Post-Exposure Prophylaxis Prescribing Practices in a Lyme Disease-Endemic Area

Area of Science:

• Infectious Diseases
• Public Health
• Clinical Practice Guidelines

Background:

• The Infectious Diseases Society of America (IDSA) guidelines suggest doxycycline for Lyme disease prophylaxis after tick bites.
• Data on current prescribing practices for Lyme disease prevention in high-risk areas are limited.

Purpose of the Study:

• To evaluate doxycycline prescribing practices for Lyme disease prophylaxis in a rural Wisconsin health system.
• To assess adherence to IDSA guidelines and identify documentation issues.

Main Methods:

• Retrospective chart review of adult patients receiving doxycycline for Lyme disease prevention (2022-2024).
• Analysis of patient and provider characteristics.
• Manual data abstraction of 155 prescriptions to assess guideline concordance.

Main Results:

• 2404 prescriptions were analyzed; most were for older adults and males in rural areas, peaking in warmer months.
• Prescribing occurred across provider types, predominantly in outpatient/urgent care.
• Only 12% of prescriptions had clear indications; others had suboptimal documentation or nonadherence.

Conclusions:

• Significant rates of incomplete documentation and uncertainty in guideline adherence were found.
• Opportunities exist to enhance evidence-based prescribing and improve documentation for Lyme disease prophylaxis.