Prescription rules change for French pharmacies and antibiotics

Pharmacies in France can now dispense antibiotics for some conditions without a prescription. 

The law is now in force after first being proposed in the new social security healthcare budget (loi de financement de la sécurité sociale) in 2023.

It aims to reduce antibiotic use in France, to ensure that only those who pass certain criteria are given them (see checks needed, below); and to take some work away from overloaded GPs.

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Another aim is to make it easier for common conditions to be treated in areas of ‘medical deserts’, where there are few GPs and it is difficult to find and/or attend an appointment.

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Which conditions are covered? 

Antibiotics can now be dispensed without a prescription for the following two conditions:

• Group A streptococcal bacterial angina (strep throat)

• Acute uncomplicated cystitis in women

Checks needed before dispensing

Pharmacists cannot simply dispense the drugs without checks. Patients who ask for the medicines must meet certain criteria, and will need to take a test to confirm their condition.

Pharmacists will have to check that:

• The person does not present any emergency exclusion criteria, or any other exclusion criteria (ie. anything that means they should not be prescribed the drugs)

• There are no other signs of seriousness (ie. signs that the condition needs more investigation)

• The patient passes the ‘rapid diagnostic orientation’ tests to ensure they have the condition stated

For example, if strep is suspected, the pharmacist will have to use a rapid ‘oro-pharyngeal diagnostic test for group A streptococcal angina’. This is a swab test.

If cystitis is suspected, the patient must take a urinary diagnostic test. The patient's age must also be taken into account.

What are the symptoms?

Strep throat symptoms include:

• Sore, red throat or tonsils (with or without pus)

• Pain on swallowing

• Fever

• Swollen and tender lymph nodes (glands) in the neck

• Vomiting, nausea and abdominal pain

• Headache and muscle aches

• General feeling of being unwell

• Loss of appetite

If you believe the patient has strep throat, it should be treated with antibiotics as soon as possible, as untreated cases can develop into more serious conditions such as scarlet fever, skin infection, and other more serious infections and diseases (such as acute rheumatic fever). 

Cystitis symptoms include: 

• A strong, persistent need to urinate

• Pain or a burning feeling when urinating

• Passing only a small amount of urine each time

• Blood in the urine (hematuria)

• Passing cloudy or strong-smelling urine

• A feeling of pressure in the lower stomach

• Low-grade fever

Cystitis is far more common in women than in men, but men can also get it (as can children). Some people appear to be at greater risk of recurring infection than others. Untreated cystitis can lead to nausea and vomiting, back pain, and kidney complications.