Ticks can transmit bacterial, protozoal, and
viral infections to humans. Specific
therapy is available for several of these
infections.
Doxycycline is the antimicrobial treatment of choice for all patients, regardless of age, with
Rocky Mountain spotted fever, human monocytic
ehrlichiosis, or human granulocytic
ehrlichiosis.
Chloramphenicol has been used to treat these
infections in children but is demonstrably inferior to
doxycycline. In patients with
Mediterranean spotted fever,
doxycycline,
chloramphenicol, and newer
macrolides all appear to be effective
therapies.
Therapy of
Lyme disease depends on the age of the child and stage of the disease. For early localized disease,
amoxicillin (for those aged <8 years) or
doxycycline (for those aged >/=8 years) is effective.
Doxycycline,
penicillin V (
phenoxymethylpenicillin) or
penicillin G (
benzylpenicillin) preparations, and
erythromycin are all effective treatments for
tick-borne relapsing fever. Hospitalized patients with
tularemia should receive
gentamicin or
streptomycin.
Doxycycline and
ciprofloxacin have each been investigated for the treatment of
tularemia in outpatients; however, these agents do not yet have established roles in the treatment of this disease in children. Combination
therapy with
clindamycin and
quinine is preferred for children with
babesiosis; the combination of
azithromycin and
atovaquone also appears promising.
Ribavirin has been recently shown to markedly improve survival in patients with
Crimean-Congo hemorrhagic fever. The role of
antiviral therapy in the treatment of other tick-borne
viral infections, including other hemorrhagic
fevers and
tick-borne encephalitis, is not yet defined.