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**Comment**

The continued advice to sit around and “watch for signs of infection” is not helping patients. ILADS recommends consideration of prophylactic treatment for ALL black legged tick bites with a minimum of 20 days of doxycycline.

It’s also important to remember that Lyme is just the tip of the spear and ticks transmit 19+ pathogens, some of which can be transmitted within minutes. Also, other types of ticks transmit disease as well and need to be considered.

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