Pharmacist prescribing to worsen public health threat, but the Guild pushes back on ‘lies’

Pharma News: The Royal Australian College of General Practitioners (RACGP) is warning that allowing non-medical prescribers will increase antimicrobial resistance (AMR), making infections harder to treat and raising the risk of disease spreading, severe illness and deaths.

The warning comes at the start of World Antimicrobial Awareness Week, from 18 – 24th of November. The World Health Organisation has declared AMR one of the top 10 global public health threats facing humanity, with an estimated 1.27 million deaths due to resistant bacteria in 2019 alone. Misuse and overuse of antibiotics are the main drivers of AMR.

This warning is also timely as the RACGP and other medical bodies have ramped up warnings about risky moves to allow retail pharmacists to prescribe antibiotics and other medications in Australia.

RACGP President Adj. Professor Karen Price said antimicrobial resistance is one of Australia’s and the world’s greatest health threats.

“We must step up efforts to combat antimicrobial resistance. Antimicrobials, which include antibiotics, antivirals, antifungals and antiparasitics, are vital medicines for fighting disease and infection, and save countless lives every year. This is why antimicrobial resistance is one of our greatest threats. The more bacteria and infectious disease that are resistant, the more we will see diseases spreading, and people suffering severe illness and deaths.

“It is not an exaggeration to say that antimicrobial resistance, if not addressed effectively, could have a far worse impact on Australia than the COVID-19 pandemic. If we lose the key tool in our kit to fight disease, we’ll rapidly find ourselves fighting a losing battle. Modern medicine as we know it could collapse, because antimicrobials are essential in so many critical medical interventions, from major surgery to cancer chemotherapy. Thankfully, we know how to fight antimicrobial resistance. We need to reduce antibiotic use, and this is a national and international priority.

“GPs resist prescribing antibiotics to their patients unless they are absolutely necessary. This is why the recent moves to introduce more non-medical prescribers of antibiotics in Australia is so alarming,” she said.

Evidence shows that putting prescribing power in the hands of retail pharmacists leads to over-prescribing of antibiotics. A 2021 study in Australia showed a dramatic rise in topical chloramphenicol prescribing after it was rescheduled to pharmacists. In Canada, pharmacists prescribed seven times more antibiotics than physicians did for urinary tract infections. In Queensland, pharmacists prescribed antibiotics to 96.3% of patients with UTI-like symptoms, without taking urine samples to confirm if they actually had the infection.

The Pharmacy Guild of Australia, Queensland Branch, is fed up with the disgraceful lies spread by the Australian Medical Association Queensland (AMAQ).

Queensland Branch President, Chris Owen, has called for the AMAQ to start focusing on achieving better health outcomes for patients instead of continually perpetuating lies about community pharmacists.

“If AMAQ had a clear understanding of the North Queensland Pharmacy Pilot, they would realise that pharmacists are not replacing general practitioners, as falsely stated. But are working collaboratively as primary healthcare professionals for the betterment of patients. AMAQ’s labelling of pharmacists as untrained is appalling and downright degrading. The need to continually rebut AMAQ’s statements about community pharmacist’s education and training is tiring but necessary.

“Over 6,500 Queensland women accessed the UTI health service during the UTIPP-Q and 87% of patients reported resolution of UTI symptoms following antibiotic treatment prescribed by their local community pharmacist. Almost 1,000 emergency department presentations were prevented by having the UTI service available through Queensland community pharmacies,” he said.

Adj. Professor Karen Price added “The introduction of pharmacist prescribers in Australia will no doubt result in a rise in antimicrobial resistance, just as it has in other countries. The United Kingdom and New Zealand have reported increased trimethoprim resistance due to inappropriate use of antibiotics. Trimethoprim used to be the first line treatment pharmacists prescribed for UTIs in the UK, but it was over prescribed and now doesn’t work for one-in-three women due to resistant bacteria.

“One of the key problems is pharmacists don’t take urine samples when women present with symptoms that might be a UTI, whereas GPs do – this is how we confirm that there is an infection, and check whether it’s resistant to the antibiotic we may prescribe. These are important elements in antimicrobial stewardship.

“The argument that retail pharmacists should be able to prescribe antibiotics because of the GP shortage simply does not make sense. Not only because pharmacists don’t have the necessary facilities, training and experience to diagnose patients, but because workforce shortages are affecting the pharmacy sector just as much as general practice.”

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