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Cystitis treatment over the counter?

Wednesday July 15th, 2015

Antibiotic treatments for cystitis should be available without a prescription, a senior GP says today.

About 30% of women will have been affected by an acute uncomplicated urinary tract infection such as cystitis by the age of 26.

Dr Kyle Knox of Nuffield Department of Primary Care Health Sciences, Oxford, UK, believes: "Uncomplicated cystitis is common and easily treated with drugs such as nitrofurantoin."

But his proposals were rejected by his professional college, which warned against increasing access to antibiotics.

Writing in The BMJ, Dr Knox states: "Acute uncomplicated urinary tract infections usually resolve without sequelae and rarely progress, but they result in considerable morbidity, and the goal of treatment is to ameliorate the severity and duration of symptoms."

Individual's responses to oral antimicrobials are known and predictable, he adds, and the guidance on their management can be summarised in a simple flowchart which requires little clinical assessment.

"In an era of ready access to information, increasing patient autonomy, and overstretched primary care services, therefore, 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 get a prescription," he believes.

With three million appointments a year being made in the UK for cystitis, and nitrofurantoin being generally well tolerated when used in short courses, over the counter availability "should be explored as part of the commitment to self care in the NHS's plan for 2014-15."

Dr Knox concludes that the current prescription-only approach "does nothing to limit antimicrobial use but creates urgent demand in primary care, as well as an additional hurdle for women accessing safe and effective treatment."

But Royal College of GPs chair Dr Maureen Baker said: "Whilst antibiotics can help in some cases, they are not always the most appropriate treatment as the cause is not always bacterial.

“Aside from the patient safety risks associated with deregulating access to some of these powerful drugs, we are currently amidst an international drive to reduce antibiotic use, in order to curb growing global resistance to them.

“Although the strain of antibiotics referenced in the article has actually seen very little resistance built up against it so far, making it more widely available would inevitably increase resistance to it and remove one of the few antibiotics with low resistance rates from the formulary, therefore adding to this global problem."

Knox, K. et al. Women should be able to treat urinary tract infections with antibiotics without a prescription. BMJ 15 July 2015 doi: 10.1136/bmj.h3441 [abstract]

Tags: Pharmaceuticals | UK News | Urology | Women's Health & Gynaecology

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