Lyme caught early — especially with the EM rash present — is most often treated with a course of an oral antibiotic. Disseminated disease is treated differently, and each of the other tick-borne infections is treated on its own terms, because a parasite or a virus does not answer to the antibiotic that treats a bacterium. Two published Lyme guidelines exist, one from the Infectious Diseases Society of America with the American Academy of Neurology and the American College of Rheumatology (2020) and one from the International Lyme and Associated Diseases Society (2014); the Common ground page links both and says what each covers. This page describes the structure of treatment and names the medicines involved; it gives no doses or durations, because that decision belongs to the clinician treating you.
Persistent symptoms after treatment are real. What to do about them is a decision for you and the clinician treating you, and this page does not settle it.
The structure of care
Tick-borne diseases are treated differently because they are biologically different organisms — bacteria, parasites, and viruses each require a different approach. The same antibiotic that treats Lyme has zero effect on Babesia, a parasite. This reference organizes the standard-of-care approach for each disease — which treatments are typically used and the reasoning behind them. It intentionally does not include doses or durations — those are determined by your provider. This page documents the structure of care, not a prescription.
Disease by disease
Each block below carries the medicines used for that disease and the reasoning behind them. The View control switches every block between a plain-language patient reading and a clinical one; the clinical reading adds detail, and never contradicts the other.
Lyme Disease
Borrelia burgdorferi (and B. mayonii)First-Line Treatment
Doxycycline
Oral. Penetrates cells and crosses the blood-brain barrier — preferred for early Lyme and when coinfection with Ehrlichia/Anaplasma is possible. Supplements and other medicines can interact with it. Tell your prescriber and pharmacist what you take.
Amoxicillin / Cefuroxime (alternatives)
Alternatives to doxycycline. Which antibiotic suits a given person, a child included, is the prescriber’s decision. Neither covers Ehrlichia or Anaplasma.
In Plain Language
Caught early — especially when the EM rash is present — Lyme is most often treated with a course of doxycycline. The rash is treated on sight rather than after a test, because a test drawn that early is usually negative regardless. If symptoms persist after treatment, that's worth a direct conversation with a Lyme-literate provider about next steps and possible coinfections.
Your provider determines your treatment based on your presentation, history, and current guidelines.
Babesiosis
Babesia microti, B. duncaniFirst-Line Treatment
Atovaquone (Mepron) + Azithromycin
Babesia is a parasite, not a bacterium — antibiotics like doxycycline have no effect. How atovaquone is taken affects how much is absorbed. Ask your prescriber or pharmacist about timing with other medicines.
Clindamycin + Quinine (severe cases)
Reserved for severe or hospitalized cases; more side effects.
In Plain Language
Babesia is a malaria-like parasite that lives in red blood cells, so it needs antiparasitic treatment — not the antibiotics used for Lyme. Symptoms like night sweats, air hunger, and drenching chills are worth flagging to your provider, since Babesia is easy to miss and often travels with Lyme. How atovaquone (Mepron) is taken affects how well it is absorbed, so follow your prescriber's instructions.
Your provider determines your treatment based on your presentation, history, and current guidelines.
Bartonella — not established as tick-borne
Bartonella henselae, B. quintanaWhat is and is not established
Bartonella is spread to people mainly by fleas, body lice and sand flies, and by scratches from flea-infested cats. CDC states there is no evidence that ticks spread Bartonella to people. It has been found in ticks, and one laboratory study showed a tick passing it to an animal; whether that happens in nature is not known. Some clinicians who treat persistent illness after a tick bite consider it anyway — a proposed route of infection, not an established one.
In Plain Language
Bartonella is spread to people mainly by fleas, body lice and sand flies, and by scratches from flea-infested cats. Those infections are real and are treated with antibiotics chosen by a clinician. CDC states there is no evidence that ticks spread Bartonella to people. If you have had contact with cats, fleas or lice, that exposure is the useful thing to mention.
Your provider determines testing and treatment based on your exposures, presentation and history.
