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GP expert calls for women to get antibiotics for cystitis without prescription

Allowing women with uncomplicated cystitis to ‘bypass’ their GP and obtain antibiotics directly from a pharmacy without a prescription would save three million GP appointments a year, a GP expert has claimed.  

The piece in the BMJ – written by Dr Kyle Knox from the Nuffield Department of Health Sciences, University of Oxford – argues that acute uncomplicated urinary tract infections (AUUTIs) such as cystitis are the most common bacterial infections in women, and that a short course of the antibiotic nitrofurantoin sees symptoms usually start to improve after a day or two.

He said that at a time of ‘overstretched primary care services’, patients should be able to access safe treatment without seeing a clinician.

However, the RCGP said there were dangers in allowing patients to sidestep GPs.

Cystitis affects around half of women at least once in their lifetime and is the reason behind 1% of the 300 million GP consultations held annually in the UK.

Dr Knox says: ‘In an era of ready access to information, increasing patient autonomy and overstretched primary care services, it would seem a good idea for women to be able to access safe and effective treatment without the costs and delays associated with consulting a clinician to obtain a prescription.’

However, despite clear guidance, characteristic clinical syndrome, and predictable efficacy and safety, nitrofurantoin remains a prescription-only drug.

The current prescription-only approach does nothing to limit antimicrobial use but creates urgent demand in primary care – and an additional hurdle for women to access safe and effective treatment, he argues.

He points out that the availability of pregnancy tests, emergency contraception and antimalarial prophylaxis is commonplace in UK pharmacies while some antibiotics are already available from pharmacies without prescription in the UK.

‘A change in the regulations that govern access to nitrofurantoin would be worthwhile only if it was taken up by women seeking treatment,’ he writes.

But RCGP chair Dr Maureen Baker said: ‘There is the risk that bypassing the GP for patients with cystitis might lead to recurrent strains of the infection being treated inappropriately, and more serious conditions going undetected.’

She also argued that greater effort should be made to identify new non-antibiotic strategies and make alternative treatments to cystitis more widely available in a bid to reduce the need for and resistance to the drugs, so that they will still be effective when patients really need them.