Treatment of urinary tract infection (UTIs) by pharmacists

Legal instrument

Under Part 6 of the Medicines and Poisons Regulations 2016 (external site), the Chief Executive Officer of Health (Department of Health) has issued a Structured Administration and Supply Arrangement (SASA) that authorises trained pharmacists to supply Schedule 4 antibiotics for the treatment of urinary tract infections in low risk patients.

A SASA is a written direction that authorises a health practitioner to administer or supply a medicine to any patient meeting the specified conditions. Pharmacists are strongly advised to read and understand the conditions listed in the SASA before providing the service.

Training

Training is currently available from the Pharmaceutical Society of Australia (external site) and the Australasian College of Pharmacy (external site).

Pharmacists must complete one of the accredited trainings available before offering the service.

WA supplementary information

The WA Department of Health has published a supplementary information for pharmacists after extensive consultations with the program working party. Pharmacists should read and understand the document in conjunction with the training and treatment protocol.

Pharmacy requirements

Pharmacists must meet professional practice standards and ensure that the consultation is conducted in an area that protects the patient’s privacy and confidentiality. During history taking, it is important to ensure that the patient is comfortable disclosing sensitive information that may be critical to the diagnosis and treatment plans.

Exclusion criteria

Pharmacists providing the service must ensure that they are familiar with the exclusion criteria. Patients must be referred to a medical practitioner if they have any of the following, or if the pharmacist is in doubt of the safety and appropriateness of the treatment

• Anatomical male urinary tract
• Age <18 years or >65 years
• Signs and symptoms of pyelonephritis or any systemic symptoms
• Previous episode of pyelonephritis
• Only one primary symptom of acute cystitis
• Vaginal symptoms
• STI risks/symptoms
• Pregnancy, recent birth, miscarriage, or abortion
• IUD in situ
• Recurrent UTIs or relapse after recent treatment
• Have risk factors for multidrug resistant bacteria
  • Recent (within last 3 months) or frequent treatment with antibiotics
  • Recent (within last 3 months), frequent or long-term resident of a healthcare facility
  • Lack of response to initial antibiotic treatment
  • Overseas travel within last 3 months
  • Previous infection with multidrug resistant bacteria in the last 3 months
• Diabetes
• Immunocompromised
• Known anatomical or functional abnormalities of urinary tract
• History of renal disease or impaired renal function
• Urinary catheter within the previous 48 hours or other instrumentation of urinary tract

Refer to the clinical protocol for more information.

Allowable treatments and limits

Ensure proper history taking during the consultation. Recurrent UTIs should be referred to a medical practitioner. If a patient has already had an episode of UTI in the past 6 months, or two or more episodes in the past 12 months, the current presentation would be considered a recurrent episode. Recurrent UTIs should be referred to a medical practitioner. Patients must not be supplied with another course of antibiotics for unresolved symptoms.

The WA pharmacy UTI program recommends nitrofurantoin as the first line antibiotic and trimethoprim as the second line option. The most recent urine E. coli antibiograms indicate that nitrofurantoin is the most effective antibiotic for empirical therapy in community acquired UTIs.

Record keeping and referral

The pharmacist must keep a clinical record of the consultation and provide a service summary to the patient. This can be done using a pharmacy practice software, or the pharmacist may choose other forms of digital or paper record keeping methods.

Patients should be encouraged to present the service summary to their GP to have the UTI episode recorded on their personal medical history. In some cases, patients may need to be referred because they were unsuitable to be treated in a pharmacy based on the consultation, or the treatment provided has failed. The service summary can provide valuable information for the medical practitioner for their clinical assessment.

Pharmacists may forward the service summary to a patient's usual GP where appropriate.

My Health Record

The SASA mandates that the dispensing record is transmitted to My Health Record. This should occur automatically via the dispensing software that has been configured correctly. For dispensing software-specific information, pharmacists should consult the software vendor.

The purpose of the mandate is to ensure that relevant patient details were obtained, and the pharmacist’s HPI-I is linked to the dispensing record to allow the transmission to occur. Patients can adjust viewing rights in their My Health Record based on their own preferences.

Some people may have opted out of using My Health Record or have recently arrived in Australia. It is important to note that people without My Health Record are not excluded from accessing treatment.

Follow up and treatment failure

Patients supplied with antibiotics should be provided with follow-up advice on when they should seek an assessment from a medical practitioner. Particularly when

• Symptoms of UTI did not improve within 48-72 hours after starting treatment
• New symptoms develop that could indicate that it is not an uncomplicated UTI
• Symptoms relapse after treatment

Proper patient counselling on the medication provided is expected.

Fees and charges

Pharmacists should make sure that the patient understood the costs involved when offering the service and inform them that free consultations are available through bulk-billing general practitioners.