Background/Aims Rocky Mountain spotted fever (RMSF) and human Ehrlichiosis are common tick-borne infections in the United States and many patients may be treated as outpatients with doxycycline. However, bacterial meningitis presents with similar symptoms. We evaluated whether empiric outpatient treatment for possible tick-borne illness resulted in cases of inadequately treated bacterial meningitis.

Methods We performed a review of all patients seen in our tertiary children’s hospital emergency department (PED) from May to August of 2004–2013 who had a diagnosis consistent with possible tick-borne infection. Clinical and laboratory characteristics of all patients who returned to the PED within two weeks were collected from the electronic medical record.

Results 718 patients were discharged from the PED during our study period and 43 (6.0%) returned to the PED within 2 weeks. There were no cases of bacterial meningitis and no deaths among patients who returned to the PED. 27/43 children (63%) were discharged with doxycycline. 11/43 children (26%) underwent lumbar puncture (LP) at their initial visit; 3/43 patients (7.0%), all of whom returned with neck pain, had an LP at their return visit and all three were diagnosed with viral meningitis. 16/43 patients (37%) were admitted after their second visit, with an average length of stay of 2.7 days.

Conclusion Empiric treatment of suspected tick-borne illness in our PED did not result in any cases of unrecognised bacterial meningitis. Further prospective studies may identify low risk children who may be discharged from the PED without extensive laboratory testing.