Suspicion of angina or cystitis? Patients will soon be able to perform a diagnostic test in the pharmacy and in the process, get antibiotic treatment if necessary, without going to the doctor. A measure proposed in the next Social Security financing bill. Since 2021, pharmacists can already prescribe antibiotics after rapid diagnostic orientation tests (Trod) that confirm the bacterial nature of tonsillitis and urinary tract infections, but only if they practice in health facilities where a doctor agrees to delegate this task to them.
A restriction that will soon no longer apply: from 2024, all 20,000 pharmacies in France will be able to deliver amoxicillin to patients, after a positive "rapid angina test", or fosfomycin to treat specific urinary tract infections (more than 80% of cystitis) after a Trod. Through this extended competence, the executive seeks to fight antibiotic resistance in a country where antibiotic consumption remains among the highest in Europe. According to the Health Insurance, out of six million prescriptions of antibiotics against angina, only two million would be justified.
The device is also designed to relieve general practitioners and to respond to medical deserts. The acceleration in the field of screening tests is welcomed by pharmacists' representatives who want to go even further by advocating access to "Trod CRP", the C-reactive protein, a marker of inflammation - which can help avoid consuming antibiotics when they are not needed.
See alsoPrevention of bronchiolitis: a new battle between pharmacy giants
Towards an increase in demand?
For its part, the industrial sector is preparing for an increase in demand for these tests for angina and cystitis. "It starts, we deliver it every day. We expect an acceleration from November or December," says Fabien Larue, director of AZZ, the French manufacturer of Trod - which also has to manage the increase in demand for Covid tests, due to the epidemic recovery. At the same time, pharmacists will have to be trained. "We are in the process of sending Trods to training organizations," adds the manager, who uses workers with disabilities to manufacture the tests.
However, there is no question of overcomplicating the lives of pharmacists, already in charge of the classic delivery of medicines, vaccination, or tests diagnosing influenza and Covid carried out in pharmacies. Manufacturers therefore focus on the speed and ease of execution of Trod, because "if it is not easy, pharmacists will not seize it," says Fabien Larue. His company has developed a cystitis test system that can be used "in two minutes", "on the corner of a table or counter". Regarding angina, the specialist "works to improve the Trod, to do it in less than five minutes against 10 to 15 minutes" currently. The majority of orders are placed through wholesaler-distributors who deliver to pharmacies in France.
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 have known during Covid," says Fabien Larue. However, the price of the act has yet to be fixed for pharmacists. Diagnostic aids "meet a need", acknowledges the president of the National Union of Medical Biologists (SNMB) Jean-Claude Azoulay but, according to him, "in case of too much repetition of cystitis, it is necessary to make an exploration behind, in the laboratory. And especially mistrust for men, who rarely have simple cystitis!" Nurses are also able to perform Trods, but not prescribe antibiotics.