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Women should be able to get antibiotics for urinary tract infection without a prescription

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3441 (Published 14 July 2015) Cite this as: BMJ 2015;351:h3441

Re: Women should be able to get antibiotics for urinary tract infection without a prescription

Kyle Knox's commendable article1 making a strong case for nitrofurantoin as the empirical drug of choice to be made available without prescription for women with Acute Uncomplicated Urinary Tract Infections (AUUTIs), fails to mention an important drawback to this practice. Both AUUTIs and genital Sexually Transmitted Infections (STIs) are common in sexually active young women. STI clinics come close second to GP surgeries young women with symptoms of lower UTI present to, and, the experience gained here cannot be cast aside. Dysuria, in the absence of frequency - often coming under the umbrella of the 'Urethral Syndrome' - makes a strong case for suspecting an underlying STI, especially if nitrites are also absent in the urine. Chlamydia trachomatis (CT), which remain the leading cause for this syndrome, would be missed if every woman with dysuria were to self medicate with nitrofurantoin. At its onset, nearly 70% of women infected with CT remain asymptomatic. The small group of symptomatic women, therefore, present a window of opportunity for screening and diagnosing this infection. The contact tracing that follows will lead to the source/s of the infection as well. All this would be negated if all women with symptoms of lower UTI were to self medicate without advice.

Furthermore, left untreated, the urethral symptoms caused by CT would resolve, and, this resolution coinciding with nitrofurantoin treatment only gives the woman a false sense of security. The serious consequences that may follow cannot be overemphasized, as women with untreated CT infection has the potential for developing pelvic infection and its associated late sequelae of tubal infertility and ectopic pregnancy. While broadly agreeing with Dr Knox's plea, we do advice some caution before putting this into practice. Another word of warning omitted in the excellent article is the interaction nitrofurantoin could have with drugs taken for other conditions, which will be applicable even to short courses of the drug. Carbonic anhydrase inhibitors such as acetazolamide taken for glaucoma comes to mind.

Reference:
1. Women should be able to get antibiotics for urinary tract infection without a prescription. BMJ 2015;351:h3441

Competing interests: No competing interests

19 July 2015
S-J Winceslaus
Consultant GUM/HIV
Sivaraj Venkateshwaran, Speciality Doctor
Kent Community Health NHS Foundation Trust
Riverside Clinic, Gravesham Community Hospital, Gravesend, Kent DA11 0DG