Patient Group Direction for the supply of Trimethoprim Tablets by community pharmacists
in the management of uncomplicated urinary tract infections in women.
Clinical condition
Clinical need which this PGD is intended
to address
Relevant national guidance
Criteria for inclusion for treatment
Criteria for exclusion for treatment
Action to be followed if patient excluded
Staff characteristics
Qualifications required
Additional requirements
Requirements for continuing training and
education
MAS/PGD05/OCT06/ISSUE004
Treatment of uncomplicated urinary tract infections in women.
Joint Formulary 4th Edition. RCHT, PCOs and GPs with
Cornwall and the Isles of Scilly, June 2003. Latest edition of the
BNF.
Women must be registered with a Doctor in the area (see
separate sheet) or be a Temporary Resident
Women over the age of 18.
Women presenting with two or more of the following symptoms:
Dysuria, Urinary frequency, nocturia, urinary urgency,
suprapubic pain.
Urinalysis showing the presence of leucocytes, nitrites or blood.
(see protocol for urinalysis)
The woman must be present at the consultation
Known allergy to Trimethoprim or any of its components.
Women who refuse treatment.
All female patients below 18 years of age.
Women presenting with symptoms of pyelonephritis i.e. fever,
flank pain, chills, rigors, nausea, vomiting and headache.
Women with associated vaginal discharge.
Women who have had 2 or more urinary tract infections within
the past 3 months or more than 5 during the previous 12
months.
Pregnant or breastfeeding women.
Women with diabetes.
Renal disease.
Women who have any urological abnormalities or had surgery
involving the lower urinary tract.
Women with an indwelling catheter.
Any woman taking any of the following medicines; ciclosporin,
bone marrow depressants, digoxin, rifampicin, or phenytoin .
The patient is already taking a course of antibiotics.
All men.
Refer to GP for advice and treatment. If necessary complete a
referral form for patient to give to GP.
Registered Community Pharmacist
Attendance at a specific training event organised by Cornwall and
Isles of Scilly PCT and the satisfactory completion of post-event
course work on the treatment of uncomplicated urinary tract
infections in women.
Regular update in the treatment of uncomplicated lower urinary
tract infections.
Patient Group Direction for the supply of Trimethoprim tablets by community pharmacists
in the management of uncomplicated urinary tract infections.
Treatment
Name of medicine
Method of obtaining supply of medicine
Legal status of medicine
Dose of medicine
Method of administration
Total number of doses to be supplied
Special
precautions
concerning
concurrent medication
Follow up treatment which may be
required
Advice to be given to the patient before
or after treatment
Treatment records to be completed
Audit trail
MAS/PGD05/OCT06/ISSUE004
Trimethoprim 200mg tablets
From Pharmacy stock.
POM
200mg every twelve hours for three days.
Oral
6 doses
Trimethoprim may reduce the efficacy of oral contraceptives.
Additional contraceptive precautions should be taken whilst taking
the course and for 7 days after. If the 7 days run beyond the end
of a packet the next packet should be started immediately without
a break.
Seek medical attention from GP if infection does not improve or
gets worse during the 3 day course.
If unacceptable side effects occur discontinue taking the
Trimethoprim immediately and seek medical advice.
Read the Patient Information leaflet provided.
Tablets should be swallowed whole with a glass of water.
Take with food.
Advise on personal hygiene.
Encourage to maintain a high fluid intake. (3 litres of clear fluids
each day).
Take at regular intervals and complete the 3 day course even if
original infection appears to be better.
Mild side effects may be experienced. These may include
stomach upset, and mild headaches. Seek medical advice if skin
redness, skin rashes, or itching are a problem.
If symptoms are still present after completing the course of
antibiotics make an appointment to see GP. Take an early
morning urine sample to appointment.
Name, address and DOB of patient. Date of supply. GP name
and surgery Signature of pharmacist making the supply. Batch
number and expiry date of trimethoprim issued. Completion of
relevant check list. Completion by patient of prescription
charges/exemption form.
Entry made on computerised patient medication records. Label
product with directions for use and “supplied under Patient Group
Directions”.
2 copies of the above information to be made.
1 copy to be retained by Pharmacy for 2 years.
1 copy to be sent to GP within 48 hours of supply of trimethoprim
for inclusion in patient’s notes.
2 copies of the Audit Form to be made. Retain one copy in the
Pharmacy and send one to the Prescribing Team, Sedgemoor
Centre for payment. Paperwork to be forwarded to the office once
each month.
Patient Group Direction for the supply of Trimethoprim tablets by community pharmacists
in the management of uncomplicated urinary tract infections.
