Just days after the announcement that pharmacist-led prescribing is to go ahead in NSW, World Antimicrobial Awareness Week has kicked off.
Antimicrobial resistance is an existential threat to healthcare, but NSW is set to become the second state to allow pharmacists to prescribe antibiotics for UTIs without dipstick testing.
The World Health Organization has declared rising rates of antimicrobial resistance one of its top 10 global public health threats, saying it was largely driven by misuse or overuse of antibiotics.
Meanwhile, from 18 to 24 November, it’s World Antimicrobial Awareness Week.
Australia has higher antibiotic use than most other countries – it ranks sixth out of 31 comparator nations, and use rates are double that of Sweden and the Netherlands.
Although rates have been gradually decreasing, it would take Australia another 40 years to lower antibiotic prescribing to Sweden’s current level of use.
“Similar to action on climate change, that pace is far too slow,” a recent editorial in the Australian Journal of General Practice reads.
Some eastern states, however, would seemingly disagree.
Following Queensland’s lead, NSW will fund a 12-month trial to evaluate allowing pharmacists to prescribe antibiotics for “uncomplicated” urinary tract infections.
It is expected to be effectively a reproduction of the Queensland pilot, which has since been made permanent.
The AMA Queensland claims that at least 240 patients developed complications after being treated as part of the trial.
According to the authors of that AJGP editorial, evidence-based medicine researcher Professor Paul Glasziou and National Centre for Antimicrobial Stewardship director Professor Karin Thursky, one essential intervention has demonstrated that antibiotics can be safely reduced: delayed prescribing.
If the NSW trial follows the same protocol as Queensland, pharmacists will not be able to send urine samples off for confirmatory testing before initiating patients on antibiotics.
In fact, the Queensland pharmacists prescribed antibiotics to 97% of the patients who presented with UTI-like symptoms.
“GPs resist prescribing antibiotics to their patients unless they are absolutely necessary,” RACGP president Adjunct Professor Karen Price said.
“This is why the recent moves to introduce more non-medical prescribers of antibiotics in Australia is so alarming.”
Other countries that have allowed pharmacist-led antibiotic prescribing for UTIs include Canada, the UK and New Zealand.
A 2021 systemic analysis of community pharmacist antibiotic prescribing, which included papers on UTI prescribing from those three countries, found pharmacist-led prescribing for uncomplicated cystitis was associated with high rates of clinical cure, low rates of recurrence and low rates of adverse events.
“There is also evidence that pharmacist prescribing for uncomplicated UTIs does not increase overall antibiotic use or use of second-line agents,” the authors wrote in the Canadian Pharmacists Journal.
However, an earlier article published in the same journal would appear to refute that finding.
In a 2019 letter to the editor, written in response to an even earlier study in the Canadian Pharmacists Journal, two Canadian pharmacists-turned-doctors expressed concern at the rosy reporting on antibiotic prescription figures.
“We are alarmed that the study had 656 prescriptions initiated by pharmacists, compared to 94 prescriptions initiated by physicians,” they wrote.
“This was almost a 7-times difference in the number of prescriptions.
“Are the data suggesting pharmacists can better detect UTI than physicians do, even without physical examination and investigations?”
New Zealand physicians, too, have questioned whether pharmacists prescribing for UTIs has played a critical role in rising antimicrobial resistance in the island nation.
