Pharmacists ‘not currently qualified’ for UTI trial

woman on toilet

A pharmacist and several doctors have again called for the Queensland UTI trial to be halted, citing concerns about antimicrobial resistance

Senior Infectious Diseases Pharmacist, Aryan Shahabi-Sirjani, Chair of the NSW Antimicrobial Stewardship Pharmacist Network (NASPN), said in a statement this week that proposals for a similar trial in the UK had been withdrawn because of concerns about increasing resistance to antibiotics.

He said that a similar trial in New Zealand led to the region having the country’s highest use of trimethoprim and a corresponding increase in rates of resistance to the drug by the common bacteria that cause UTIs.

NASPN made a submission to the TGA last year opposing what it calls the “downscheduling” of trimethoprim to enable pharmacists to prescribe it.

“Pharmacists in Australia are not currently qualified to diagnose UTIs (which requires) utilising the appropriate history, physical examination and investigations of the patient,” the group submitted to the TGA.

“There is an inherent risk of pharmacists missing a differential diagnosis or complications of a UTI. The most important complication that bears significant mortality is sepsis.”

In the submission, Mr Shahabi-Sirjani wrote patient care needed to be delivered in a holistic manner, using all available diagnostic tools and skills, rather than what he calls a “fragmented” fashion enabled by the pharmacy trial.

In the same statement, AMA Queensland President Dr Chris Perry said doctors have grave concerns about the risk of misdiagnosis of symptoms and the threat of patients’ conditions worsening.

“This is a really dangerous initiative and one that doctors have vehemently opposed,” Dr Perry said. “Unfortunately, our concerns have fallen on deaf ears.

“It takes unnecessary and unwanted risks with patients’ health,” he said.

“AMA Queensland calls on the State Government to put an end to the trial and work with doctors and pharmacists on ways to deliver collaborative, efficient and safe patient care.”

Reporting on the statement, RACGP’s newsGP spoke to RACGP Queensland chair Dr Bruce Willett, who said that antimicrobial resistance was one of two top health risks faced by international health stakeholders, the other being pandemics such as COVID-19.

“Antimicrobial resistance is in a sense very similar to this pandemic, both have the potential to kill millions,” he said.
“Antimicrobial resistance is the slow-motion version of COVID-19. We have seen the importance in Australia of being able to plan for the pandemic.
“But, unfortunately, in Queensland there is a tendency to ignore the growing tsunami of antimicrobial resistance and to go the other way, rather than to improve it.”

He said that “retail pharmacies” were not a suitable setting for patients to receive this treatment, and that the commentary by NASPN illustrates a difference between “retail pharmacies and hospital pharmacists”.

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