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Experience
Pharmacist initiation of postexposure doxycycline for Lyme disease prophylaxis
Anita N. Jackson; K. Kelly Orr; Jeffrey P. Bratberg; Frederic Silverblatt
J Am Pharm Assoc (2003) 2014;54:69-73. doi:10.1331/JAPhA.2014.13106
View Author Identification Section
Anita N. Jackson: Anita N. Jackson, PharmD, Clinical Assistant Professor, College of Pharmacy, University of Rhode Island, Kingston
K. Kelly Orr: K. Kelly Orr, PharmD, Clinical Associate Professor, College of Pharmacy, University of Rhode Island, Kingston
Jeffrey P. Bratberg: Jeffrey P. Bratberg, PharmD, BCPS, Clinical Associate Professor, College of Pharmacy, University of Rhode Island, Kingston
Frederic Silverblatt: Frederic Silverblatt, MD, Professor Emeritus, Warren Alpert School of Medicine, Brown University, Providence, RI

Abstract

Objectives  To enhance public access to prophylaxis for Lyme disease following an identified Ixodes scapularis tick bite through pharmacist-initiated antibiotic therapy and to assess patient satisfaction with the pharmacy-based service provided.

Setting  Independent community pharmacy in Charlestown, RI, from May to October 2012.

Practice description  Under a collaborative practice agreement, trained pharmacists at an independent pharmacy identified patients eligible for postexposure antibiotic prophylaxis following attachment and removal of an I. scapularis tick (commonly known as a deer tick) and dispensed two 100 mg tablets of doxycycline. Patients were included if they were 18 years or older, provided informed consent, had an estimated time of tick attachment of 36 hours or more, had the tick removed within 72 hours of visit, denied contraindications to doxycycline therapy, and reported telephone access for follow-up. Patients enrolled in the study protocol were given counseling related to doxycycline, signs and symptoms of Lyme disease, and future tick prevention strategies.

Practice innovation  Pharmacist initiation of doxycycline prophylaxis has not been described in the literature previously. Successful pharmacist initiation of antibiotic prophylaxis may have broader implications for states with endemic Lyme disease or other infectious disease public health concerns.

Main outcome measures  Patient self-reported adverse outcomes and satisfaction with the pharmacy-based service.

Results  Eight patients enrolled in the study and completed the follow-up survey. The results indicated a high level of satisfaction with the pharmacy services provided, with no reports of the subsequent development of Lyme disease symptoms or major adverse events.

Conclusion  The project has expanded to three community pharmacy sites in southern Rhode Island based on this experience. Similar pharmacy-based collaborative practice models should be considered in highly endemic Lyme disease areas.

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References

Centers for Disease Control and Prevention. Lyme disease transmission. www.cdc.gov/lyme/transmission/index.html. Accessed  May 11, 2013.
 
Bacon RM, Kugeler KJ, Mead PS, et al.  Surveillance for Lyme disease: United States, 1992–2006.  MMWR Surveill Summ.  2008; 57( 10): 1– 9. [PubMed]
 
Centers for Disease Control and Prevention. Lyme disease data. www.cdc.gov/lyme/stats/index.html. Accessed  May 11, 2013.
 
Larkin J, Mitty J.  Introduction: Lyme disease.  Medicine Health Rhode Island.  2008; 91( 7): 208– 9.
 
Stricker RB, Johnson L.  Lyme disease: the next decade.  Infect Drug Resist.  2011; 4: 1– 9. [CrossRef][PubMed]
 
Centers for Disease Control and Prevention. Post-treatment Lyme disease syndrome. www.cdc.gov/lyme/postLDS/index.html. Accessed  May 11, 2013.
 
Nadelman RB, Nowakowski J, Fish D, et al.  Prophylaxis with single dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite.  N Engl J Med.  2001; 345( 2): 79– 84. [CrossRef][PubMed]
 
Warshafsky S, Lee DH, Francois LK, et al.  Efficacy of antibiotic prophylaxis for the prevention of Lyme disease: an updated systematic review and meta-analysis.  J Antimicrob Chemo.  2010; 65( 6): 1137– 44. [CrossRef]
 
Wormser GP, Dattwyler RJ, Shapiro ED, et al.  The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America.  Clin Infect Dis.  2006; 43( 9): 1089– 134. [CrossRef][PubMed]
 
University of Rhode Island Tick Encounter Resource Center. Frequently asked questions: tickborne disease. www.tickencounter.org/faq/tick_borne_disease. Accessed  July 31, 2013.
 
