11 APRIL 2025

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Expert group says nitrofurantoin the‘ superior choice’.

Rachel Fieldhouse NITROFURANTOIN is now first line for adult patients with acute cystitis because of high resistance to trimethoprim, new guidelines say.

The change is part of the largest overhaul to date of the Therapeutic Guidelines’ recommendations for antibiotics.

Infectious diseases physician Professor Peter Collignon, who was not involved with the updates, said nitrofurantoin was a“ very good choice” for uncomplicated UTIs.

“ The most common organism in uncomplicated UTIs, particularly in females, is E. coli, and nitrofurantoin has about a 95 % sensitivity for it,” said Professor Collignon, from the Australian National University in Canberra.

“ Trimethoprim is systemically absorbed and penetrates easily into most tissues, so it’ ll have more side effects, and [ it’ s ] also more likely to affect bacteria in other parts of the body as well.”

Therapeutic Guidelines senior editor Lisa Waddell said nitrofurantoin had“ a bit of bad reputation” due to its

adverse effects and efficacy for patients with kidney impairment, but an expert group had concluded it was the superior choice to trimethoprim based on resistance rates.

“ The concerning adverse effects are associated with long-term rather than short-term use, and the drug is effective for patients with a GFR of 30mL / min or higher,” she added.

Trimethoprim is still first line in Pharmaceutical Society of Australia

‘ Very good’ for uncomplicated UTIs.

guidelines for pharmacists diagnosing and treating UTIs.

It said the guidelines would be updated.

Therapeutic Guidelines said its staggered release of updated recommendations could continue into 2026, following this initial tranche of updates focused on infections managed in primary care.

Its multidisciplinary review covered 200 clinical topics and more than 1400 drug recommendations.

Among other updates, it has advised against prescribing PAGE 11

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Antony Scholefield HALF of patients who went to one of the Federal Government’ s urgent care clinics used it as an alternative to general practice rather than ED, an interim analysis suggests.

Under a policy that will cost over a billion dollars, the government has set up 87 urgent care clinics( UCCs) since 2023, with 50 more promised going into the federal election on 3 May.

The first evaluation of the program put the cost per urgent care presentation at $ 247 after excluding the ACT UCCs— which have no doctors— and seven other UCCs that lacked Medicare data.

This cost included an average of $ 82.70 billed to the MBS, for those UCCs with billing data.

However, it found that 50 % of patients said they would have seen another GP if the UCCs were unavailable, compared with 46 % who said they

50 % of patients said they would have seen a GP.

would have otherwise gone to ED. The finding was based on available data from 401,000 presentations, out of roughly a million presentations since the first UCC was opened in June 2023.

However, the report by health consultancy firm Nous Group warned that the self-reports“ may be overstated or understated”, saying that it appeared that some UCC staff had entered responses rather than actual patients. The biggest questions have been around the nature of the presentations and the extent to which they could be managed through general practice.

Yet the only clinical details of UCC presentations in the report were divided into broad categories of“ acute illness”( 63 % of presentations),“ acute injury”( 26 %) and“ acute exacerbation”( 3 %).

And this was only based on information provided by staff at the clinics.

“ At this early stage, the PAGE 3