Pathway to Access UTI Management (PATH-UTI): evaluating pharmacist prescribing and management practices for uncomplicated urinary tract infections in community pharmacy in New South Wales and the Australian Capital Territory, Australia.

INTRODUCTION: Pharmacist prescribing has been introduced internationally to improve timely access to treatment in primary care. For uncomplicated urinary tract infections, pharmacist-led services report favourable outcomes, however, the evidence base remains limited by small sample sizes and heterogenous study designs. Large-scale evaluations are needed to better understand pharmacist management practices and prescribing outcomes. AIM: To explore pharmacist management practices for uncomplicated urinary tract infections in community pharmacy settings, including the effectiveness and safety of pharmacist prescribing and variation in clinical outcomes by antibiotic type. METHOD: Data from the PATH-UTI cohort study were analysed across community pharmacies in New South Wales and the Australian Capital Territory. The trial included an initial two-month feasibility pilot followed by a 10-month main study period (July 2023-May 2024). Women aged 18-65 years presenting with symptoms consistent with an uncomplicated urinary tract infection were assessed and managed by trained pharmacists using a structured clinical management protocol aligned with national guidelines. Consultation data were routinely recorded during the pharmacy visit, and patient-reported outcomes were collected by follow-up survey 7 days later. The primary outcome was self-reported complete symptom resolution at 7-day follow-up. Secondary outcomes included antibiotic prescribing rates, patient reported adherence, referrals, and patient reported adverse events. Differences in symptom resolution by antibiotic type were assessed using a chi-square test of independence. RESULTS: A total of 18,143 consultations were recorded, with 14,680 follow-up surveys (81.0%) completed. Antibiotics were supplied in 92.6% of consultations, most commonly trimethoprim (95.5%). Complete symptom resolution at 7 days was reported by 79.4% of patients. A further 17.9% reported partial symptom improvement. There was no statistically significant difference in effectiveness across the three antibiotics (χ2(2) = 3.88, p = 0.14). Referrals to a general practitioner or emergency department occurred in 6.9% of cases. Self-reported adverse events were documented in 5.0% of patients, predominantly mild gastrointestinal side effects. CONCLUSION: Pharmacist prescribing for uncomplicated urinary tract infections achieved symptom resolution rates comparable to previous pharmacy- and physician-led studies. Low rates of adverse events and complications, and strong adherence to the clinical management protocol were also observed. These results suggest that structured, protocol-based pharmacist prescribing for uncomplicated urinary tract infections can support safe and effective management in primary care, with the potential to improve access to treatment and help manage demand on general practice. TRIAL REGISTRATION: Retrospectively registered: ACTRN 12623000882628.