Q: Over the holidays, while our doctor’s office was closed, I tried to book an appointment at the pharmacy for my husband, who had a urinary tract infection, but was told that only female patients could be assessed. He gets these infections fairly frequently, so why isn’t the pharmacist able to prescribe antibiotics for him?
This is a very common question we get at the pharmacy. In New Brunswick, pharmacists are only authorized to assess and prescribe antibiotics for uncomplicated urinary tract infections (UTIs); we are not permitted to manage complicated UTIs. The primary reason for this restriction is that, currently, community pharmacists are unable to order lab tests, and urine cultures are often essential for effectively managing the treatment of more complex infections.
Uncomplicated UTIs are considered to be straightforward bladder infections that occur in otherwise healthy women who have a normal urinary tract and no risk factors for a more serious infection. These infections typically respond quickly to short courses of antibiotics and rarely lead to complications. Because of this predictable pattern, uncomplicated UTIs can generally be treated safely by a pharmacist based on symptoms alone, without the need for urine testing.
A complicated UTI, on the other hand, involves additional factors that increase the risk of antibiotic treatment failure, recurrence of infection, or spread beyond the bladder. These factors include structural or functional abnormalities of the urinary tract, infection involving the kidneys or prostate, immunocompromised individuals, chronic medical conditions such as diabetes, and male sex.
Urinary tract infections in adult males are relatively uncommon compared to females, largely because of differences in anatomy. In males, bacteria must travel a much greater distance from the outside of the body through the urethra to reach the bladder. When UTIs do occur in males, they are often a sign of an underlying issue such as a problem with the prostate, urinary obstruction, or incomplete bladder emptying, rather than a simple bladder infection alone. For this reason, UTIs in males are automatically classified as complicated, regardless of how mild the symptoms may appear. Proper treatment requires longer courses of antibiotics, urine cultures, and sometimes additional diagnostic testing or specialist involvement, all of which fall outside the scope of care that pharmacists are currently able to provide.
As defined by the NB College of Pharmacists, pharmacists may only assess female patients between the ages of 16 and 75 who present with symptoms of an uncomplicated UTI and who have previously been diagnosed with a UTI by a doctor or nurse practitioner. We are also unable to assess patients who live in long-term care facilities, who are pregnant, or who are breastfeeding an infant under one month of age.
Another important point you raised in your question is the frequency of infection. This is a key consideration during any UTI assessment. Many patients report a history of 'frequent' UTIs, but on closer examination, this term varies greatly from person to person. For some, it may refer to several infections within the past year, while for others, they actually haven’t had a UTI for many years. During assessments, pharmacists may use the electronic health record to help confirm dates of previous infections and the antibiotics that were used to treat them.
If UTIs are occurring frequently, this is considered a red flag for complicated infection and should be assessed further by a physician or nurse practitioner to ensure there is no underlying condition contributing to the problem. In some females, frequent UTIs may lead to treatment strategies such as single doses of an antibiotic taken after intercourse to help prevent infection, or a low-dose antibiotic taken daily for an extended period to reduce the frequency of infection.
While it can be frustrating to be turned away for an assessment at the pharmacy or have the result of the assessment be a referral to another provider when timely care is difficult to access, these limits exist to ensure serious infections are not under-treated and that patients receive the appropriate investigation and follow-up to prevent long-term complications.
Erin Thompson (BSc, BScPharm) is a graduate of Dalhousie University and a community pharmacist practicing at Shoppers Drug Mart in Quispamsis N.B. Her opinions expressed in this column are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment.