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International Journal of Clinical Pharmacy

, Volume 39, Issue 1, pp 165–172 | Cite as

Antibiotic treatment of women with uncomplicated cystitis before and after allowing pharmacist-supply of trimethoprim

  • Natalie J. Gauld
  • Irene S. L. Zeng
  • Rosemary B. Ikram
  • Mark G. Thomas
  • Stephen A. Buetow
Research Article

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.

Keywords

Anti-bacterials Antimicrobial stewardship General practice New Zealand Non-prescription drugs Pharmacy Trimethoprim 

Notes

Acknowledgements

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.

Funding

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.

References

  1. 1.
    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. doi: 10.1002/14651858.CD007182.pub2.PubMedGoogle Scholar
  2. 2.
    American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 91: treatment of urinary tract infections in nonpregnant women. Obstet Gynecol. 2008;111(3):785–94.CrossRefGoogle Scholar
  3. 3.
    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.CrossRefPubMedGoogle Scholar
  4. 4.
    Knox K. Women should be able to get antibiotics for urinary tract infection without a prescription. BMJ. 2015;. doi: 10.1136/bmj.h3441.PubMedGoogle Scholar
  5. 5.
    Gauld N. Improving access to urinary tract infection treatment: the reclassification of trimethoprim. SelfCare J. 2012;3(6):115–20.Google Scholar
  6. 6.
    Classification of Medicines. New Zealand Gazette. 2012;4347:2281.Google Scholar
  7. 7.
    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;38:1357–61.CrossRefPubMedGoogle Scholar
  8. 8.
    Antibiotics: choices for common infections. Best Practice J. 2011;35 Suppl, April.Google Scholar
  9. 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.
  10. 10.
    Booth JL, Mullen AB, Thomson DAM, Johnstone C, Galbraith SJ, Bryson SM, et al. Antibiotic treatment of urinary tract infection by community pharmacists: a cross-sectional study. Br J Gen Pract. 2013;63(609):e244–9. doi: 10.3399/bjgp13X665206.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
  12. 12.
    Dryden MS, Cook J, Davey P. Antibiotic stewardship—more education and regulation not more availability? J Antimicrob Chemother. 2009;64:885–8.CrossRefPubMedGoogle Scholar
  13. 13.
    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.CrossRefPubMedGoogle Scholar
  14. 14.
    Davis H, Mant D, Scott C, Lasserson D, Rose PW. Relative impact of clinical evidence and over-the-counter prescribing on topical antibiotic use for acute infective conjunctivitis. Br J Gen Pract. 2009;59:897–900.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Gauld NJ, Jennings LC, Frampton C, Huang QS. Five years of non-prescription oseltamivir: effects on resistance, immunization and stock-piling. J Antimicrob Chemother. 2012;67:2949–56. doi: 10.1093/jac/dks337.CrossRefPubMedGoogle Scholar
  16. 16.
    Shaw JP, 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. 2016;24(1):6–12. doi: 10.1111/ijpp.12200.CrossRefPubMedGoogle Scholar
  17. 17.
    Schneider CR, Everett AW, Geelhoed E, Kendall PA, Murray K, Garnett P, et al. Provision of primary care to patients with chronic cough in the community pharmacy setting. Ann Pharmacother. 2011;45(3):402–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Watson MC, Bond CM, 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.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kelly FS, Williams KA, Benrimoj SI. Does advice from pharmacy staff vary according to the nonprescription medicine requested? Ann Pharmacother. 2009;43(11):1877–86.CrossRefPubMedGoogle Scholar
  20. 20.
    Wertheimer AI, 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.CrossRefPubMedGoogle Scholar
  21. 21.
    Väänänen MH, Pietilä K, Airaksinen M. Self-medication with antibiotics—does it really happen in Europe? Health Policy. 2006;77(2):166–71. doi: 10.1016/j.healthpol.2005.07.001.CrossRefPubMedGoogle Scholar
  22. 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. 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. 24.
    Finch R, Cooke J, Charani E. Will switching lead to increased resistance? (letter). Pharm J. 2008;280:535.Google Scholar
  25. 25.
    Dryden M, Johnson AP, Ashiru-Oredope D, Sharland M. Using antibiotics responsibly: right drug, right time, right dose, right duration. J Antimicrob Chemother. 2011;66:2441–3.CrossRefPubMedGoogle Scholar
  26. 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.
  27. 27.
    Lane DR, Takhar SS. Diagnosis and management of urinary tract infection and pyelonephritis. Emerg Med Clin North Am. 2011;29(3):539–52.CrossRefPubMedGoogle Scholar
  28. 28.
    Ikäheimo R, Siitonen A, Heiskanen T, Kärkkäinen U, Kuosmanen P, Lipponen P, et al. 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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  1. 1.Natalie Gauld LtdNewmarket, AucklandNew Zealand
  2. 2.Department of General Practice and Primary Health CareUniversity of AucklandAucklandNew Zealand
  3. 3.Department of StatisticsUniversity of AucklandAucklandNew Zealand
  4. 4.Independent ConsultantChristchurchNew Zealand
  5. 5.Department of Molecular Medicine and PathologyUniversity of AucklandAucklandNew Zealand

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