Antibiotic treatment of women with uncomplicated cystitis before and after allowing pharmacist-supply of trimethoprim
- 322 Downloads
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.
KeywordsAnti-bacterials Antimicrobial stewardship General practice New Zealand Non-prescription drugs Pharmacy Trimethoprim
The efforts of pharmacy staff in NZ and the women who completed questionnaires for this project are greatly appreciated. We are grateful to the Ministry of Health in NZ for providing the Pharmaceutical Collection prescribing data for trimethoprim, nitrofurantoin and norfloxacin from January 2012 until July 2015.
This work was supported by unrestricted grants from Pharmacybrands Ltd (now Green Cross Health); ProPharma; the Pharmacy Guild of New Zealand; and the Pharmaceutical Society of New Zealand. No funders had any role in the design, execution, analysis, reporting or publication of the research.
Conflicts of interest
NG consulted to Green Cross Health Ltd to reclassify trimethoprim, and has consulted on other reclassifications. NG has consulted to the Pharmacy Guild of NZ on unrelated projects. She is a member of the National Executive of the Pharmaceutical Society of NZ which provides training for pharmacists on trimethoprim and cystitis, and was paid to contribute to this training. RI has consulted to Green Cross Health Ltd on the trimethoprim reclassification, and to the Pharmaceutical Society of New Zealand on the trimethoprim and cystitis training. The other authors have no conflicts to declare.
- 5.Gauld N. Improving access to urinary tract infection treatment: the reclassification of trimethoprim. SelfCare J. 2012;3(6):115–20.Google Scholar
- 6.Classification of Medicines. New Zealand Gazette. 2012;4347:2281.Google Scholar
- 8.Antibiotics: choices for common infections. Best Practice J. 2011;35 Suppl, April.Google Scholar
- 9.Antibiotics: choices for common infections. In: Best practice journal. Best Practice Advocacy Centre (BPAC). 2013. http://www.bpac.org.nz/Supplement/2013/July/docs/Antibioitcs_guide_2013.pdf. Accessed 2 Dec 2016.
- 11.Trimethoprim and nitrofurantoin POM-to-P switches abandoned. Pharm J. 2010;284:417. http://www.pharmaceutical-journal.com/news-and-analysis/news/trimethoprim-and-nitrofurantoin-pom-to-pswitches-abandoned/11008849.article.
- 22.Thomas MG, Smith AJ, Tilyard MW. Rising antimicrobial resistance: a strong reason to reduce excessive antimicrobial consumption in New Zealand. NZ Med J. 2014;127(1394):72–84.Google Scholar
- 23.Gauld N, Zeng I, Ikram R, Thomas M, Buetow S. Treatment of uncomplicated cystitis: analysis of prescribing in New Zealand. NZ Med J. 2016;129(1437):55–63.Google Scholar
- 24.Finch R, Cooke J, Charani E. Will switching lead to increased resistance? (letter). Pharm J. 2008;280:535.Google Scholar
- 26.Norfloxacin—restriction change reminder. Pharmaceutical Management Agency, Wellington, New Zealand. 2014. http://www.pharmac.health.nz/news/notification-2014-05-16-norfloxacin/. Accessed 2 Dec 2016.