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


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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