“The bacteria you have is known to be resistant to Nitrofurantoin. Did she culture before prescribing?”
“So when the three-day course didn’t work, she gave you the same again, on a stronger, longer course?”
“You have borderline sepsis. We should take you in. I wish GPs would read the guidelines.”
So said the Emergency Doctor at St Mary’s Hospital on the Isle of Wight where I had just arrived for a short holiday and now found myself shaking, sweating and feeling terrified. It was not fun.
It is common knowledge among women who suffer a Urinary Tract Infection (UTI) that the three-day course of a broad-spectrum antibiotic does not work, yet GPs insist on following what are, in my opinion, misguided guidelines, only to find further prescribing is necessary. This was not my first experience of an ineffective prescribing practice from a GP.
As it happens, my business is in urine collection; my brother Dr Vincent Forte a now retired NHS GP invented Peezy Midstream precisely to solve the problem of failed first-time treatment of his patients presenting with UTI. [Editor’s note: this is a reference to a product that BSAC has neither tested nor endorsed]. We have spent 16 years bringing the device to market and our clinical evidence shows an astounding 0% specimen contamination rate (the national average is 20%) and up to 70% reduction of false positives and anecdotally reduced prescribing.
It is often unreliable urine samples that lead to “just in case” prescriptions, and the failure to culture the urine sample before so doing. However, it’s important to remember that GPs are not to blame here. UTI guidance recommends immediate prescribing of a three-day broad-spectrum antibiotic, followed by culture if that does not work.
Compare this to the UK 20-year vision for antimicrobial resistance, which clearly states an ambition to ‘only use antimicrobials where appropriate by ensuring… a fully integrated, harmonised, standardised and comprehensive One-Health surveillance system.’
It is my belief that whoever is responsible for guidance needs to revisit this anomaly, join the dots and keep otherwise healthy women like me out of hospital and save the NHS millions in time and money. While I appreciate there is a definite self-declared interest here, I nevertheless feel it highlights a serious problem in identifying routes and mechanisms by which to bring devices to the patient pathway that can have strong potential benefit to patients (individually, through the timely resolution of infection, and as a community, by helping contain AMR through more targeted prescribing). I am certain we are not alone, I am certain there are a host of other devices within infection management and outside of it that could bring health benefits, time efficiencies, and cost savings, if only a more efficient route to acceptance and procurement to patient pathways could be identified.
If anyone can make this happen, please let me know. I, and millions of other UTI sufferers out there, would be thrilled to return unscathed from the AMR frontline.
Giovanna Forte, CEO, Forte Medical Limited (The Specimen Collection Company)