The Pharmaceutical Journal
Vol 280 No 7501 p566
10 May 2008

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• New professional body (2)
• Council election (2)
• Trimethoprim
• Restricted title
• Addiction
• Medicines use reviews
• English Pharmacy Board
• Epilepsy
• Euthanasia
• Public relations
• The Society

Letters to the Editor

Trimethoprim

Reclassification is not likely to increase usage

From Mr D. M. Pruce, MRPharmS

In response to the letter “Will switching lead to increased resistance?” (PJ, 3 May 2008, p535) the Royal Pharmaceutical Society would like to reinforce the message that pharmacists are highly qualified professionals, experts in medicines management and are fully aware of the issues of antimicrobial resistance.

The Society’s code of ethics sets the professional standards relating to sale and supply of medicines that pharmacists would be expected to follow.

The proposed protocol for sale of antibiotics for the treatment of urinary tract infections follows current clinical guidelines from Prodigy, the Scottish Intercollegiate Guidelines Network and MeReC. This is the same guidance that applies to all healthcare professionals.

There is no evidence that pharmacists are more likely to deviate from the guidelines than other healthcare professionals. Indeed there is some evidence that shows pharmacists are likely to be more cautious. It is also worth noting that pharmacists are specifically employed in many NHS trusts to help manage antimicrobial resistance.

The Society is aware that the Commission on Human Medicines has been considering expert views on the issues of antimicrobial resistance. The proposals to reclassify trimethoprim/nitrofurantoin seek to substitute for prescriptions rather than to increase overall usage.

Indeed, a restriction of the pack size to three-day supply will limit the amount of antibiotic that is supplied to nationally agreed quantities. It should, therefore, not be assumed that changing the legal status from POM to P will increase usage of these medicines.

The CHM and the Medicines and Healthcare products Regulatory Agency impose rigorous safety criteria when considering switching and we would expect them to give due consideration to issues of antimicrobial resistance when determining whether these proposed switches should go ahead.

In terms of symptom management, pharmacists are familiar with the management of cystitis already. Pharmacy staff will be provided with appropriate training material before any antibiotics becoming commercially available over the counter.

Pharmacists are among the most accessible healthcare professionals, with branches open in the high street at convenient times, so it makes sense for patients to acquire medication through a pharmacist, following the correct procedures.

David Pruce
Director of Practice and Quality Improvement
Royal Pharmaceutical Society

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