Women should be allowed to get treatment for cystitis without a prescription

Women should be able to treat cystitis themselves with antibiotics without a prescription, says a general practitioner in The BMJ this week.

Dr Kyle Knox says this would save three million scarce GP appointments a year.

Acute uncomplicated urinary tract infections (AUUTIs) such as cystitis are the most common bacterial infections in women. Cystitis affects around half of women at least once in their lifetime and is coded as the reason for 1% of the 300 million GP consultations held annually in the UK.

Management of cystitis is straightforward - a short course of the antibiotic nitrofurantoin and symptoms usually start to improve after a day or two.

"Therefore, in an era of ready access to information, increasing patient autonomy, and overstretched primary care services, it would seem a good idea for women to be able to access safe and effective treatment without the costs and delays associated with consulting a clinician to obtain a prescription," suggests Knox.

However, despite clear guidance, characteristic clinical syndrome, and predictable efficacy and safety, nitrofurantoin remains a prescription-only drug.

The current prescription-only approach does nothing to limit antimicrobial use but creates urgent demand in primary care - and an additional hurdle for women to access safe and effective treatment, he argues.

He points out that the availability of pregnancy tests, emergency contraception, and antimalarial prophylaxis is commonplace in UK pharmacies - and some antibiotics are already available from pharmacies without prescription in the UK.

"A change in the regulations that govern access to nitrofurantoin would be worthwhile only if it was taken up by women seeking treatment," he writes.

He acknowledges that the weight women give to a clinician's assessment compared with more convenient access to treatment is unclear, but says "should be explored as part of the commitment to self care in the NHS Plan 2014-15."