URI-led program first in nation to provide treatment from pharmacists that could prevent Lyme disease

Those eligible receive single dose of antibiotics at pharmacy, without doctor visit

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Anita Jacobson, clinical associate professor at URI’s College of Pharmacy, is pictured with pharmacist Christina Procaccianti at her business, Green Line Apothecary in South Kingstown. Photo by Nora Lewis.

KINGSTON, R.I., July 19, 2017 — In the first program of its kind in the nation, local pharmacies are offering eligible consumers on-site antibiotic treatment to reduce the chance of developing Lyme disease.

The initiative is the result of collaborative practice agreements among the University of Rhode Island College of Pharmacy, Green Line Apothecary in South Kingstown, Seaside Pharmacy in Westerly and Dr. Fredric Silverblatt, an infectious disease specialist with South County Health. As part of the agreements, Anita Jacobson, clinical associate professor of pharmacy at URI and the program catalyst, trains pharmacists to provide the service, and Silverblatt acts as the clinical overseer.

In June, Green Line Apothecary, owned by pharmacist Christina Procaccianti, became the nation’s first pharmacy to provide the single, 200-milligram dose of doxycycline on site without a doctor’s order. “It’s been much more popular than I thought it would be,” said Procaccianti, who administered about 20 doses in the first three weeks. “It’s been very rewarding. If this can help prevent one case of Lyme disease, it’s worth it.”

Prompt treatment with the antibiotic doxycycline is crucial to successful treatment of the tick-borne illness, and making it readily available without a doctor’s visit could help reduce the incidence of Lyme disease, Jacobson said. In fact, a 2001 study published in the New England Journal of Medicine reported that such prophylactic treatment can reduce the risk of developing Lyme Disease by 87 percent.

“Due to the time-sensitivity of treatment, community pharmacies like Green Line and Seaside are ideal practice locations,” Jacobson said. “The availability and convenience of a pharmacy are important to potentially preventing development of Lyme disease.”

William Quirk, a URI pharmacy alumnus, will soon offer the program at Seaside Pharmacy.

The service fits easily into Procaccianti’s practice. “It takes about the same time as filling a prescription, and it is exciting for the students (URI pharmacy interns) who get a chance to see a collaborative practice agreement in a real-life setting,” she said.

The ease of pharmacy-based care is particularly beneficial to tourists and others from out of town who might not get to their own doctor for days or whose doctors might not recognize Lyme disease symptoms, Jacobson noted. Procaccianti said she has treated several tourists who learned of the service at local hotels.

Pharmacists assess the customers and determine whether they meet U.S. Centers for Disease Control and Prevention criteria. The antibiotic can be given only to patients who are at least 8 years old, have had a deer tick attached to the body for at least 36 hours and have removed it no more than 72 hours prior. The protocol is only effective as prophylaxis against Lyme disease, not other tick-borne illnesses.

Procaccianti said she has turned away customers who either did not meet the criteria or removed insects that were not ticks. She said education is an important part of the service, and to this end, she provides interested customers with a detailed handout on tick-borne illnesses, treatment and prevention.

Jacobson conceived the idea in 2012, and with pharmacy colleagues Kelly Orr and Jeffrey Bratberg, conducted a research study to determine the efficacy and practicality of offering the treatment in community pharmacies. The study was a success: No subjects developed Lyme Disease after receiving the treatment or developed serious adverse effects.

“The only way we could have pharmacists initiate antibiotic therapy was for it to be a research study,” Jacobson said, explaining that the practice required a research exemption from the Rhode Island Board of Pharmacy.

Jacobson then collaborated with the Rhode Island Pharmacists Association and the Rhode Island Society of Health-System Pharmacists to pass legislation in the state’s General Assembly in 2016 expanding pharmacists’ role to include initiation of drug therapies under collaborative practice agreements.

Any pharmacy in Rhode Island can participate once its pharmacists receive training at URI and it is part of a collaborative practice agreement with a doctor. To learn more, contact Anita Jacobson at anitaj@uri.edu.