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There has been no clear evidence that early, brief treatment, before onset of any symptoms (such as the typical rash, called “erythema chronicum migrans”) actually prevents the disease, even though antibiotics are almost always effective against Lyme disease once it appears. Now there is evidence supporting this approach. The study, conducted in New York’s Westchester County, where Lyme disease is relatively common, found that a one-dose regimen of just two pills of doxycycline was highly effective, if given within three days of a bite.

This study was led by Robert Nadelman, M.D., of New York Medical College in Valhalla, N.Y. On a random basis, they were given either a 200-milligram dose of doxycycline, or inactive placebo pills. Evidence of definite Lyme disease developed in only one of 235 patients who received doxycycline (0.4%), as compared to 8 of 247 who received placebo (3.2%). This difference was highly significant.

While confirming the effectiveness of this prophylactic antibiotic regimen, the study also shows that even in a Lyme disease-carrying tick-infested area, infection after deer tick bites are very uncommon.

In an editorial in the same issue, Eugene Shapiro, M.D. of the Yale University School of Medicine states that if the analysis by Dr. Nadelman s group is accurate, “it would be necessary to treat about 40 persons to prevent one case of Lyme disease.” He also points out that “nearly one-third of the subjects who were treated with doxycycline reported transient adverse side effects, primarily nausea or vomiting.” In addition, this drug can cause adverse effects in children below age 8, and in pregnant or nursing women. “In areas where Lyme disease is [common], checking carefully for ticks and removing them promptly may be an effective strategy for preventing Lyme disease,” Dr. Shapiro concludes.

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