Integrative medicine, Tick-borne disease, Children

Pediatric Pearls

To Treat or Not to Treat?

An Approach to Tick Bites and Kids

Michelle Perro, MD

Recently, while deep into the literature regarding kids and COVID, a call came in from a colleague. Her five-year-old son had just been bitten by a tick. The parents sent it to the lab for testing, and it came back positive for two Borrelia species. I quickly switched gears into Lyme mode and created a plan with the parents on what to do next.

So many articles, so many opinions and so many treatment options! For those of us who have treated Lyme disease and co-infections, (tick-borne infections or TBI), we have had to battle colleagues, fight with insurance companies for drug payment coverage, and watch countless numbers of patients fail to thrive or remain chronically ill after their three-week incomplete courses of treatment. Scars and bruises can’t deter us from the question that remains: what is the best integrative approach of dealing with infection-positive tick bites in kids?

Putting the case together so far, we’ve simply got an asymptomatic healthy kid, a Borrelia-positive tick and worried parents. Heading to the conventional medical literature, one encounters the same tired falsehoods of seasonal biting, the infrequency of ticks carrying the organisms that cause TBI, the lack of discussion regarding co-infections, the myth that three weeks of antibiotics will “cure” infection and the very concerning inaccuracy of “…post-Lyme disease syndrome…symptoms last longer than 6 months and does not respond to antibiotics” (From Cedars-Sinai Health Library, “Lyme Disease in Children”).

One of the first dilemmas to tackle is tick-testing. Bravo that the family was able to get the tick out in one piece and send it to the lab. The first step is removing the tick intact, preserving it carefully and getting it to a lab that does complete testing. An excellent reference for tick removal can be found at the Lyme Disease Association website: https://lymediseaseassociation.org/about-lyme/tick-removal-a-testing/tick-testing-2/.

Which lab to use is paramount since ideally you want both a quality laboratory that also tests for co-infections as well. This family utilized their local public health laboratory, which only tested for Borrelia species. There are many labs offering testing, and I recommend IGeneX Labs (Palo Alto, CA; 800-832-3200; www.IGENEX.com). I also find Tick Report to be a good resource (https://www.tickreport.com).

As many of my colleagues do, I value and lean on the publications and conferences by ILADS as well as their recommendations.¹ However, many of the integrative tools we employ are not presented in detail for kids, so we turn to our favorite complementary journals.² My first approach is to deal with the fresh bite. I generally like to use homeopathic Ledum 1M for five-to-seven days. If the site is inflamed and pruritic, I’ll bring in Apis 30c and Histaminum 30c while awaiting the tick testing results.

Experience has taught me to be aggressive with treatment for this type of potential infection, born from the reasoning that the tick is known to be infected with Borrelia and there was attachment as per the history. (Another myth is that there needs to be prolonged attachment for disease to occur.) Treatment for chronic TBI in children is no less challenging than for adults and something better to avoid when possible. A clinical-experience-based approach, reading the research, and talking to Lyme-literate colleagues allows me to employ a multipronged therapeutic approach utilizing the magical blend of homeopathics, herbal medicine, and pharmaceuticals.

In addition to Ledum, homeopathic nosodes can be an effective adjunct to therapy. I gave the child Tick Pathogen Nosode (Professional Formulas), five drops, twice a day for three days, and then I’ll give it once a week for three months. The combination of Bartonella and Borrelia herbal formulas together can be effective and well-tolerated by children. They tend to do well on the Beyond Balance formulas, which are also tasty. Covering at least both organisms (and potentially others), I prescribed MC-BB2 with MC-Bar1, both five drops twice a day in an ounce of filtered water for six weeks. At all costs, I try to introduce Bartonella coverage with the initial treatment since it can be difficult to eradicate when the child becomes chronically infected. There shouldn’t be any Herx reactions/die-off in a child with a new bite without an underlying pre-existing infection, but Tox-Ease GL is also something to have in the toolbox to off-set herxing if that issue should arise.

Additionally, I use pharmaceutical antibiotics; and in children under eight years old, amoxicillin (50 mg/kg 2x/day) or cefuroxime (30 mg/kg 2x/day) for three weeks are my go-to’s for prophylactic treatment as based on ILADS recommendations.³ In children older than eight years, doxycycline is my first choice (100 mg 2x/day) for the same time period. This child was prescribed three weeks of amoxicillin. If a child is symptomatic, I will recommend both herbal and pharmaceutical antibiotics for three months along with immunologic testing.

Some might argue that this strategy is overly aggressive. In consideration of the insidious nature of these organisms coupled with the underlying fragile overall status of our children’s health and immune systems, employing a broad therapeutic regime to target multiple organisms has had the most favorable outcomes historically in my experience. There is a window of opportunity that exists to treat before the organisms disseminate, take hold, and begin their business of immunological hijacking.

Some of our readers might be thinking that this is an easy-peasy case; you have the actual tick, which was tested, and it was positive for infection. How often does that happen? Should we treat when the tick has been mashed and can’t be tested or unidentified as the blacklegged tick? Good questions! I’ve pondered what to do in those situations, and I still maintain treatment with the prophylactic protocol as written above.

Of course, we are employing all the other holistic treatment requirements simultaneously including nutrient and immune support. A special mention should be made about providing an organic diet rich in prebiotics, fermented foods, and probiotics. There is no doubt that the combination herbal and pharmaceutical antibiotic therapy will create havoc for the gut microbiota, and I began probiotics soon into therapy. I chose an alternating schedule of sporebiotics and combination probiotics with beneficial lactobacilli/bifidobacteria. An interesting treatment was proposed in an Israeli study using autologous fecal microbiome transplantation,⁴ collecting poop before treatment and then administering it back to the patient after treatment. Whether we should be making this recommendation to our patients is something we might consider.

There are many ways to approach tick bites in children, and the reader undoubtedly will introduce their own experiential treatment strategies into the mix. The outcome of this child’s treatment is yet to be determined so stay tuned to future Pearls for follow up.

References

1. Cameron DJ, et al. Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Journal Expert Review of Anti-infective Therapy. 2014;12(9).

Bachewich J. How Lyme and Hidden Infections Sabotage Our Clinical Outcomes. Townsend Letter. July 2019; 432.

2. International Lyme and Associated Diseases Educational Foundation; https://iladef.org/education/how-to-handle-a-tick-bite/

3. Suez J, et al. Post Antibiotic Gut Mucosal Microbiome Reconstitution is Impaired by Probiotics and Improved by Autolgous FMT. Cell. September 6, 2018; 174(6):1406-1423.

Post-Antibiotic Gut Mucosal Microbiome Reconstitution Is Impaired by Probiotics and Improved by Autologous FM

Post-Antibiotic Gut Mucosal Microbiome Reconstitution Is Impaired by Probiotics and Improved by Autologous FM