Ehrlichiosis / Anaplasmosis
Ehrlichia chaffeensis; Anaplasma phagocytophilumFirst-Line Treatment
Doxycycline
First-line for all ages, and started on clinical suspicion rather than after a test, because these infections can become severe quickly — especially in older or immunocompromised people.
In Plain Language
These infections are treated with doxycycline. Because they can escalate fast, providers frequently start treatment based on symptoms and exposure rather than waiting for test confirmation.
Your provider determines your treatment based on your presentation, history, and current guidelines.
Alpha-gal Syndrome
Lone Star tick–induced (galactose-α-1,3-galactose allergy)Management Approach
Alpha-gal is not an infection — it's an acquired allergy to a sugar found in mammalian meat, triggered by tick bites. There is no antibiotic treatment. Management is avoidance of mammalian meat and derived products, plus allergy preparedness.
Allergy management
Antihistamines for mild reactions; epinephrine auto-injector prescribed for those at risk of anaphylaxis. Avoiding further tick bites may allow sensitivity to decrease over time in some people.
In Plain Language
A tick bite can make your body react to red meat — sometimes hours after eating it, which makes it confusing to spot. There's no pill that cures it; the approach is avoiding mammalian meat (beef, pork, lamb) and related products, and carrying emergency allergy medication if your reactions are severe. An allergist can guide you.
An allergist or your provider guides management based on your reaction severity and testing.
Rocky Mountain Spotted Fever
Rickettsia rickettsiiFirst-Line Treatment — Time-Critical
Doxycycline — start immediately on suspicion
RMSF is a medical emergency. Treatment must not wait for laboratory confirmation — delayed treatment is associated with serious outcomes. Doxycycline is first-line for all ages, including children, when RMSF is suspected.
In Plain Language
RMSF is serious and moves fast — fever, headache, and a rash that often starts on wrists and ankles. If a provider suspects it, they will start doxycycline right away rather than waiting for tests, because early treatment is what prevents serious harm. Seek care urgently for these symptoms after a tick bite.
Powassan Virus
Powassan virus (flavivirus)Management Approach
Powassan is a virus — antibiotics do not work, and there is currently no specific antiviral treatment. Care is supportive, often in a hospital for severe neurological cases (encephalitis/meningitis).
Supportive care
Hospitalization, respiratory support, IV fluids, and management of brain swelling in severe cases. Prevention (tick avoidance) is especially critical because the virus can pass soon after a tick attaches.
In Plain Language
Powassan is rare but serious, and because it's a virus, there's no antibiotic or specific cure — doctors treat the symptoms and support the body, especially if the brain is affected. This is one where prevention matters most: it can transmit very quickly after a tick attaches, so prompt tick removal and bite prevention are key.
Tularemia
Francisella tularensisFirst-Line Treatment
Aminoglycosides (e.g., streptomycin or gentamicin)
First-line for significant disease, typically given by injection/IV. Tularemia is highly infectious and treated promptly; the antibiotic class differs entirely from Lyme treatment.
Doxycycline / ciprofloxacin (alternatives)
Used in milder cases or as alternatives; relapse can occur, so duration matters.
In Plain Language
Tularemia is uncommon, and it is treated with different antibiotics from Lyme. It can come from tick bites as well as contact with infected animals. Prompt treatment matters, so tell your provider about any tick or animal exposure.
Your provider determines your treatment based on your presentation, history, and current guidelines.
Once treatment starts
Symptoms can worsen briefly at the start of treatment. Report it; do not interpret it alone. What a change in symptoms means in your case is a question for the clinician treating you, and the answer depends on which infection is being treated.
Whether extended antibiotic treatment helps symptoms that persist after treatment, and for whom: this page does not settle it. What causes those symptoms is not settled here either, and the page takes no view.
- Which guideline are you working from, and where do you depart from it for me?
- What would tell us treatment is working, and by when?
Review statePending clinical review
Every drug named and the rationale given for it, including the doxycycline card’s line on supplements and other medicines, which names none of them and routes to the prescriber and pharmacist. No dose or duration appears on the page, deliberately — that absence is part of what needs checking. A clinically-informed reviewer has not yet signed this off, and it stays marked until one does.