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3 days of antibiotics from pharmacists could lead to chronic UTIs, experts warn

Pharmacy First aims to take the pressure off GPs (Photo: Julien Behal/PA)
Pharmacy First aims to take the pressure off GPs (Photo: Julien Behal/PA)
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Doctors have cautioned that a new programme allowing pharmacists to administer brief courses of antibiotics may increase the incidence of chronic urinary tract infections (UTIs).

Launched on January 31, the NHS Pharmacy First service allows patients to receive treatment for seven common diseases, including “uncomplicated urinary tract infections” for women aged 16 to 64, without visiting a general practitioner.

By enabling community pharmacists to administer medication for seven common ailments, such as earache, sore throat, sinusitis, impetigo, shingles, and infected bug bites, the programme is anticipated to reduce the burden on GP surgeries. In 2020, Scotland implemented a comparable policy that is currently in effect for the treatment of UTIs.

Patients with one-off acute UTIs are likely to benefit from the scheme as it allows access to a three-day course of antibiotics via their local pharmacy.

But there are fears this three-day course could in fact lead to an increase in chronic UTI cases.

Dr Catriona Anderson, who runs a specialist UTI clinic in Stoke, welcomed the Pharmacy First scheme for improving access for acute UTI patients, but said it is unlikely to help recurrent and chronic patients – potentially even removing access in some cases.

She told i: “Even when [chronic UTI patients] are treated, the three-day antibiotic treatments being handed out are more appropriate for acute UTI.

“Key opinion leaders are all in agreement that the three-day courses of antibiotics often do not serve patients who have persistently recurrent and chronic infections.”

The majority of uncomplicated, acute UTIs get better within days, often with a relatively short course of antibiotics, but some do not respond and go on to cause constant, ongoing symptoms for patients.

Specialists say chronic UTI infections, which often begin as an acute bout of cystitis, can occur when bacteria become embedded within the bladder wall and become difficult to treat with short courses of antibiotics.

Three-day courses of antibiotics can eventually trigger a chronic infection in some patients as it is not always enough to kill the bacteria, leading it to embed in the bladder lining, Dr Anderson said.

She added that patients in desperate need of antibiotics will “do what they need to do to gain relief” – even potentially withholding information about previous infections in an attempt to get more medication.

Campaigners also fear the new scheme could put up “extra barriers” to care for patients with recurrent and chronic infections.

GP appointments for UTIs could become harder to get, campaigners have warned, if patients are redirected to pharmacies as a first point-of-call.

The guidelines clearly state that some patients require specialist input and cannot be managed in a community pharmacy.

But the National Institute for Health and Care Excellence (NICE) only recently recognised chronic UTI as a distinct condition and campaigners fear a lack of understanding of UTIs could lead to confusion over when patients need specialist support.

i previously reported that chronic UTI patients face being “gaslit and dismissed” by healthcare professionals who might not have a full understanding of the condition, with some waiting up to 12 years for a diagnosis.

Patient and campaigner Leah Herridge said the Pharmacy First move risks putting up “extra barriers” to specialist treatment for recurrent and chronic UTI sufferers as it adds another stage to the patient pathway.

The 37-year-old, who has suffered from a chronic UTI for years, said: “I’m concerned that patients will just be told by GP practices to go to their pharmacy and then refused by pharmacy.

“No one may end up helping and taking responsibility and the patient suffers.

“One of my biggest concerns is if a patient doesn’t describe their symptoms in the right way because pharmacists will be working off the protocol. If they are denied antibiotics, will they just be sent away with a cystitis sachet?

“It feels like it’s adding extra barriers for patients to be able to potentially access their care.”

She added that the scheme “minimises and trivialises UTIs experienced by women” as any uncomplicated UTI is at risk it becoming recurrent or chronic if not treated properly in the first instance.

Carolyn Andrew, director of the Chronic Urinary Tract Infection Campaign (CUTIC), said: “We have a fear that when you ring your doctor’s surgery to say you need an appointment and the receptionist hears it a UTI, it immediately flags up to send you to a pharmacist.

“We do not know what GP surgeries are going to do by way of training because anyone that has had a recurrent UTI or who has a history of UTI should not be sent to the pharmacist.”

Pharmacists have strict guidelines to follow with three pages of exclusion criteria, including more than two UTIs in the past six months, antibiotics for UTI in the previous three months, and those who are under a urologist.

If symptoms do not clear up with the three-day course of antibiotics, patients are immediately referred to a GP for a urine culture.

A spokesperson from the Pharmacists’ Defence Association (PDA) also said a patient could, in theory, obtain a double dose of antibiotics as the digital communication system between GPs and pharmacists is not a “real-time event”.

Susannah Fraser, a spokesperson from Bladder Health UK, said the policy is likely to work “reasonably well” for acute UTIs, but feared a lack of communication between pharmacists and GPs could lead to disjointed care.

As well as allowing desperate patients to game the system by accessing double doses of antibiotics, a lack of joined-up care could prevent patients with recurrent infections from being flagged and directed towards specialist care.

Ms Fraser added that in an “ideal world”, UTI patients would be able to see a GP, but she added that accessing antibiotics at a pharmacy is a “good thing” when GP appointments are increasingly scarce.

The government has invested in improving digital infrastructure allowing GPs and community pharmacies to communicate with each other more easily.

Pharmacists’ Defence Association (PDA) said that once a consultation has taken place under the Pharmacy First service, a record of the consultation is sent to the patient’s doctor including details about any antibiotic supply. This must be sent by the next working day using the NHS-approved electronic communication system

“The pharmacist would usually check the electronic patient record – with the patients consent – to check history of allergies, prescriptions and any other relevant information, prior to making a supply of the antibiotic,” they said.

“However, as the patient record update is not a real-time event there may be a possibility for a patient to obtain a double dose of antibiotics,” they added.

A spokesperson from the Royal Pharmaceutical Society said: “The delivery plan ensures that UTI sufferers, including those with recurrent or chronic infections, have access to timely and comprehensive care.

“Through improved data sharing between general practice and community pharmacies, we can promptly identify patients’ medical histories, previous antibiotic exposure, and resistant infections.

“This proactive approach facilitates seamless coordination between healthcare providers, ensuring patients receive the necessary attention and treatment without undue barriers.”

Professor Kamila Hawthorne, Chair of the Royal College of GPs, said: “Whilst the Pharmacy First initiative means that patients will be able to see their pharmacist as their first port of call for several minor conditions, it does not mean patients cannot make a GP appointment, if they are concerned about their health or believe their condition to be more serious.

“Pharmacists taking part in the scheme will take a short history from patients, and will refer them back to the GP if the presentation is at all complex or unusual.

“GPs are highly-trained to consider the various physical, psychological and social factors potentially impacting on the health of their patient when formulating a diagnosis and treatment plan, in conversation with them and taking into account relevant clinical guidelines as they are updated based on the latest evidence and research.”

Dr Amanda Doyle, GP and national director for primary care at NHS England said: “GPs will always be available and women with recurrent UTIs will continue to be offered assessment and treatment at their GP surgery. Local pharmacies now offer a simple and convenient option for women to receive the care they need without a GP appointment for one-off cases.” Source:iNews

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