Current recommendations for prophylactic antibiotic use after a tick bite are largely dictated by the Centers for Disease Control and Prevention.1 These guidelines recommend a single high dose of doxycycline—a one-time antibiotic dose—under a fairly narrow set of criteria. At first glance, the criteria seem reasonable. In practice, there are several problems with this model.

Review of Lone Star Tick transmitted diseases, Southern Tick-Associated Rash Illness or STARI, and Alphal-gal Syndrome.