Pharmacists key in NZ antimicrobial prescribing study

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Pharmacists in New Zealand have played a key role in a study looking into antimicrobial prescribing and demonstrated pharmacy’s interest in its increasing role in primary care, its lead author says.

The study, which examined the overall drug treatment of cystitis before and after the reclassification of trimethoprim, saw 139 community pharmacies provide data.

The pharmacy staff completed forms on relevant dispensings, and OTC consultations, and asked women with suspected cystitis who received a prescription or were managed in the pharmacy to complete a questionnaire.

“Given the increasing concerns about antimicrobial resistance internationally antimicrobial stewardship recommends to follow national and local guidelines, use the right drug, in the right dose and for the shortest duration that is effective,” says lead author, pharmacist and medicines reclassification expert Dr Natalie Gauld.

“The current BPAC Antibiotic Guide recommends that for women with uncomplicated cystitis, trimethoprim (300mg daily for three days), or nitrofurantoin (50mg daily for five days) are used first-line with norfloxacin only used where isolates are resistant to first-line agents.

“The research found that prescribers were usually using the recommended first-line agents, with around three-quarters of women with cystitis without complicating features prescribed trimethoprim or nitrofurantoin.

“However, only one in five actually followed the BPAC recommendations on drug, dose and duration.”

The study also found there was room to improve in pregnancy: many prescribers were using courses that were too short or in different doses to recommendations.

“The BPAC guide recommends that for cystitis in pregnancy norfloxacin needs to be avoided, and trimethoprim (avoided in first trimester) and nitrofurantoin (avoided from 36 weeks) are used in the same dose as above, but for seven days,” says Dr Gauld.

“Pregnant women should have a urine culture before starting the antibiotic and one to two weeks after completing the antibiotic course to ensure it has cleared.

“Pharmacists could usefully guide prescribing, particularly in pregnancy, and with nitrofurantoin dosing where prescribing was highly variable.”

She says the study findings were useful in the light of recent widening access to trimethoprim.

“The Green Cross Health/Natalie Gauld Ltd application to the Medicines Classification Committee last year could demonstrate that prescribers still used trimethoprim where an antibiotic had been used in the previous 6 months.

“Additionally, community pharmacy’s strong participation in this research, and the funders of the study, showed how seriously community pharmacy have taken their increasing role in primary care and a willingness and capability to demonstrate outcomes from this role.”

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