Women should be allowed to get treatment for cystitis directly from a pharmacy without a prescription, says GP

Women should be able to treat cystitis themselves with antibiotics without a prescription, says a general practitioner in The BMJ this week.

Dr Kyle Knox says this would save three million scarce GP appointments a year.

Acute uncomplicated urinary tract infections (AUUTIs) such as cystitis are the most common bacterial infections in women. Cystitis affects around half of women at least once in their lifetime and is coded as the reason for 1% of the 300 million GP consultations held annually in the UK.

Management of cystitis is straightforward - a short course of the antibiotic nitrofurantoin and symptoms usually start to improve after a day or two.

"Therefore, in an era of ready access to information, increasing patient autonomy, and overstretched primary care services, it would seem a good idea for women to be able to access safe and effective treatment without the costs and delays associated with consulting a clinician to obtain a prescription," suggests Knox.

However, despite clear guidance, characteristic clinical syndrome, and predictable efficacy and safety, nitrofurantoin remains a prescription-only drug.

The current prescription-only approach does nothing to limit antimicrobial use but creates urgent demand in primary care - and an additional hurdle for women to access safe and effective treatment, he argues.

He points out that the availability of pregnancy tests, emergency contraception, and antimalarial prophylaxis is commonplace in UK pharmacies - and some antibiotics are already available from pharmacies without prescription in the UK.

"A change in the regulations that govern access to nitrofurantoin would be worthwhile only if it was taken up by women seeking treatment," he writes.

He acknowledges that the weight women give to a clinician's assessment compared with more convenient access to treatment is unclear, but says "should be explored as part of the commitment to self care in the NHS Plan 2014-15."

RCGP response to BMJ article on treating cystitis with antibiotics

Dr Maureen Baker, Chair of the Royal College of GPs, said: "Cystitis can cause a huge amount of discomfort for patients, and whilst antibiotics can help in some cases, they are not always the most appropriate treatment as the cause is not always bacterial.

"Aside from the patient safety risks associated with deregulating access to some of these powerful drugs, we are currently amidst an international drive to reduce antibiotic use, in order to curb growing global resistance to them.

"Although the strain of antibiotics referenced in the article has actually seen very little resistance built up against it so far, making it more widely available would inevitably increase resistance to it and remove one of the few antibiotics with low resistance rates from the formulary, therefore adding to this global problem.

"GPs already face enormous pressure to prescribe antibiotics, and it often takes a lot of effort to persuade patients that they are not always the answer to treating illness - making them available without a prescription would simply undermine this. There is also the risk that bypassing the GP for patients with cystitis might lead to recurrent strains of the infection being treated inappropriately, and more serious conditions going undetected.

"Instead of increasing the availability of antibiotics for patients suffering from cystitis, we should concentrate our efforts on making alternative treatments to cystitis more widely available - and identifying new non-antibiotic strategies - to reduce the need for and resistance to the drugs, so that they will still be effective when our patients really need them."