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.