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Antibiotics dropped from pharmacy access scheme after resistance concerns

Exclusive Pharmacy leaders have rowed back from including several antibiotics in a pharmacy access scheme making the drugs available without an individual prescription, after a meeting with the Department of Health.

The antibiotics trimethoprim, doxycycline and ciprofloxacin will now be removed from the scheme which is designed to offer prescription-only medicines (POMs) without an individual prescription and which will be rolled out to up to 12,500 pharmacies this month.

But the scheme will still include medicines such as salbutamol inhalers and sildenafil.

The last-minute change to the scheme came after GP leaders raised concerns over the plans to offer a raft of patient group directions to all members of the National Pharmacy Association, after a pilot in Day-Lewis pharmacies.

The DH also said it had concerns over the scheme, and organised a meeting with the NPA and Day-Lewis Pharmacy before Christmas.

In a joint statement to Pulse, they said that they had agreed at the meeting that all antibiotics apart from azythromycin would be removed from the scheme to prevent increasing antibiotic resistance.

The NPA also agreed to provide the DH with data from the pilots, so that the patient group directions under which the drugs are dispensed could be evaluated.

In order to offer the scheme, pharmacists have to complete additional training online, with patients able to obtain medicines after completing an online medical questionnaire and having a face-to-face consultation with the pharmacist or using a walk-in service.

A joint statement from the DH, the NPA and Day Lewis Pharmacy, said: ‘The chief pharmaceutical officers welcome NPA’s decision not to include PGDs involving antibiotics in the service going forward. This underlines their support in helping to combat antimicrobial resistance.’

‘An exception to this is the use of azithromycin in the treatment of chlamydia, which is an established and effective way to treat this sexually transmitted disease in a safe and convenient way, following a laboratory positive chlamydia test.’

‘The chief pharmaceutical officers acknowledged that the NPA had gone to some lengths to provide a robust PGD service and welcomed the NPA’s offer to provide data on the evaluation of the pilot scheme on the use of PGDs for a range of conditions.’

‘This will help inform future consideration of how best to use PGDs in the armoury of methods to improve safe access to the medicines the public need and meeting public health objectives.’

Dr Bill Beeby, chair of the GPC’s clinical and prescribing subcommittee, said: ‘While recognising that removing antibiotics from the scheme is an improvement, I still have concerns.’

‘These organisations take on these schemes without looking at the wider issues. And as I predicted, if one does it, all of them do it.’

He said that there was already provision for treating chlamydia: ‘Prescribing azithromycin for chlamydia is already covered by a LES, organised by the local health community or PCT or CCG, so we shouldn’t need an outside organisation to provide this.’

 

Drugs that will be available without a prescription as part of the NPA scheme:

Sildenafil

Tadalafil

Vardenafil

Azithromycin

Ulipristal

Salbutamol

Fexofenadine

Calcipotriol

Malarone

Mefloquine

Hyoscine patches

Drugs removed from the scheme:

Trimethoprim

Ciprofloxacin

Doxycycline

Readers' comments (11)

  • Thank goodness common sense has prevailed, its not about stopping use, but ensuring appropiate use.
    Now who is going to address vetinary and agricultural use of antimicrobials?

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  • We (the veterinary community) have the Veterinary Medicines Directorate governing this. We have already been informed of overuse of amoxyclav and some other common ABx used in practice. The VMD are in the process of providing us with a new protocol so that overuse is addressed. As far as agricultural use is concerned, this really involves the discretion if the individual vet surgeon. It is he/she who prescribes the relevant herd treatment. Whether farmers are obtaining drugs from Ireland is another matter!!

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  • Vinci Ho

    While this may be considered as a U turn , you wonder what was the original rationale or temptation to push this through with little common sense . Political ? Financial ? This does not exclude further attempts to open the flood gate in the future .......

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  • I remain unclear as to who pays for these drugs - and whose insurance covers the liability if they are mis-used.

    i.e. will it now be possible for men with ED not due to the limited reasons covered by the NHS to obtain Sildenafil,Tadalafil, and/or Vardenafil on the NHS?
    If so, which prescription budget will be liable for the cost? Will it be the registered GP - who has not issued the prescription, has not seen the patient - and who has no control over the amounts (or cost-effectiveness) of medication issued?
    If not, and there are side-effects, do pharmacists carry liability insurance, and do the product licenses allow dispensing in this way?

    Pharmacy chains appear to run on locum (or peripatetic) pharmacists: even if trained, does this constitute an additional risk to the patient?

    And finally, the commercial model in pharmacies and general practice is different: GPs discourage use of medication: pharmacies have a financial interest in increasing business..

    Who did start this?
    And why?


    Or is this a means of

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  • The patient will be paying. This is effectively a private transaction between pharmacy and patient.
    I would expect the pharmacist will be required to have personal liability insurance, although this may be offered by employers. I would also expect the PGD to allow use for licensed indications only, but I haven't seen it and PGDs don't have to, although there should be a good reason for going outside licence.
    This is a business driven process with the aim of increasing pharmacy income.

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  • Now that those antibiotics have been removed, I think its a good move.

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  • Good move for men too now that 5PDEi been made nonprescription.

    Good for their personal lives and those not wanting to see their GP now have an alternative to the internet wolves.

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  • Whilst I think that PDE5 inhibitors OTC are generally OK, it is important that the setup of the scheme means that the patient is still directed to the GP for risk-factor evaluation. This is because ED has a high predictive value for cardiovascular disease and also can be the presenting complaint in diabetes.

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  • Does anyone actually read others' comments or is it a pure figment of my imagination?

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  • Doxycycline would be included, as its an anti malaria, and I see no reason why pharmacist can't issue it.
    Same with trimethoprim, for uti , it's a good rx, especially for elderly pts and may prevent unnecessary admissions in to hospital, if given early enough,

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