The Urological Society of Australia and New Zealand (USANZ) and the Royal Australian College of GPs (RACGP) have warned that a decision by Queensland Health to allow pharmacists to prescribe antibiotics without medical review or investigations for urinary tract infections (UTI) in women risks wide ranging adverse health repercussions including delayed diagnosis of cancer.
It comes following the decision of the Queensland Government to extend the Urinary Tract Infection Pharmacy Pilot until 30 June this year.
President of USANZ, Associate Professor Prem Rashid, said that the move by Queensland Health undermines the correct diagnosis of UTI’s, which are very common but require microbiological confirmation on urine testing.
“As a member of our board, Dr McKertich, wrote in an article published in the Australian Journal of General Practice last year, the importance of the mid-stream urine test in recurrent and chronic UTIs cannot be underestimated,” he said.
“This defines whether the patient has a bacterial UTI as opposed to other potential causes of similar symptoms and is also fundamental to ensure optimal and accurate treatment with the appropriate antibiotic.”
Vice President of USANZ, Professor Helen O’Connell AO, said that the health and safety of patients must come first.
“Tracking of urinary white cells and epithelial cells is critical to assessment of patient progress and exclusion of a chronic state,” she said.
“It does not represent best practice for women to simply attend a pharmacist with symptoms which may or may not be due to bacteria and receive antibiotics which may not treat the bacteria present due to resistance.
“The symptoms of a UTI are common to a number of serious health issues, including bladder cancer, which is why a correct diagnosis of an UTI is necessary to rule out other potential health serious issues.
“Blood in the urine and a burning feeling while passing urine are just two of the symptoms common to both bladder cancer and UTIs. More than 3000 people are diagnosed with bladder cancer each year, a significant number of these are women. This cancer is treatable if detected early but delayed diagnosis and treatment can compromise outcomes, and at worst may mean someone cannot be cured.
“An overhaul of the management of UTIs and recurrent UTIs is welcomed by USANZ but this pilot falls well short of meeting those needs and risks harm to women. Why should a common condition in women be redirected from medical care without long term proof of its safety?”
RACGP President Dr Karen Price said that extending the pilot was not backed by evidence.
“The RACGP has deep concerns about moves by the retail pharmacy sector to push through policy changes that put financial gains ahead of patient care and safety,” she said.
“The trial in Queensland of pharmacists prescribing antibiotics for urinary tract infections is concerning.
“One of the main problems here is that this trial is effectively an implementation trial. It’s not research on best practice and the results of the trial should be made publicly available.”
RACGP Queensland Chair Dr Bruce Willett warned that making the pilot a permanent fixture of Australia’s healthcare system would be a recipe for disaster.
“One of the greatest challenges our healthcare system faces is antimicrobial resistance caused by the misuse and over-use of antibiotics,” he said.
“GPs are actively working to reduce the prescription of unnecessary medicines and extending this pilot is certainly a step in the wrong direction. Introducing multiple prescribers – particularly those who stand to gain financially from handing out more medicines – will jeopardise global efforts to reduce antimicrobial resistance.”