Centers for Disease Control and Prevention. Lyme disease: a public information guide. www.cdc.gov/lyme/resources/brochure/508_LD_Brochure.pdf. Accessed  May 11, 2013.
 
Centers for Disease Control and Prevention. Ticks and Lyme disease. www.cdc.gov/lyme/resources/toolkit/factsheets/10_508_Lyme%20disease_HikersCampers_FACTSheet.pdf. Accessed  May 11, 2013.
 
Bearden DT, Holt T.  Statewide impact of pharmacist-delivered adult influenza vaccinations.  Am J Prev Med.  2005; 29( 5): 450– 2. [CrossRef][PubMed]
 
Steyer TE, Ragucci KR, Pearson WS, AG 3rd Mainous.  The role of pharmacists in the delivery of influenza vaccinations.  Vaccine.  2004; 22( 8): 1001– 6. [CrossRef][PubMed]
 
Raine TR, Harper CC, Rocca CH, et al.  Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized controlled trial.  JAMA.  2005; 293( 1): 54– 62. [CrossRef][PubMed]
 
Dent LA, Harris KJ, Noonan CW.  Randomized trial assessing the effectiveness of a pharmacist-delivered program for smoking cessation.  Ann Pharmacother.  2009; 43( 2): 194– 201. [PubMed]
 
Potter MB, Gildengorin G, Wang Y, et al.  Comparative effectiveness of two pharmacy-based colorectal cancer screening interventions during an annual influenza vaccination campaign.  J Am Pharm Assoc.  2010; 50( 2): 181– 7. [CrossRef]
 
Clark PM, Karagoz T, Apikoglu-Rabus S, Izzettin FV.  Effect of pharmacist-led patient education on adherence to tuberculosis treatment.  Am J Health Syst Pharm.  2007; 64( 5): 497– 505. [CrossRef][PubMed]
 
Taitel M, Cohen E, Duncan I, Pegus C.  Pharmacists as providers: targeting pneumococcal vaccinations to high risk populations.  Vaccine.  2011; 29( 45): 8073– 6. [CrossRef][PubMed]
 
Gardner JS, Hutchings J, Fuller TS, Downing D.  Increasing access to emergency contraception through community pharmacies: lessons from Washington State.  Fam Plann Perspect.  2001; 33( 4): 172– 5. [CrossRef][PubMed]
 
Roberst S, Gainsburgh R.  Medication therapy management and collaborative drug therapy management.  J Manag Care Pharm.  2010; 16( 1): 67– 8. [PubMed]
 
Gardner JS, Miller L, Downing DF, et al.  Pharmacist prescribing of hormonal contraceptives: results of the Direct Access study.  J Am Pharm Assoc.  2008; 48( 2): 212– 21. [CrossRef]
 
Northwest Center for Public Health Practice. Collaborative drug therapy agreement for influenza antivirals in Washington State. www.nwcphp.org/training/opportunities/toolkits‐guides/collaborative‐drug‐therapy‐agreement‐for‐influenza‐antivirals‐in‐washington‐state. Accessed  May 11, 2013.
 
Redlich GS. R.I.'s Good Samaritan Law offers protection: up to a point. http://block‐island.villagesoup.com/p/r‐i‐s‐good‐samaritan‐law‐offers‐protection‐up‐to‐a‐point/1002266#. Accessed  May 24, 2013.
 
SteelFisher G, Koonin LM, Rothholz MC, Patel A. New approaches during a pandemic for antiviral medication dispensing: collaboration that utilizes the community pharmacist [webinar]. http://elearning.pharmacist.com/products/1111/new‐approaches‐during‐a‐pandemic‐for‐antiviral‐medication‐dispensing‐collaboration‐that‐utilizes‐the‐community‐pharmacist. Accessed  May 24, 2013.
 
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