Earlier Lyme Disease Treatment Possible When Compounding Pharmacists Identify Symptoms
Summer is just around the corner and many are already anticipating hiking, gardening, fishing or simply relaxing in the warm weather. While some live for the long days of summer, it’s important to be careful because this is also prime time for tick bites, which lead to 30,000 cases of Lyme disease every year. A lot of people don’t worry because they figure Lyme disease is treatable. What they may not realize is how easy it is to miss a tick bite—even to miss the subsequent rash—which means they don’t get early treatment. When compounding pharmacists identify symptoms, they can help patients avoid the potentially serious side effects of untreated Lyme disease.
The Changing Landscape of Lyme Disease
Lyme disease and deer ticks are so synonymous that people tend to believe these tiny arachnids are the only source. But that’s not the case. Mice, chipmunks, squirrels, lizards and birds also carry the tick. Hitching a ride with songbirds changes the picture—or more technically, the tick vector— entirely, as the ticks are carried to distant places.
A survey published in March 2016 reveals that the deer tick, or blacklegged tick, has been reported in more than 45 percent of counties across the U.S.1 Taking it a step further, the survey shows that the tick is well established in these hot spots: New England, New York, Pennsylvania, the eastern half of Ohio, California, Wisconsin, Minnesota and large parts of Florida.
Experts used to believe that deer ticks only transmitted Borrelia burgdorferi. Then a report from Mayo Clinic scientists released in February 2016 revealed the discovery of a new pathogen transmitted by the same tick, which they called B. mayonii.2 So far it has only appeared in patients in Minnesota, North Dakota and Wisconsin.
Early Identification More Likely with Pharmacist Involvement
Even though 80 percent of those bitten by the deer tick develop erythema migrans, 70 percent of them don’t remember getting a tick bite and only a third develop the classic bullseye rash. Then toss generic flu-like symptoms into the mix and it’s easy to see how hard it is for patients to realize they might have Lyme disease. That’s why pharmacist intervention is so vital. By assessing symptoms, you can help them get to the doctor while the illness is still in the early stages:
Stage 1—Early Localized Lyme Disease: Isolated erythema migrans appears seven days after the tick bite on average, but may develop between days one and 30. The rash lasts two to three weeks, but it’s often not itchy or painful. About 20 percent of patients experience recurrent episodes due to hematogenous dissemination.3 Other stage 1 symptoms include:
- Flu-like symptoms occur in about half of all patients within a week after the bite.
- Fatigue and myalgia are reported in 80 percent of patients.
- Arthralgia and neck stiffness may appear but resolve without treatment.
Stage 2—Early Disseminated Lyme Disease: When Lyme disease isn’t treated in stage 1, systemic symptoms develop within three to 10 weeks in about 25 percent of patients. Symptoms may begin as fever and malaise, then progress into:
- Musculoskeletal manifestations: Intermittent inflammatory arthritis initially involves multiple joints then evolves into a monoarticular process in the knee, ankle or wrist. Symptoms often resolve then recur every two to three months.
- Neurologic manifestations: About 5 to 20 percent of patients develop Lyme neuroborreliosis, most often in the form of facial palsy and blurred vision, but meningitis and encephalopathy can also occur. Mild to severe headaches, neck pain and photophobia indicate meningeal involvement. Symptoms of encephalopathy include mild confusion and disturbances in memory, mood, sleep and concentration.
- Lyme carditis: Mild to severe heart block develops in about 1 percent of people with Lyme disease, causing symptoms such as light-headedness, fainting, shortness of breath, heart palpitations and chest pains.4
- Cutaneous manifestations: Multiple erythema migrans lesions may appear; at this stage they don’t expand like the early rash.
Stage 3—Late Disseminated Lyme Disease: Patients may go through a period of latency, then months to years later develop rheumatologic and neurologic symptoms, such as arthritis in large joints, radicular pain, subacute encephalopathy, late axonal neuropathies and symptoms consistent with fibromyalgia. About half of all patients with neuroborreliosis have myelitis.
Roles for Pharmacists in Lyme Disease Treatment and Prevention
First-line Lyme disease treatment for patients age eight and older consists of doxycycline and amoxicillin, but children younger than eight should only take doxycycline. While cefuroxime axetil is also approved for all age groups, its higher cost means most doctors reserve it for patients who can’t take amoxicillin or doxycycline. When first-line pharmaceuticals aren’t tolerated or are contraindicated, macrolides are the choice for second-line treatment.
When it comes to treatment, compounding pharmacists can make a difference by reaching out to recommend topical pain relief for patients with Lyme arthritis. Depending on the severity of their condition, and knowing that the symptoms should resolve with time, physicians may suggest OTC pain medications but little else. Some patients will continue to suffer, not knowing that it’s possible to get topical NSAIDs compounded with other pharmaceuticals to relieve their pain.
Let’s Talk About Prevention
You are quite possibly the best chance your patients have for learning how to avoid Lyme disease, thanks to your expertise and visibility in the community. In that light, here are a few tips:
- Identify erythema migrans: Some patients may buy OTC creams or lotions for their rash. Try to catch them at the checkout and assess for Lyme disease.
- Medication review: As you normally would, be sure patients on antibiotics receive the right dose of the appropriate medication and monitor for efficacy and adherence.
- Guidance about insect repellents: DEET and picaridin are the only insect repellents currently approved for use on skin and clothing, while permethrin is also approved to spray on clothing. DEET is the gold standard, but it carries the risk of neurotoxicity from excessive use. Have staff advise patients to follow dosing directions.
- Monitor for side effects: Encourage patients to talk with their doctor before discontinuing meds should they develop gastrointestinal problems or other side effects. Don’t forget that antibiotics can cause nutritional deficiencies, so depending on the length of the regimen, you may want to recommend vitamins and probiotics.
- Have a handout ready: Print out the info or order brochures that cover all the info patients need and put the handouts in a visible spot.5
Proactive Involvement to Target Patients at Risk
An article in U.S. Pharmacist encourages pharmacists to get involved in Lyme disease prevention and management by counseling patients and proactively targeting those who may have been exposed to the pathogen.6 What the article doesn’t mention is the impact on patients when your efforts help them avoid tick bites or you catch their symptoms in the early stage. This is the type of excellent patient care that builds loyal customers.
Pharmaceutica North America provides high-quality bulk pharmaceuticals, compounding kits and OTC dietary supplements to treat all your patients. Contact us today to talk about how our pharmaceuticals support the customized patient care that sets your pharmacy apart from the rest.
- “Ticks That Transmit Lyme Disease Reported in Nearly Half of All US Counties,” February 2016, https://www.sciencedaily.com/releases/2016/01/160118102524.htm ↩
- “Identification of a Novel Pathogenic Borrelia Species Causing Lyme Borreliosis with Unusually High Spirochaetaemia: A Descriptive Study,” February 2016, http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2815%2900464-8/abstract ↩
- “Lyme Disease Clinical Presentation,” March 2016, http://emedicine.medscape.com/article/330178-clinical ↩
- “What You Need to Know About Lyme Carditis,” March 2015, http://www.cdc.gov/lyme/signs_symptoms/lymecarditis.html ↩
- “Lyme Disease Educational Materials,” December 2015, http://www.cdc.gov/lyme/toolkit/ ↩
- “Lyme Disease: The Pharmacists Role in Treatment and Prevention,” April 2016, http://www.uspharmacist.com/content/d/feature/c/60555/ ↩