Thank you for publishing this helpful guide on managing insect bites, a common presentation in primary care. I am concerned by the statement in Fig 1, 'Suspected insect bites: decision aid for primary care,' which states: "Erythema migrans or visible tick - treat as Lyme disease."
Only a small proportion of tick bites result in Lyme disease transmission and NICE guidelines(1) reflect this:
"Do not: Diagnose Lyme disease in people without symptoms, even if they have had a tick bite."
I am concerned that this advice will lead to needless courses of antibiotics, resulting in harm in the form of side effects, increased antibiotic resistance and excessive alarm among the asymptomatic tick-bitten general public. It may have been more helpful to provide a picture of the erythema migrans rash or redirect to appropriate guidelines on testing in suspected Lyme disease.
Rapid Response:
Re: Insect bites
Dear Editor
Thank you for publishing this helpful guide on managing insect bites, a common presentation in primary care. I am concerned by the statement in Fig 1, 'Suspected insect bites: decision aid for primary care,' which states: "Erythema migrans or visible tick - treat as Lyme disease."
Only a small proportion of tick bites result in Lyme disease transmission and NICE guidelines(1) reflect this:
"Do not: Diagnose Lyme disease in people without symptoms, even if they have had a tick bite."
I am concerned that this advice will lead to needless courses of antibiotics, resulting in harm in the form of side effects, increased antibiotic resistance and excessive alarm among the asymptomatic tick-bitten general public. It may have been more helpful to provide a picture of the erythema migrans rash or redirect to appropriate guidelines on testing in suspected Lyme disease.
1.Lyme disease. NICE guideline [NG95] https://www.nice.org.uk/guidance/ng95/chapter/recommendations
Competing interests: No competing interests