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BPJ 35 April 2011

Best Practice Journal

The role of General Practice in the care of pregnant women

Although most GPs in New Zealand no longer provide lead maternity care services, general practice is encouraged to have a role in providing continuity of care for pregnant women. Many acute and long-term conditions can be managed in primary care, avoiding referral into the secondary care system. GPs, practice nurses and pharmacists can all be involved in providing effective pre-natal advice and management. View Article

Pre-conception care in general practice

Education to improve pre-conception health should be viewed as a routine aspect of primary care for all women of reproductive age. View Article

Continuing care for pregnant women with asthma

When asthma is well controlled during pregnancy, there is little or no increased risk of adverse maternal or foetal complications. Therefore, it is important to control asthma and minimise exacerbations by optimising management during pregnancy. View Article

Managing urinary tract infections in pregnancy

Urinary tract infections (UTIs) occur commonly during pregnancy. UTIs are managed more aggressively in pregnant women than in non-pregnant women. Urine samples should be sent for culture and empiric treatment given while awaiting results. Nitrofurantoin, trimethoprim or cephalexin are appropriate antibiotic choices (although restrictions apply depending on the stage of pregnancy). Quinolones, e.g. norfloxacin, should not be used during pregnancy. View Article

Contraception in early adolescence

Young people are having sex. Advice about sexual health and contraception should be considered for all adolescents, including those aged as young as 12 or 13 years. Condoms plus one other method of contraception is recommended in this age group, to protect against sexually transmitted infections and pregnancy. The pros and cons for each type of contraception should be discussed and provided there are no contraindications, patient choice encouraged, as this is likely to increase compliance. View Article

Quinolone antibiotics - limit use

Quinolones are associated with increasing antimicrobial resistance. Their use needs to be reserved for specific indications involving serious bacterial infections, in order to protect their effectiveness. There are very few situations in general practice where a quinolone would be considered first-line treatment. Ciprofloxacin may be considered for the treatment of patients with pyelonephritis, travellers’ diarrhoea, gonorrhoea (if sensitive) and severe cases of salmonellosis. Norfloxacin may be considered as a second-line treatment for urinary tract infection if other antibiotic treatment has failed or is not suitable. View Article

Seasonal influenza vaccination: changes for 2011

The seasonal influenza vaccine for 2011 protects against the same virus strains as in 2010. However, people who were vaccinated in 2010 still require a vaccination this year as immunity diminishes over time. Two brands of vaccine are available this year – children aged between six months and nine years should receive Fluarix, children aged over nine years and adults should receive either Fluarix or Fluvax. View Article

Pneumococcal vaccine for adults: Pneumovax23

Invasive pneumococcal disease caused by Streptococcus pneumoniae can result in life-threatening pneumonia, meningitis and septicaemia. Vaccination is the only method of prevention. Pneumovax23, a pneumococcal vaccine, is recommended (but not funded, except post-splenectomy) for all adults aged over 65 years, as well as people at increased risk of invasive pneumococcal disease due to co-morbidity or immunodeficiency. Other pneumococcal vaccines are available for children. View Article