The Royal Australian College of General Practitioners (RACGP) has warned that the nation-wide shortage of trimethoprim is yet another reminder of why allowing pharmacists to prescribe medicines, including antibiotics, is such a bad idea.
It comes following many communities experiencing a shortage of the antibiotic, which is used to treat bacterial infections including urinary tract infections or UTIs. Queensland has controversially extended a UTI prescribing pilot against the advice of health groups including the RACGP and launched a North Queensland pharmacy prescribing pilot. Several jurisdictions, including Victoria and New South Wales, are following suit despite protestations from GPs that expanding pharmacist prescribing powers will lead to greater antimicrobial resistance and risk patient safety and wellbeing.
RACGP President Dr Nicole Higgins said that the trimethoprim shortage was a much-needed wake-up call.
"The trimethoprim shortage highlights why carefully managing antibiotic prescribing is so important and must be left to the experts with proper medical training," she said.
"Australia does experience medicine shortages from time to time and they are particularly pronounced at the moment due to manufacturing and supply issues. Where I live and work in Mackay, we have limited supplies of trimethoprim and no amoxicillin nor augmentin.
"A shortage of a commonly-prescribed antibiotic is much higher stakes in terms of poor clinical outcomes. It can actually compound the issue of antimicrobial resistance as GPs are forced to prescribe broader spectrum antibiotics, making the entire problem much worse. That is why the judicious use of antibiotics is more important now than ever before.
"Australia needs proper antibiotic stewardship and evidence shows that community pharmacists overprescribe antibiotics. GPs are the ones who understand that UTI treatment needs to be done with conservative options, if at all possible, to both conserve antibiotics when they are so hard to access and to prevent antimicrobial resistance."
Dr Higgins said that this isn't the time to test if pharmacists are up to the ask by rolling out more pharmacy prescribing schemes.
"Prescribing any drug, including antibiotics, is not a straightforward task," she said.
"When a patient with symptoms of a suspected UTI walks into a pharmacy they will be handed trimethoprim because when your only tool is a hammer every solution is a nail. Pharmacies also have a profit motive because they will be the ones dispensing the very antibiotic they themselves have just prescribed. So, what you will see across Australia under these pharmacy prescribing schemes is an explosion in antibiotic prescribing at a time when we are trying to combat one of the great public health challenges of this century in antimicrobial resistance.
"GPs have the requisite know-how and experience to be able to substitute an antibiotic like trimethoprim and conserve precious supply. That is essential when we are facing shortages of medicines commonly used around Australia. Pharmacists simply don't have the right training to make such difficult decisions and will hand out antibiotics in greater numbers under expanded pharmacy prescribing schemes.
"In the United Kingdom and next door in New Zealand, increased trimethoprim resistance has resulted from inappropriate prescribing and use of antibiotics. The antibiotic was over-prescribed and now doesn't work for one-in-three women due to resistant bacteria. Similarly, in Canada, pharmacists prescribed seven times more antibiotics than doctors for UTIs and in Queensland, pharmacists prescribed antibiotics to 96.3% of patients with UTI-like symptoms, without taking urine samples to confirm if there actually was an infection. We should be learning from these jurisdictions and abandoning plans for pharmacist prescribing rather than heading full steam in the other direction.
"So, action is needed to stand up to the Pharmacy Guild and stop these pharmacy prescribing powers before it is too late. The trimethoprim shortage highlights just how important it is we get this right and act without delay. Otherwise, patients across Australia will suffer the consequences and that is something no one wants."
