Urinary tract infections can be a minor medical annoyance or lead to a hospital stay - especially for older people.
Authors
Jacinta L. Johnson
Senior Lecturer in Pharmacy Practice, University of South Australia
Wern Chern Chai
Lecturer in Pharmacy and Pharmacology, University of South Australia
If you think you might have a urinary tract infection (UTI) you need prompt advice and often antibiotics. But it can be difficult to get an appointment with your doctor at short notice, especially in rural areas.
Now trained pharmacists in most Australian states are able to review your symptoms and supply antibiotics if appropriate.
But there are still times when you should see a doctor.
What is a UTI? And when is it serious?
The urinary tract consists of the kidneys, ureters, and bladder and urethra. It's the body system responsible for producing, storing and removing urine from the body.
When bacteria invade the urinary system - mostly from the bowel or the skin - they can multiply and cause infection.
Roughly half of all women and one in 20 men will have a UTI at least once in their lifetime. The risk increases with age. One in ten postmenopausal women report having a UTI in the last year.
Typical signs of infection include a painful or burning sensation when urinating, feeling like you need to urinate urgently and often and cloudy or foul-smelling urine. In more severe cases symptoms can include fever, lethargy and pain in the lower back.
In older adults, UTIs can cause confusion, agitation and falls.
For some people, UTIs can have serious complications, such as kidney damage, kidney failure or infection in the blood (sepsis), particularly if treatment is delayed.
A common reason for hospital admission
UTIs are the second most common cause of preventable hospital visits in Australia. Across the country they are reported to result in 100,000 emergency department visits and 75,000 hospital stays each year.
The rate of hospitalisation for UTIs for Aboriginal and Torres Strait Islander people is around double the rate for other Australians. People aged over 65 years are five times more likely to be hospitalised with a UTI than younger Australians.
A quicker option
The newly rolled out pharmacist consultations do not replace the option of visiting your GP. But they do provide an additional choice.
In Queensland, South Australia and Western Australia the legislation has been changed to allow pharmacists to supply antibiotics to treat women (or people with female anatomy) aged 18 to 65 years with uncomplicated UTIs.
In New South Wales, the ACT, Victoria and Tasmania trials allowing pharmacists to treat UTIs in the same patient group are underway or have been announced.
This approach to provide accessible and timely treatment options for UTIs through pharmacies aligns with that in New Zealand, the United Kingdom and Canada.
Not for everyone
State guidelines direct pharmacists to only provide antibiotics to women (or people with female anatomy) aged 18 to 65 years with uncomplicated UTIs. If the pharmacist finds warning signs for a serious infection, or a complicated UTI, you will be referred for further consultation with a doctor.
Under this program, UTIs that occur in people who have an anatomically male urinary tract, are under 18 years or over 65, or are pregnant would be considered to have complicated UTIs, and such patients would be referred to their doctor.
Some other situations where UTIs are considered complicated and should be assessed by a doctor include when they occur in people with kidney disease, urinary catheters, a condition that weakens the immune system (such as diabetes, cancer or HIV) or reoccurring symptoms.
To supply antibiotics for UTI treatment pharmacists are required to undertake additional training. Pharmacists can only prescribe antibiotics according to an agreed evidence-based treatment guideline, such as South Australia's.
Pharmacists will assess if you are eligible for the pharmacy UTI service and ask specific questions to check your symptoms match those of an uncomplicated UTI or for warning signs you need to see a doctor. If treatment is appropriate, they will ask questions about your medical and medication history to determine which type of antibiotic is most suitable for you.
Pharmacists will not test urine for bacteria, as Australian guidelines state antibiotic treatment can be started for women with uncomplicated UTIs straight away. If your symptoms or history suggest urine testing might be required the pharmacist will refer you to a doctor.
You can get a record of the consultation that you can share with your doctor. The requirements for documentation differ in different states but pharmacists can upload information to My Health Record (if you haven't opted out and are happy for them to do so).
This new service is not without controversy. GPs have expressed concerns about misdiagnosis and antimicrobial resistance where the bacteria could evolve and become much harder to treat. Detailed procedures have been developed for pharmacists to minimise these risks.
What else can you do?
While taking antibiotics to treat a UTI you should also drink lots of water and ensure you empty your bladder completely every time you go to the toilet.
Pain relievers can help ease discomfort from a UTI. But it's important to speak with your pharmacist or doctor to find the best pain management option for you.
Jacinta L. Johnson is employed as the Senior Pharmacist for Research within SA Pharmacy and is a Board Director for the Society of Hospital Pharmacists of Australia. In the last five years, she has received research funding or consultancy funds (for development and delivery of educational materials) from SA Health, the Medical Research Future Fund, the Hospital Research Foundation - Parkinson's, the Pharmaceutical Society of Australia, the Pharmacy Guild of Australia, the Society of Hospital Pharmacists of Australia, the Australian College of Pharmacy, Mundipharma Pty Ltd, Aspen Pharmacare Australia Pty Ltd, Reckitt Benckiser (Australia) Pty Ltd and Viatris Pty Ltd. Jacinta has not received funding from any organisation related to pharmacist consultations for provision of antibiotics for urinary tract infections.
Wern Chern Chai does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
