Rapid treatment with antibiotics is the best prevention against Lyme disease.
Now, an initiative led by the University of Rhode Island (URI) is attempting to speed up Lyme disease treatment by allowing pharmacists to deliver a single dose of doxycycline.
That would allow people with tick bites to initially skip going to the doctor and start treatment sooner.
A collaborative agreement has been reached between Dr. Fredric Silverblatt of South County Hospital and a pair of local pharmacies. Silverblatt is URI’s College of Pharmacy infectious disease specialist.
The agreement establishes screening and administration procedures for people who are at least 8 years old, have had a deer tick attached to their body for 36 hours or longer, and had the tick removed no more than 72 hours prior to seeking treatment.
The procedure mirrors the Lyme treatment protocols outlined by the U.S. Centers for Disease Control and Prevention (CDC).
Since June, pharmacists at Seaside Pharmacy in Westerly, Rhode Island and Green Line Apothecary in South Kingstown, Rhode Island have been authorized to deliver a single, 200-milligram (mg) dose of doxycycline to eligible patients.
A 2001 study published in the New England Journal of Medicine concluded that such prophylactic treatment could reduce the risk of developing Lyme disease by up to 87 percent.
Quicker, cheaper treatment
People with tick bites can seek care at a hospital emergency room, with their primary care physician, or at a walk-in medical clinic.
However, each of these settings can involve significant cost and — outside of the emergency room — limited hours, according to Anita Jacobson, PharmD. Jacobson is a URI clinical associate professor of pharmacy who is in charge of training the pharmacists involved in the URI initiative.
“Pharmacists are the most accessible healthcare professionals,” she told Healthline. “This is a situation where timeliness is important, so people who have been bitten and are concerned can go to a pharmacy — which has weekend and nighttime hours — and be evaluated in a timely and cost-effective fashion.”
Pharmacist Christina Procaccianti said in a press statement that she delivered about 20 doses of the antibiotic in the first three weeks of the program.
“It’s been much more popular than I thought it would be,” she said. “If this can prevent one case of Lyme disease, it’s worth it.”
Procaccianti noted that the service could be especially useful to visitors who get a tick bite on vacation and otherwise might wait until they get home to be treated by their own physician.
Reaction to the program
The Rhode Island initiative has won praise from the American Pharmacists Association (APhA).
“Lyme disease prevention is a novel use of collaborative practice agreements for expanding access to needed care and more fully using the expertise of pharmacists,” Anne Burns, APhA’s vice president for professional affairs, told Healthline. “With the prevalence of Lyme disease, community pharmacists can play an important role in prevention efforts, and the efforts in Rhode Island will likely generate great interest across the country.”
Phillip J. Baker, PhD, executive director of the American Lyme Disease Foundation, told Healthline that the URI initiative “seems to be reasonable as long as the pharmacy follows the precautions noted by the CDC.”
A small observational 2012 study by Jacobson concluded that people bitten by ticks could be successfully treated at community pharmacies.
None of the 18 individuals who took part in the study subsequently developed Lyme disease or had any serious adverse effect, Jacobson and colleagues reported.
Dr. Daniel Cameron, a Lyme disease expert and past president of the International Lyme and Associated Diseases Society, expressed skepticism about the 2001 Lyme study. He noted that only a handful of the research subjects had the classic “bullseye” rash typical of Lyme infection.
He told Healthline that a three-week course of prophylactic antibiotic treatment is more effective.
He also pointed out that doxycycline does not treat common Lyme coinfections like babesia. Babesia is found in about 40 percent of Lyme patients in New England.
“This starts the process [of treatment], but there’s uncertainty on how to finish it,” he said of the URI project.
He also stressed the need for pharmacies to have a referral procedure in place for follow-up care.
“We try not to interrupt antibiotic treatment, so by the next day [after receiving the 200 mg dose of doxycycline] there needs to be a plan in place” for continued treatment by a physician, Cameron said.
Silverblatt, who is overseeing the clinical aspects of the URI initiative, will conduct follow-ups with each individual who gets Lyme treatment at the participating pharmacies, said Jacobson.
“Of course patients will be encouraged to follow up with their physician,” she said.