Management
PGD developed by
Authorising Pharmacist
Cornwall and Isles of Scilly Primary Care Trust
Prescribing Team
Rosalind Palmer
Prescribing Adviser
Cornwall and Isles of Scilly Primary Care Trust.
Signature of Authorising Pharmacist
Date of PGD
Date this PGD becomes due for review
August 2008
Approved by:
Name
Cornwall & Isles of Scilly PCT
Nominated Doctor
Cornwall & Isles of Scilly PCT
Pharmaceutical Adviser
MAS/PGD05/OCT06/ISSUE004
Signature
Customer Details
Name
Address
Check List for Management of Uncomplicated Urinary tract Infections in Women
A urine sample is required before treatment can be initiated.
Yes
Patient is present at consultation
Patient is over the age of 18 years
Patient presents with two or more of the following
Symptoms:
Dysuria
Urinary frequency
Nocturia
Urinary urgency
Suprapubic pain
Urinalysis shows the presence of leucocytes, nitrites or blood.
Criteria for exclusion for treatment checked and none apply.
(see table on page 2)
Consent form completed by Pharmacist & signed.
Prescription charge collected if applicable and form signed by
patient.
PMR completed and Trimethoprim 200mg tablets labelled as
per PGD.
PIL given to patient.
Treatment regimen explained and understood
Advice given should condition not improve.
Follow up advice given on measures to reduce recurrent
episodes, e.g. increase fluid intake.
For oral; contraceptive users advice regarding the need for
additional contraceptive precautions
Pharmacist’s Signature
Date.
MAS/PGD05/OCT06/ISSUE004
No
Check List for Management of Uncomplicated Urinary Tract Infections in Women
Criteria for exclusion for treatment
Yes
Allergy to Trimethoprim
Presenting with any of the following symptoms, fever, flank
pain, chills, rigors, nausea, vomiting and headache.
Presenting with vaginal discharge
Already had 2 or more UTI’s in past 3 months or more than 5
during the previous 12 months.
Woman is pregnant or breastfeeding.
Woman has diabetes
Has renal disease, urological abnormalities or had surgery
involving the lower urinary tract.
On any of the following medicines:
Ciclosporin
Bone marrow
depressants
Digoxin
Rifampicin
Phenytoin.
Already taking a course of antibiotics.
If the patient answers yes to any of the above criteria then refer to GP.
MAS/PGD05/OCT06/ISSUE004
No
Patient Group Direction for the supply of Trimethoprim Tablets by community pharmacists
in the management of uncomplicated urinary tract infections in women.
Protocol for Urinalysis
Multistix GP (1 x 25 strip pack) for the testing of Blood, Leucocytes and Nitrites.
Information for Patients.
Either supply patient with sterile urine pot or ensure that the container used for the urine sample has been
thoroughly cleaned and then rinsed with boiling water to reduce the incidence of false results.
Urine sample should be no more than 4 hours old and collected midstream if possible.
High doses of Vitamin C may affect the results for blood and nitrites. The intensity of the colour on the strip
will be reduced possibly giving a false negative result.
Equipment needed for test.
Shallow plastic/ stainless steel tray for containing sample in case of spillage.
Pair of disposable gloves
Paper towel
Multistix GP Reagent Strip
Medical waste container.
Watch with second hand.
Method
1
2
3
4
5
6
7
8
9
10
Wash hands with warm soapy water and dry.
Put on disposable gloves.
Assemble all other equipment needed for the test.
Place urine sample on tray and open pot carefully.
Take a fresh reagent strip and immerse all the reagent areas in the specimen and remove
immediately. Tap strip against side of container. Hold strip at an angle to prevent urine from
running from square to square mixing the reagents.
Read results between 60 and 120 seconds after removing the strip from the specimen. Check
for the presence of blood, leucocytes and nitrites using the scale on the side of the reagent
bottle.
Record findings on UTI check list form.
Positive result.
Treat with Trimethoprim as per PGD.
Negative result.
Offer advice as in PGD and suggest an OTC preparation if appropriate.
Discard reagent strip in medical waste container and dispose of urine sample by flushing down
the toilet.
Wash tray with soapy water, dispose of gloves.
Wash hands.
MAS/PGD05/OCT06/ISSUE004
Patient Group Direction for the supply of Trimethoprim Tablets by community
pharmacists in the management of uncomplicated urinary tract infections in women.
Testing Strategy for UTI using Reagent Strips
Urine Specimen
Visual Appearance
Test with Multistix GP
If All of the
Following are
Negative
If Any of the
Following are
Positive
Blood
Leucocytes
Nitrites
Blood
Leucocytes
Nitrites
Offer advice
and appropriate
OTC medicine.
Treat with
Trimethoprim as
per PGD
MAS/PGD05/OCT06/ISSUE004