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Two thirds of doctors against OTC trimethoprim switch

By Lilian Anekwe

Almost two thirds of doctors are opposed to the drug regulator's plans to make the antibiotic trimethoprim available over the counter, according to a survey of readers of an influential journal.

Pulse first revealed the consultation by the Medicines and Healthcare products Regulatory Agency (MHRA), to switch trimethoprim from a prescription-only medicine to one available for sale in pharmacies for the treatment of uncomplicated cystitis, in August.

But a survey of 251 readers - the majority of which were GPs - of the Drugs and Therapeutics Bulletin (DTB) found 64.5% were against the proposal.

More than half (58.2%) said they felt the switch would lead to an increase in antibiotic resistance – the same objection that prompted senior infectious disease experts to write to Health Secretary Alan Johnson to plead for the move to be rejected.

51% thought that OTC availability would encourage people to overuse or misuse trimethoprim.

The British Society for Antimicrobial Chemotherapy branded the proposed move an ‘entirely commercially driven' one, and one in four (24%) of the healthcare professionals surveyed felt that drug companies wishes would have the largest influence on the decision to reclassify the drug.

The survey also found that nearly 80% of doctors opposed the switching of the drug tamsulosin for benign prostatic hyperplasia (BPH), which is also currently under consideration by the MHRA. 72.9% of respondents felt there was a risk that BPH could be misdiagnosed.

The findings were similarly damning about the reclassification of simvastatin 10mg, which became available OTC in 2004.

57% said they did not think the switch had reduced GPs' workload, and the same proportion said they doubted the move had reduced the number of heart attacks and deaths in the general population.

Dr Ike Iheanacho, editor of DTB, said: ‘The survey indicates major concerns about proposals to make certain medicines available without prescription.

'Healthcare professionals seem largely unconvinced that these changes would provide net benefits to patients.

'They are also sceptical about the motives underlying the proposed switches. We believe that the regulator must take such worries seriously.'

A spokesperson for the MHRA said: 'The evolving role of pharmacy, set out in the White Paper published on 3 April 2008, ensures that the safety net of professional controls continues to adapt to the introduction of new OTC medicines. The pharmacy profession's successful handling of a varied range of reclassified medicines is evidence of this.

'At MHRA we keep the safety of OTC medicines under continual review and are ready to take action if new evidence emerges, including via patient Yellow Card reports. Our conclusion is that the benefits of wider access to medicines overwhelmingly outweigh the risks.'

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