Switching trimethoprim will not lead to increased resistance
Geoff Kidd/Science Photo Library
Making trimethoprim tablets available over the counter will not
increase use |
Changing the status of a prescription-only antibiotic for the treatment of cystitis to an over-the-counter medicine will not lead to an increase in antibiotic resistance, according to the National Pharmacy Association.
The NPA view follows a warning against the reclassification of trimethoprim
from Robin Howe, head of the antimicrobial resistance programme in Wales.
Dr Howe, in a letter to the BMJ (2008;336:787), cautions against changing
trimethoprim’s status from prescription-only medicine to pharmacy
medicine on the grounds that it could damage public health by triggering
antibiotic resistance.
But Colette McCreedy, chief pharmacist and director of practice at the
NPA, disagreed. “He is making the assumption that if you make this
drug available as a P medicine that it will increase its usage. I don’t
necessarily agree that is the case. What I think it does increase, is
choice of access.”
She said some pharmacists have already successfully been offering trimethoprim
to patients over the counter as part of a patient group direction.
“Although [a patient group direction] is a more structured intervention,
I think it is possible to take the learning from that scenario to go
forward in community pharmacy.
“This is something which pharmacists can do competently and confidently,
provided the training packages are correct and the guidelines from the
Royal Pharmaceutical Society are robust,” said Mrs McCreedy.
In his letter, Dr Howe cites evidence from a case-control study examining
the risk of an antibiotic-resistant Escherichia coli urinary tract infection.
The study suggested that the risk of a trimethoprim-resistant infection
was associated with the patient having received a trimethoprim prescription
in the preceding month.
He pointed out that trimethoprim is a useful alternative to other antibiotics
which fail in the treatment of infections such as meticillin-resistant
Staphylococcus aureus. Increased use of trimethoprim could jeopardise
that prescribing option, he said.
Dr Howe also said that reclassification goes against recommendations
from the EC and a House of Lords select committee which both recommend
that systemic antibacterial agents should remain prescription-only treatments.
“Given the ever-increasing restrictions on antibiotic use in hospitals
that are being encouraged by the Department of Health in an effort to
control resistance and Clostridium difficile, it seems paradoxical to
reclassify trimethoprim,” said Dr Howe.
Drug manufacturer Alpharma applied to the Medicines and Healthcare products
Regulatory Agency in 2005 for the drug to be reclassified for the treatment
of cystitis. Consultation on the reclassification is over but the MHRA
has yet to reach a decision.
Meanwhile, last month Goldshield Pharmaceuticals applied to the MHRA
for nitrofurantoin
to be reclassified from a POM to a P for the treatment
of cystitis (PJ, 8 March 2008, p266). |
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