Letters Antibiotics without prescription for urinary tract infection

Antibiotics without prescription: more cons than pros

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4202 (Published 11 August 2015) Cite this as: BMJ 2015;351:h4202
  1. Carl Llor, general practitioner and senior researcher1
  1. 1Primary Healthcare Centre Via Roma, 08015 Barcelona, Spain
  1. carles.llor{at}gmail.com

Knox suggests that women should be able to get antibiotics for urinary tract infections (UTI) without prescription in the UK.1 This strategy could avoid unnecessary visits to the GP but might be hazardous for several reasons.

Firstly, the diagnosis of UTIs is not straightforward—34-60% of patients treated with an antibiotic do not have microbiologically confirmed UTI.2

Secondly, the link between this practice and antibiotic overconsumption is clear. Southern European countries come top in terms of antibiotic consumption, and over-the-counter sale of antibiotics—not just narrow spectrum antimicrobials—is common in such countries.3 This practice also encourages self medication and storage of leftover drugs, which may later be considered for self medication. This can lead to inappropriate use of these drugs and compound the problem of antimicrobial resistance.

Thirdly, over-the-counter sales can mask underlying infectious processes. In Taiwan, patients with detectable antibiotic in their urine were nearly twice as likely as those with no antibiotic to have a missed diagnosis of bacterial infection.4 Furthermore, people get used to going directly to pharmacies and bypassing their GPs. Antibiotics were purchased by 41% of a Finnish community living in Spain, who admitted having taken them in the previous six months.5

Over-the-counter sale of antibiotics has pros and cons, and pharmacists have a key part to play. This policy might be considered for women with uncomplicated recurrent UTIs who clearly know their symptoms if limited to short courses of narrow spectrum antibacterials, such as nitrofurantoin (or fosfomycin or pivmecillinam in other countries).


Cite this as: BMJ 2015;351:h4202


  • Competing interests: I received a grant from the Fundació Jordi Gol I Gurina for research at the University of Cardiff in 2013. I have also received research grants from the European Commission (Sixth and Seventh Programme Frameworks), Catalan Society of Family Medicine, and Instituto de Salud Carlos III (Spanish Ministry of Health).

  • Full response at: www.bmj.com/content/351/bmj.h3441/rr-2.


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