title: Antibiotic treatment of women with uncomplicated cystitis before and after allowing pharmacist-supply of trimethoprim.
abstract: Background In 2012, New Zealand reclassified trimethoprim to allow specially trained pharmacists to supply it without a prescription to women with symptoms suggesting uncomplicated cystitis, under strict criteria for supply. Objective To assess how this policy change allowing pharmacist supply of trimethoprim affected overall antibiotic supply. Setting Randomly selected community pharmacies throughout New Zealand. Methods Data were collected in pharmacies before the implementation ('baseline') and 1 year later ('post-implementation'). Pharmacy staff recorded prescription and nonprescription supplies for treatment or prevention of suspected urinary tract infections. Women with a prescription for treatment or prevention of presumed urinary tract infection or purchasing a non-prescription medicine for this purpose were invited to self-complete a questionnaire. National prescribing data were extracted for trimethoprim, nitrofurantoin and norfloxacin. Main outcome measure Antibiotic use in women with UTIs from dispensed prescriptions (baseline and post-implementation) and pharmacist-supplied trimethoprim (post-implementation), particularly focusing on women aged 16-65 years with an antibiotic for presumed cystitis without complicating features. Results Baseline data were provided by 139 pharmacies, 120 of which provided post-implementation data. In women with presumed cystitis without complicating features, prescriptions before and after the implementation were primarily for trimethoprim. Overall antibiotic use, and use of second-line agents did not increase post-implementation. Pharmacist-supplies of trimethoprim were modest nearly 1 year after the service started. Conclusion Supply of trimethoprim by specially trained pharmacists working within strict criteria for supply appeared to have little overall effect on antibiotic use. Further research on patient outcomes, resistance and changes over time is recommended.
authors.affiliation: Natalie Gauld Ltd, PO Box 9349, Newmarket, Auckland, 1149, New Zealand. n.gauld@auckland.ac.nz.|Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand. n.gauld@auckland.ac.nz.
authors.forename: Natalie J
authors.identifier: http://orcid.org/0000-0003-0366-0357
authors.initials: NJ
authors.lastname: Gauld
authors.affiliation: Department of Statistics, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand.
authors.forename: Irene S L
authors.initials: IS
authors.lastname: Zeng
authors.affiliation: Independent Consultant, Christchurch, New Zealand.
authors.forename: Rosemary B
authors.initials: RB
authors.lastname: Ikram
authors.affiliation: Department of Molecular Medicine and Pathology, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Thomas
authors.affiliation: Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Buetow
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D003556:Cystitis / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D010595:Pharmacists / Q000639:trends*; D010865:Pilot Projects; D024382:Professional Role; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014295:Trimethoprim / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D000892:Anti-Infective Agents, Urinary; D014295:Trimethoprim
keywords: Anti-bacterials; Antimicrobial stewardship; General practice; New Zealand; Non-prescription drugs; Pharmacy; Trimethoprim