
>>
>>Good for her. And just to be nitpicky, it would not have been
>>prophylaxis, but treatment if you started Amoxicillin after the onset
>>of "symptoms". Prophylaxis, if memory serves, is accomplished
>>immediately, with 200 mg of doxycycline X 1 dose, though that is
>>still controversial.
>>
>>Anna Meenan, MD
>>
>>>The patient's 6 YO has a sore throat today, and she thinks it is a virus
>>>and will not start prophylaxis as of this point.
>>>
>>>Thanks to all,
>>>
>>>Garry
>>>
>>>At Thu, 1 Jun 2006, Meenan, Anna wrote:
>>>>
>>>>Your memory doesn't fail you, Joe, but I have found that once a pt
>>>>has identified a deer tick that's been hanging onto them for even a
>>>>few hours, they tend to want to get treated no matter what, and I
>>>>would imagine that's even more likely if the pt is pregnant and has
>>>>what she thinks are "symptoms" of Lyme disease. I try to talk them
>>>>out of it if they have no sx, but once they develop any kind of rash
>>>>or nonspecific flu-like sx, you might as well treat.
>>>>
>>>>Anna Meenan, MD
>>>>
>>>>>My memory does fail me : but I thought tick had to be embedded for
>>>>>at least 24 hours before infectious transfer. Joe C
>>>>>
>>>>>Garry E. Siegel, M.D. wrote:
>>>>>>37 YO P2002 at 20-ish weeks called with a tick bite, removed after
>>>>>>around 4 hours, and a concern regarding Lyme disease. She has been
>>>>>>without symptoms, and this occurred around 3 weeks ago.
>>>>>>
>>>>>>After reviewing a summary article from the CDC, routine prophylaxis was
>>>>>>not recommended pretty much across the board. If the patient developed
>>>>>>any symptomatology, the treatment was indicated.
>>>>>>
>>>>>>Today, she called with a few small marks near the site and a sore
>>>>>>throat.
>>>>>>
>>>>>>Treatment of early disease is pregnant is with Amoxicillin for 14 to 28
>>>>>>days (can't remember the exact regimen).
>>>>>>
>>>>>>At this point, it seems unlikely that anything on physical exam will
>>>>>>give a clear answer as to how to proceed, and serology is apparently not
>>>>>>that accurate.
>>>>>>
>>>>>>I've offered for her to see an Infectious Disease specialist, but my
>>>>>>instinct is to treat, since she now has some symptoms that MAY be
>>>>>>attributed to exposure.
>>>>>>
>>>>>>Any thoughts?
>>>>>>
>>>>>>Garry
>>>>>>
>>>>>>--
>>>>>>Garry E. Siegel, M.D.
>>>>>>Private Practice
>>>>>>Roswell, GA
>>>
>>>--
>>>Garry E. Siegel, M.D.
>>>Private Practice
>>>Roswell, GA
>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
