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    Innovative pharmacy service aids Lyme disease prevention

    Anita JacksonAnita JacksonLyme disease prevention strategies to reduce the risk of tick exposure can have a positive impact on the incidence of the tick-borne illness. However, only 40% to 50% of people aware of these tactics employ them. Antibiotic prophylaxis, delivered by a pharmacist working under a collaborative practice agreement, would be an innovative service for pharmacies to consider in regions with endemic Lyme disease, specifically New England, the mid-Atlantic states, and upper Midwest, said Anita Jackson, PharmD, clinical assistant professor, College of Pharmacy, University of Rhode Island, Kingston, R.I.

    Lyme disease, the most commonly reported vector-borne illness in the United States, is a serious public health issue that affects individuals of all ages. In 2013, the Centers for Disease Control and Prevention reported more than 35,000 probable cases of Lyme disease in the United States, with 95% reported in just 14 states: Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, and Wisconsin.

    Treatment

    Lyme disease, caused by Borrelia burgdorferi and transmitted by the deer tick, Ixodes scapularis, can be treated prophylactically with a 200-mg dose of doxycycline given within 72 hours of a tick bite.

    This prophylactic treatment for Lyme disease has a relative risk reduction of 87% to 91%. Doxycycline prophylaxis is especially important to prevent the systemic manifestations of the illness, including dermatologic, rheumatologic, neurologic, and cardiac abnormalities, said Jackson.

    “We feel this therapy would be really great to have available in pharmacies, because there is time sensitivity [for this treatment],” Jackson told Drug Topics. “If a tick is removed on Friday and it’s a holiday weekend, the patient can’t wait until Tuesday to get the antibiotic. That is one reason that we thought pharmacists could have a role in initiation of therapy.”

    The pilot study

    In 2012, Jackson and three colleagues initiated a pilot study to evaluate a pharmacy service for adult patients who sought prophylactic treatment following a tick bite. She and her collaborators trained the pharmacy staff of an independent pharmacy in Rhode Island to offer this innovative service as a way to improve patient access to timely treatment. The pharmacists received three hours of continuing education credits. Patients were recruited through local advertisements and announcements posted in the pharmacy and surrounding retail establishments.

    Pharmacists worked under a collaborative practice agreement with a physician and followed an approved study protocol for screening patients and dispensing the single dose of doxycycline. They also provided counseling to patients about medication dosing and administration, potential side effects and precautions, and education about Lyme disease symptoms and subsequent tick prevention.

    Patient satisfaction with the service was assessed 30 days post-treatment and outcomes were also recorded. Patients reported high satisfaction with the pharmacy service and none developed Lyme disease, Jackson noted.

    Julia Talsma, Content Channel Director
    Julia Talsma is lead editor for Drug Topics magazine.

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