Antibiotic Treatment of Women with Uncomplicated Cystitis Before and After Allowing Pharmacist-supply of Trimethoprim

Overview

Journal Int J Clin Pharm

Publisher Springer

Specialties Pharmacology
Pharmacy

Date 2016 Dec 25

PMID 28012119

Citations 10

Authors

Natalie J Gauld

Irene S L Zeng

Rosemary B Ikram

Mark G Thomas

Stephen A Buetow

Affiliations

Soon will be listed here.

Abstract

Background In 2012, New Zealand reclassified trimethoprim to allow specially trained pharmacists to supply it without a prescription to women with symptoms suggesting uncomplicated cystitis, under strict criteria for supply. Objective To assess how this policy change allowing pharmacist supply of trimethoprim affected overall antibiotic supply. Setting Randomly selected community pharmacies throughout New Zealand. Methods Data were collected in pharmacies before the implementation ('baseline') and 1 year later ('post-implementation'). Pharmacy staff recorded prescription and nonprescription supplies for treatment or prevention of suspected urinary tract infections. Women with a prescription for treatment or prevention of presumed urinary tract infection or purchasing a non-prescription medicine for this purpose were invited to self-complete a questionnaire. National prescribing data were extracted for trimethoprim, nitrofurantoin and norfloxacin. Main outcome measure Antibiotic use in women with UTIs from dispensed prescriptions (baseline and post-implementation) and pharmacist-supplied trimethoprim (post-implementation), particularly focusing on women aged 16-65 years with an antibiotic for presumed cystitis without complicating features. Results Baseline data were provided by 139 pharmacies, 120 of which provided post-implementation data. In women with presumed cystitis without complicating features, prescriptions before and after the implementation were primarily for trimethoprim. Overall antibiotic use, and use of second-line agents did not increase post-implementation. Pharmacist-supplies of trimethoprim were modest nearly 1 year after the service started. Conclusion Supply of trimethoprim by specially trained pharmacists working within strict criteria for supply appeared to have little overall effect on antibiotic use. Further research on patient outcomes, resistance and changes over time is recommended.

Citing Articles

Regulating pharmacist services: Achieving a full scope of practice.

Adams A Can Pharm J (Ott). 2024; 156(5):231-234.

PMID: 38222885 PMC: 10786013. DOI: 10.1177/17151635231188330.

The clinical and economic evidence of the management of urinary tract infections by community pharmacists in women aged 16 to 65 years: a systematic review.

Swart A, Benrimoj S, Dineen-Griffin S Int J Clin Pharm. 2024; 46(3):574-589.

PMID: 38194009 DOI: 10.1007/s11096-023-01679-6.

Community pharmacists as antimicrobial guardians and gatekeepers - A qualitative study of the perspectives of pharmacy sector stakeholders.

Lim K, Broom A, Olsen A, Seale H Explor Res Clin Soc Pharm. 2022; 9:100212.

PMID: 36582997 PMC: 9793303. DOI: 10.1016/j.rcsop.2022.100212.

Diagnosis of acute cystitis in primary care: symptom-based versus urinalysis-based diagnosis.

Lelie-van der Zande R, Koster E, Grol M, Naber K, Alidjanov J, Teichert M Prim Health Care Res Dev. 2022; 23:e74.

PMID: 36384980 PMC: 9706387. DOI: 10.1017/S1463423622000627.

Community pharmacists' views on their current role and future opportunities for antibiotic stewardship: a French qualitative study.

Essilini A, Pierre A, Bocquier A, Pulcini C, Wilcke C, Gravoulet J JAC Antimicrob Resist. 2021; 3(3):dlab129.

PMID: 34671729 PMC: 8521646. DOI: 10.1093/jacamr/dlab129.

References

Reeves D . The 2005 Garrod Lecture: the changing access of patients to antibiotics--for better or worse?. J Antimicrob Chemother. 2007; 59(3):333-41. DOI: 10.1093/jac/dkl502. View

Lane D, Takhar S . Diagnosis and management of urinary tract infection and pyelonephritis. Emerg Med Clin North Am. 2011; 29(3):539-52. DOI: 10.1016/j.emc.2011.04.001. View

Booth J, Mullen A, Thomson D, Johnstone C, Galbraith S, Bryson S . Antibiotic treatment of urinary tract infection by community pharmacists: a cross-sectional study. Br J Gen Pract. 2013; 63(609):e244-9. PMC: 3609471. DOI: 10.3399/bjgp13X665206. View

