Ticks is unavoidable, measures recommended to reduce the risk of infection include using both protective clothing and tick repellents, checking the entire body for ticks daily, and promptly removing attached ticks, before transmission of 48 h (on the basis of the degree of engorgement of the tick with blood), in conjunction with epidemiological information regarding the prevalence of tick-transmitted infection (C-III). However, accurate determinations of species of tick and degree of engorgement are not routinely possible, and data are insufficient to demonstrate efficacy of antimicrobial therapy in this setting. Persons who remove attached ticks should be monitored closely for signs and symptoms of tick-borne diseases for up to 30 days and specifically for the occurrence of a skin lesion at the site of the tick bite (which may suggest Lyme disease) or a temperature 38°C (which may suggest human granulocytic ehrlichiosis [HGE] or babesiosis). Persons who develop a skin lesion or other illness within 1 month after removing an attached tick should promptly seek medical attention for assessment of the possibility of having acquired a tick-borne disease (A-II). Health care practitioners, particularly those in areas where Lyme disease is endemic, should become familiar with its clinical manifestations, recommended practices for testing for it, and therapy for the disease, as well as for HGE and babesiosis (A-III). Testing of ticks for tick-borne infectious organisms is not recommended, except in research studies (D-III). Prior vaccination with the recently licensed recombinant outer-surface protein A (Osp A) vaccine preparation reduces the risk of developing Lyme disease associated with tick bites but should not alter the above recommendations (A-I).. zoloft detox People treated with appropriate antibiotics in the early stages of Lyme disease usually recover rapidly and completely. Antibiotics commonly used for oral treatment include doxycycline, amoxicillin, or cefuroxime axetil. People with certain neurological or cardiac forms of illness may require intravenous treatment with antibiotics such as ceftriaxone or penicillin. Treatment regimens listed in the following table are for localized (early) Lyme disease. See references below (Hu 2016; Sanchez 2016) for treatment of patients with disseminated (late) Lyme disease. These regimens are guidelines only and may need to be adjusted depending on a person’s age, medical history, underlying health conditions, pregnancy status, or allergies. For people intolerant of amoxicillin, doxycycline, and cefuroxime axetil, the macrolides azithromycin, clarithromycin, or erythromycin may be used, although they have a lower efficacy. 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