Urologists Join Health Experts Warning of Dangers of Pharmacists Prescribing Antibiotics
15 December 2022
Urologists are concerned that allowing pharmacists to prescribe antibiotics to women presenting with urinary tract infections (UTIs) without being assessed by a GP undermines the safe and effective management of women’s health and may ultimately be harmful in some cases.
Furthermore, an independent review, cited by governments to support this practice, overlooks important risk factors previously raised by urologists and other healthcare stakeholders.
“The management of UTIs, or UTI symptoms, in women requires more than an over-the-counter assessment to not only confirm accurate diagnosis but to ensure that more serious conditions aren’t escaping detection,” says Urologist, Dr Anita Clarke from the Urological Society of Australia and New Zealand (USANZ).
“USANZ believes the well-being of women risks being seriously compromised by this short-sighted scheme.”
UTIs are one of the most common reasons for women to visit GPs with around 50% of women experiencing at least one UTI during their adult life. Limited access to GPs during the pandemic prompted the Queensland Government to trial a scheme whereby pharmacists were given scope to prescribe antibiotics to women presenting with UTI symptoms.
The pilot scheme involved payment of a consultation fee to the pharmacist, and it is important to note, was not a scientific trial which would be required to override current evidence-based practice.
However, based on a ‘review’ of that program, the Queensland Government has permanently implemented the scheme and the NSW Government is considering the same system.
“This is a slippery slope where GPs are cut out of the diagnostic process which is handed to those not in a position to provide the same level of clinical assessment,” says Dr Clarke.
“While there were some advantages when Covid presented unique challenges, we oppose the permanent introduction of the scheme, that appears to depend on a flawed review that fails to address some significant issues.
“UTI symptoms are not unique to infection. Haematuria (blood in the urine) and irritating voiding symptoms, can also be signs of bladder cancer or gynaecological issues such as ectopic pregnancy. The consequences of delayed diagnosis in these circumstances can be life-threatening.”
Best practice management of UTI symptoms requires testing of the urine to confirm the infection and identify the specific bacteria to make sure the appropriate antibiotic for that bacteria is prescribed.
“The rising threat of antibiotic resistance in the community and the consequent need to limit over-prescription is not best served in a pharmacy scenario where there is also a direct conflict of interest,” says Dr Clarke.
Issues of antibiotic reaction and allergies were also omitted from the review of the scheme.
“We are also concerned the outcomes were not subject to robust assessment of safety or long-term follow-up which would have presented a more fully nuanced and accurate review.”
A review by AMAQ (Australian Medical Association Queensland) members calculated 200 cases of complications (from 9000 women) including misdiagnoses, incorrect treatment and a missed ectopic pregnancy.
Other deficiencies identified by the AMAQ included patient reluctance to disclose information due to the lack of privacy in a pharmacy setting, leading to missed opportunities to screen for UTIs or other relevant health issues in a generally young, and sometimes itinerant, population;
“We urge the Queensland and NSW governments to reconsider this change to health management of UTIs to ensure women in these states aren’t adversely impacted by the removal of the GP from the process”, says Dr Clarke.
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The Urological Society of Australia and New Zealand is the peak professional body for urological surgeons in Australia and New Zealand. Urologists are surgeons who treat men, women and children with problems involving the kidney, bladder, prostate and male reproductive organs. These conditions include cancer, stones, infection, incontinence, sexual dysfunction and pelvic floor problems.
Access the PDF of the Media Release: Urologists Join Health Experts Warning of Dangers of Parnacists prescribing antibiotics.