So how much does UTI antibiotics for Dad cost the NHS?

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Dad is in his 90s and a common problem for folk that age seems to be urinary tract infections (UTIs). We ward it off with Ocean Spray Cranberry Juice and regular soaking in water with a bit of disinfectant in it. But sometimes they occur - maybe three times a year and we get antibiotics to cure it. He goes from being dithery and unresponsive to back on it - sometimes very quickly.

One time we struggled to give him the capsules to to his poor swallow, as he was so out of it. We asked for this one in liquid form but the doctor said, we don't do this as for that one in liquid form it's around £400! Fair enough. But It got me thinking - medication is free for us, but how much would regular antibiotics cost the GP or NHS?

Only sometimes do I wonder if there's a finite pot that the elderly can draw on for the year, or in a lifetime, and once that's finished the drawbridge comes up. He has regular other medication too that is unavoidable.

It it sometimes better to pay for meds oneself if they're available for sale in Boots etc?

Antibiotics aren't on sale in Boots though. You'd need a private prescription for that, plus to pay for the costs of the medicines which, for antibiotic tablets, range between a few and tens of £. The oral liquids are more expensive.

It's possible to crush most antibiotic tablets, or open the capsules. You can ask your pharmacist for advice about this.

Prescriptions are free in Scotland, if that’s where the OP is.

I don’t see why they can’t just prescribe it for your DH OP but I dare say that there is a budget that GP prescriptions come from for maybe area?

Penicillin is dead cheap. You can buy it over the counter at pharmacists in some other countries.

Other antibiotics vary I imagine.

There's no finite pot, no.

re the liquid antibiotic, it might cost the NHS £400 to buy but if you get it on private prescription, it may be a lot less.

Prescriptions are free in Wales also.

About £5 on a very very broad average, according to nhs statistics. But that doesn’t include the cost of the gp time diagnosing and prescribing, and I don’t know if it includes the cost of getting the drugs into and out of the pharmacy.

You can look up medicine prices, including different forms in the BNF (British national formulary).

Trimethoprim, which is a common antibiotic for UTIs is around £2 a box of tablets, around £10-15 a bottle for liquid. Amoxicillin is a couple of pounds for either.

That’s how much I used roughly pay abroad too @Mandatorymongoose
not sure where £400 comes from. They give children the liquid form too. It’s within means of anyone.

The GP is probably talking about Nitrofurantoin, it’s the 1st line treatment for UTI, trimethoprim isn’t used as much these days although we do occasionally still dispense it, mainly to children.
The liquid is £460 a bottle but the capsules are only £9.50.
In my pharmacy I’ve never dispensed the liquid but I’ve given 8 boxes of the capsules just today.

If it is Nitrofurantoin, google suggests it's gone up in price x 4. So would be similar if private. There really needs to be legislation around this - it can't cost that much more to make, can it?

PS I mean tne liquid version.

I've no idea how they work out prices for medication some days, personally I have tablets they come in 20/10/5 the 10s are massively more expensive than the others my dose is 35 a day the Dr's asked me if I minded taking three fives as the tens cost so much they would need to justify it (can't cut the 20s they are tiny tablets) personally I don't mind but someone who has difficulty might

It's probably supply and demand - for some things, especially those prescribed to adults, most people will have tablets so there's all the costs of setting up a production line to make what in the scheme of things, will be a "small" quantity of the liquid meds.

Have you tried D-mannose? It is a natural substance which forms a lining on the bladder similar to cranberry & prevents infections. It comes in capsules but you could break them open & mix with yoghurt or ice cream if he can't swallow. I was getting a uti a month until I started taking it.

Most antibiotics cost very little in grand scheme. There are many types though and some are a lot more expensive, especially if still under licence. However hospitals are actively encouraged to reduce antibiotic use and there may be financial incentives to do so. Antibiotic use is heavily monitored.
At the same time there is increasing awareness that UTIs in elderly (which is often cause of death) need better treatment due to effects and knock ons such as falling.

Yes this is one of those oddities of the NHS, the lack of coherent negotiation on medication prices. (See, for instance, the fact that antibiotics prices for Strep A have been allowed to skyrocket after a few well-publicised deaths!) My dad in Canada is permanently on antibiotics for UTIs and having them liquid is not an issue at all. But one of my DC here in the UK has disabilities and even as a near-adult can't swallow tablets, yet the hospital couldn't prescribe his medication in liquid form. Full disclosure, I went online and found it, and get it shipped (from India!) at my own expense regularly. No one seems to care in the Customs! I pay for it, obviously, but not at the rate apparently the NHS might. But then beware, a lot of online pharmacies could be scams selling fake drugs ... it's all very weird, isn't it?

