Angina and cystitis: soon screening tests in pharmacies with a prescription for antibiotics

Since 2021, pharmacists can already prescribe antibiotics after rapid diagnostic orientation tests (Trod) which confirm the bacterial nature of tonsillitis and urinary infections, but only if they practice in health structures where a doctor agrees to delegate this task to them.

A restriction which will soon no longer apply: from 2024, all 20,000 pharmacies in Europe will be able to provide patients with amoxicillin, after a positive “rapid angina test”, or fosfomycin to treat occasional urinary infections ( i.e. more than 80% of cystitis) following a Trod.

To relieve general practitioners and respond to medical deserts

Through this extended competence, the executive seeks to fight against antibiotic resistance in a country where the consumption of antibiotics remains among the highest in Europe. According to Health Insurance, out of six million antibiotic prescriptions for angina, only two million are justified.

The device is also designed to relieve general practitioners and respond to medical deserts. The acceleration in the field of screening tests is welcomed by representatives of pharmacists who wish to go even further by advocating access to “Trod CRP”, C-reactive protein, a marker of inflammation – which can help prevent to consume antibiotics when they are not necessary.

For its part, the industrial sector is preparing for an increase in demand for these tests concerning angina and cystitis.

“It’s starting, we’re delivering them every day. We expect an acceleration from November or December“, tells AFP Fabien Larue, director of AZZ, French manufacturer of Trod – which must also manage the increase in demand for Covid tests, due to the resumption of the epidemic.

At the same time, pharmacists must be trained: “We are in the process of sending Trods to training organizations” adds the manager who uses disabled workers to produce the tests.

Quick response on the corner of the table?

However, there is no question of overly complicating the lives of pharmacists, already in charge of the traditional delivery of medicines, vaccination, or even tests diagnosing flu and Covid carried out in pharmacies.

Manufacturers therefore emphasize the speed and ease of execution of Trods, because “if it’s not easy, pharmacists won’t take it up“, assures Mr. Larue. His company has thus developed a cystitis testing system that can be used “in two minutes”, “on the corner of a table or counter”.

Concerning angina, the specialist “is working to improve the Trod, to do it in less than five minutes compared to 10 to 15 minutes” Currently.

Questioned by TipsForWomens during the first announcement, Dr. Yves Dour, pharmacist and member of the TipsForWomens expert committee, specified: “This measure will allow patients to do without doctors and to be treated quickly, particularly in areas known as medical deserts.” Will the act be any simpler? “Not necessarily”, tempers our expert. “Already, not all pharmacists do TROD for angina, in particular. But above all, this must go with access to fosfomycin for urinary infections and amoxicillin for tonsillitis. However, at the moment, there are very tight stocks which are lacking in pharmacies. So how to do it?”

Diagnostic aids that meet a need

The majority of orders are placed by wholesalers-distributors who deliver to pharmacies in Europe. At two euros per Trod for cystitis, and one euro for angina, the cost seems moderate for the health system, especially since these tests “do not represent colossal volumes compared to what we experienced during Covid“, underlines Mr. Larue. The price of the procedure must however still be fixed for pharmacists.

Diagnostic aids “respond to a need”, recognizes the president of the National Union of Medical Biologists (SNMB) Jean-Claude Azoulay but, according to him, “in the event of excessive repetition of cystitis, an investigation must be carried out behind it, in the laboratory. And especially wary of men, who rarely get simple cystitis!“.

Nurses are also able to perform TRDs, but not to prescribe antibiotics.

On the treating doctors side, the announcement makes people cringe

The unions are now talking about a “cover-up” measure. An argument explained to us by Dr Fabien Quedeville, general practitioner:

“We should already know if delegating tonsillitis and urinary infections would help relieve congestion in medical practices; there is no data available on this today. The real burden on doctors is administrative overload. But it’s surprising, we never delegate that!” he laments.

The doctor is not against the new responsibilities given to pharmacists, but he points out a lack of consistency in government decisions. “Giving more meaning to the profession of pharmacist by allowing them to administer vaccines for example, I find it useful, because it is a unique act, which provides a service and increases vaccination coverage. is annoying, it is to delegate medical acts which require a clinical examination and which can, in addition in this case (the search for streptococcus) increase the prescription of antibiotics, in a context where we overconsume them. Results, it is not “There is no longer any real coherence in the organization of this healthcare system.”