Davis H, Mant D, Scott C, Lasserson D, Rose P . Relative impact of clinical evidence and over-the-counter prescribing on topical antibiotic use for acute infective conjunctivitis. Br J Gen Pract. 2010; 59(569):897-900. PMC: 2784527. DOI: 10.3399/bjgp09X473132. View

. ACOG Practice Bulletin No. 91: Treatment of urinary tract infections in nonpregnant women. Obstet Gynecol. 2008; 111(3):785-94. DOI: 10.1097/AOG.0b013e318169f6ef. View

Schneider C, Everett A, Geelhoed E, Kendall P, Murray K, Garnett P . Provision of primary care to patients with chronic cough in the community pharmacy setting. Ann Pharmacother. 2011; 45(3):402-8. DOI: 10.1345/aph.1P514. View

Upton A, Lang S, Heffernan H . Mupirocin and Staphylococcus aureus: a recent paradigm of emerging antibiotic resistance. J Antimicrob Chemother. 2003; 51(3):613-7. DOI: 10.1093/jac/dkg127. View

Ikaheimo R, Siitonen A, Heiskanen T, Karkkainen U, Kuosmanen P, Lipponen P . Recurrence of urinary tract infection in a primary care setting: analysis of a 1-year follow-up of 179 women. Clin Infect Dis. 1996; 22(1):91-9. DOI: 10.1093/clinids/22.1.91. View

Watson M, Bond C, Grimshaw J, Johnston M . Factors predicting the guideline compliant supply (or non-supply) of non-prescription medicines in the community pharmacy setting. Qual Saf Health Care. 2006; 15(1):53-7. PMC: 2564005. DOI: 10.1136/qshc.2005.014720. View

10.

Vaananen M, Pietila K, Airaksinen M . Self-medication with antibiotics--does it really happen in Europe?. Health Policy. 2005; 77(2):166-71. DOI: 10.1016/j.healthpol.2005.07.001. View

11.

Shaw J, Gauld N, Kelly F . Barriers to positive policy change that aims to increase access to medicines through reclassification: the case of oseltamivir in New Zealand. Int J Pharm Pract. 2015; 24(1):6-12. DOI: 10.1111/ijpp.12200. View

12.

Wertheimer A, Serradell J . A discussion paper on self-care and its implications for pharmacists. Pharm World Sci. 2008; 30(4):309-15. DOI: 10.1007/s11096-007-9187-y. View

13.

Gauld N, Zeng I, Ikram R, Thomas M, Buetow S . Treatment of uncomplicated cystitis: analysis of prescribing in New Zealand. N Z Med J. 2016; 129(1437):55-63. View

14.

Dryden M, Johnson A, Ashiru-Oredope D, Sharland M . Using antibiotics responsibly: right drug, right time, right dose, right duration. J Antimicrob Chemother. 2011; 66(11):2441-3. DOI: 10.1093/jac/dkr370. View

15.

Dryden M, Cooke J, Davey P . Antibiotic stewardship--more education and regulation not more availability?. J Antimicrob Chemother. 2009; 64(5):885-8. DOI: 10.1093/jac/dkp305. View

16.

Gauld N, Jennings L, Frampton C, Huang Q . Five years of non-prescription oseltamivir: effects on resistance, immunization and stockpiling. J Antimicrob Chemother. 2012; 67(12):2949-56. PMC: 7314044. DOI: 10.1093/jac/dks337. View

17.

Braund R, Henderson E, McNab E, Sarten R, Wallace E, Gauld N . Pharmacist-only trimethoprim: pharmacist satisfaction on their training and the impact on their practice. Int J Clin Pharm. 2016; 38(6):1357-1361. DOI: 10.1007/s11096-016-0388-0. View

18.

Zalmanovici Trestioreanu A, Green H, Paul M, Yaphe J, Leibovici L . Antimicrobial agents for treating uncomplicated urinary tract infection in women. Cochrane Database Syst Rev. 2010; (10):CD007182. DOI: 10.1002/14651858.CD007182.pub2. View

19.

Kelly F, Williams K, Benrimoj S . Does advice from pharmacy staff vary according to the nonprescription medicine requested?. Ann Pharmacother. 2009; 43(11):1877-86. DOI: 10.1345/aph.1L121. View

20.

Thomas M, Smith A, Tilyard M . Rising antimicrobial resistance: a strong reason to reduce excessive antimicrobial consumption in New Zealand. N Z Med J. 2014; 127(1394):72-84. View