FWIW, I use this too and have done for about 6 years. It is amazing, I was getting UTIs really frequently and irritable bladder. This has really worked in stopping these problems.

(Should have said the D Mannose) 🤦🏼‍♀️

My friend is unable to swallow tablets & gets antibiotic medicine instead, she just has to take a bigger dose of the child suspension.

They do a powder one too

What kind of legislation do you suppose would address this? Manufacturers can't be forced to make medicines. The effect of driving down prices, especially in today's climate of Brexit and manufacturing and raw material problems in India and China, is that manufacturers withdraw and we end up with a fragile supply situation. Of course some manufacturers are price gouging shysters but it's not straightforward at all.

Should the NHS make more of its own medicines? Probably. But it's a very expensive undertaking requiring expertise that's in very short supply, and investment that the government will not make.

Drug pricing is a very complex business. It’s not just about the manufacturing cost. The price calculations can cover:
Number of patients expected to be treated with the drug - the fewer patients the more expensive
The other options already available and how much more of an improvement the new drug offers
Prices already agreed in neighboring countries
Prices already agreed for similar drugs
How innovative the drug is - is it a breakthrough medicine?
How important it is for patients to gain access to these medicines
Pressure from patient advocacy groups
… to name a few
Each of these reasons is logical from both a health system and pharma perspective and lengthy research rounds and negotiations go on before a drug gets its price.
Just because it seems expensive to us doesn’t always mean it’s overpriced

@Mandatorymongoose don't forget the BNF is published 6months behind and the prices are out of date before it even goes into print! Never rely on BNF pricing.
@EmmaAgain22 yeah, legislation will not work. The NHS can stamp it's feet and demand cheaper prices but manufacturers will just sell elsewhere. GB is a tiny market in the scheme of the world and loosing that tiny bit of business wouldn't even register on global sales. And we would have no drugs at all!!

I understand the reluctance to prescribe the liquid when it's so much more expensive, but if he really can't take the tablets it's going to cost the NHS considerably more if the infection gets worse and he winds up being admitted to hospital....

Ah! Now you've raised a point, Maiyakat...

But first, many thanks for the responses on this thread, they are very illuminating and esp Nat6999's advice on how to prevent UTIs, I will look into that for my Dad...
He had also got thrush (er, non-STI variety, he's not at 93 been secretly clambering out of the window for secret sessions 'I'd be very impressed if he had,' said my doctor) and the meds cleared that up too.

I have a savagely cynical attitude to the State's treatment of the elderly based on my mothers' care in about seven Surrey care homes and not assauged by what went on during Covid. And yep, cost at some point is a thing they look at. And, picking up on Maiyakat's point - if an elderly person goes into hospital and dies, it's not really anyone's problem bar that of the family, esp if the patient is over a certain age. It saves money on prescriptions, pensions plus the State gets a hefty inheritance tax. The fact that free antibiotics and pension is a big perk means it often doesn't occur to a family that it really isn't free for the State.

This is why I wanted to have an idea of how much stuff costs. Dad also gets Gluten-free bread. Nice! But frankly we can pay for that, should we really be getting that in for him? And compare this to anyone going into a home in Surrey, you're looking at £1.5 k a week. A week! The numbers just don't correlate.

I think that was what went on with the kid Billy Caldwell a few years back who had epilepsy - seems to me the NHS simply didn't want to fund his medication. If he died of a fit, it wasn't their problem. His mother would be posting his picture on Facebook as if to say, hey, he's not one of these kids on life support! She had to go abroad to get the meds, then got arrested coming back with them - or rather she gave herself up, and they were confiscated. I think they wanted her to get arrested so they could criminalise her. It was an awful chess game they were both playing, and they messed her about big time. Again, had he died of a fit thru not having the drugs, you can't say it's legally anyone's fault. The drugs were illegal - but anyone can get hold of illegal drugs to fund a party lifestyle of course. But the State gets very interested when you're 'on its list' you can take it from me.

Anyway, many thanks for these responses!

Thankfully Dad is not reliant on the liquid antibiotics for the most part, he is okay with small capsules.