Lyme Disease is being diagnosed earlier in the season and with increasing frequency. Diagnosed annual cases of Lyme Disease in the United States tripled from 2010 to 2023 (30,158 – 89,468).1 It is primarily concentrated in the Northeast and upper Midwest, with cases spanning from Maine through the Mid-Atlantic states and extending westward to Wisconsin.1 So far in 2026, data from both agricultural tick positivity and emergency department visits suggest further jumps.2,3 The highest number of ED visits reported were in children 0 to 9 years old, highlighting the importance of timely and appropriate prophylaxis a priority in children.2
Prophylaxis with Doxycycline Recommended for All Ages
Did you know that in 2018, the American Academy of Pediatrics changed their stance on the use of doxycycline for children less than 8 years old? Specifically, they noted that doxycycline could be used in any age child for durations of up to 21 days?4 Further, the 2020 Lyme Disease Guidelines recommend the use of a single dose of doxycycline for prophylaxis (4.4 mg/kg up to max dose of 200 mg) for patients of any age (without contraindications) who meet prophylaxis criteria.5 Doxycycline is the only post-exposure prophylaxis that has shown to be effective in preventing Lyme Disease.5,6 When using single dose doxycycline, data suggest it is about 87% effective at preventing Lyme Disease.6
Lyme Disease Prophylaxis: for Who and with What?
The guidelines suggest using prophylaxis on the following patients: those who have had a deer tick (Ixodes scapularis) attached for at least 36 hours in an area where Lyme Disease is endemic. Further, the use of antibiotic prophylaxis must be given within 72 hours from the removal of the tick.5
There have been increases in the use of doxycycline as Lyme prophylaxis in young pediatric patients (i.e., < 8 years) since the change in recommendations, but it continues to be underutilized. Specifically, one study reported those 0 – 7 years had the lowest rates of doxycycline prophylaxis prescribed (0.76 per 10,000 in 0 -7 years versus 9.12 – 44.23 per 10,000 in adult age groups).7
Pharmacist Perspective
As pharmacists, we are often in a position to help identify appropriate patients, recommend doxycycline, and educate both caregivers and providers. Pharmacists who reside in states where Lyme Disease is endemic have the opportunity to make recommendations for optimal prophylaxis that will hopefully decrease incidence of Lyme Disease in children.
References:
- Centers for Disease Control and Prevention. Lyme Disease Case Maps. Accessed April 20, 2026. https://www.cdc.gov/lyme/data-research/facts-stats/lyme-disease-case-map.html
- Centers for Disease Control and Prevention. Tick Bite Data Tracker. Accessed April 20, 2026. https://www.cdc.gov/ticks/data-research/facts-stats/tick-bite-data-tracker.html
- The Connecticut Agricultural Experiment Station. CAES Alerts Residents of Increased Tick Activity and Emerging Disease Threats in Connecticut. Accessed April 20, 2026. https://portal.ct.gov/-/media/caes/press-room/caes-press-release-tick-activity-4-6-26.pdf
- Kimberlin DW, Jackson MA, Long SS. Lyme Disease. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious DiseasesAmerican Academy of Pediatrics; 2018
- Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America, American Academy of Neurology, and American College of Rheumatology: 2020 Guidelines for the Prevention, Diagnosis, and Treatment of Lyme Disease. Neurology. 2021;96(6):262–273.
- Nadelman RB, Nowakowski J, Fish D, et al. Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite. N Engl J Med. 2001;345(2):79–84.
- Marx GE, Beck A, Corey C, et al. Lyme Disease Prophylaxis by Single-Dose Doxycycline in the United States, 2010-2020. Open Forum Infect Dis. 2024;11(10):ofae593.