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BPJ 68 June 2015

Best Practice Journal

Upfront: Time to reduce antibiotic prescribing – NOW

Contributed by: Associate Professor Mark Thomas, Faculty of Medical and Health Sciences, University of Auckland. View Article

Debate: Do you prescribe antibiotics for respiratory tract infections? An everyday conundrum in general practice

Appropriate prescribing of antibiotics for patients with respiratory tract infections (RTI) is a key component of improving antimicrobial stewardship in New Zealand. View Article

Is it ok to stop antibiotics when symptoms resolve?

Traditionally, clinicians and health authorities advocate that patients should complete their full course of antibiotics as prescribed, even when their symptoms have improved, to prevent relapse of infection and the development of antibiotic resistance. A recent perspective in the Medical Journal of Australia has reignited debate on this guiding principle of antibiotic use. The argument is that stopping antibiotic treatment once the patient’s symptoms have resolved is a reasonable course of action in many situations, and is not likely to lead to relapse or promote antimicrobial resistance. Prescribers and patients are increasingly adopting this approach, in appropriate clinical situations. View Article

Delayed antibiotic prescriptions for respiratory tract infections: does the strategy work?

Delayed antibiotic prescribing, also known as a “back pocket prescription”, is a strategy of providing a patient with a prescription for an antibiotic, but advising them not to fill it unless their symptoms persist or worsen, or if laboratory results (if requested) subsequently indicate a bacterial infection. Delayed antibiotic prescriptions are most often considered for patients with acute respiratory tract infections (RTIs), which is the focus of the following article. View Article

Should I prescribe a topical antiseptic cream instead of a topical antibiotic for minor skin infections?

Increasing rates of resistance to topical antibiotics continues to change the use of these medicines in primary care. Topical antiseptics have been suggested as an alternative, but at present, there is little evidence to support their effectiveness in the treatment of minor skin infections. View Article

Is point-of-care CRP testing useful in guiding antibiotic prescribing in patients with respiratory tract infections?

Point-of-care CRP testing may help primary care clinicians to identify with more certainty which patients with features of respiratory tract infection do not require antibiotics, therefore reducing the use of antibiotics. View Article

Do probiotics provide effective and safe protection against antibiotic-associated adverse effects?

Sales of probiotic products in the community generate billions of dollars worldwide, yet many of the health claims made by the industry lack a rigorous scientific basis. Studies on the effectiveness of commercially prepared probiotic products have produced varying results and opinions are divided on the clinical benefits and risks of probiotics, which are likely to be significant in some vulnerable patient groups View Article

When is an allergy to an antibiotic really an allergy?

Many patients report allergies to antibiotics but often this will be based on vague symptoms or a historical entry in the clinical notes, which the patient cannot recall, e.g. a suspected allergy to penicillin during childhood. This can be a dilemma when a clinician does not want the patient to be deprived of the best available treatment, but is concerned about the risk of giving an antibiotic if the patient does in fact have an allergy. View Article

The role of prophylactic antibiotics for preventing infective endocarditis in people undergoing dental or other minor procedures

Infective endocarditis is a relatively rare infection of the inner layer of the heart’s valves and chambers. Approximately one-third of cases of endocarditis in New Zealand are caused by streptococci that are normal oral flora and are associated with plaque, dental caries, gingivitis and peri-odontitis. New Zealand guidelines for the prevention of infective endocarditis recommend good oral hygiene for people at higher risk because of a pre-disposing cardiac condition, and prophylactic oral antibiotics when undergoing specific dental procedures or tonsillectomy/adenoidectomy. The routine use of prophylactic antibiotics solely for endocarditis prevention for people who are not at high risk is not recommended. In this article we discuss the rationale for giving endocarditis prophylaxis, present the key points of the New Zealand 2008 Heart Foundation guidelines and provide an update on recent developments in this field. View Article

Cellulitis: skin deep and spreading across New Zealand

Adults and children with uncomplicated cellulitis can usually be managed in the community if they are clinically stable. Oral flucloxacillin is the first-line treatment for the majority of patients with mild to moderate cellulitis; broader spectrum oral antibiotics should only be considered if flucloxacillin is not tolerated, has not been effective or there is reason to believe the infection is caused by bacteria that are not normally commensal on the skin. Intravenous (IV) cefazolin with probenecid is the recommended community-based treatment for patients with cellulitis who have not responded to oral flucloxacillin or for patients with more developed cellulitis. Generally, patients with severe cellulitis should be referred to hospital for rest, elevation and IV antibiotic treatment. View Article

Prevention is better than cure: five tips for keeping older people healthy and out of hospital during winter

With winter upon us it is a timely reminder of the importance of implementing strategies to keep older people healthy, independent and out of hospital. In the primary care setting this can include performing medicine reviews, assessing and reducing falls risk and encouraging influenza and pneumococcal vaccinations. View Article

News Update

The Australasian Society of Infectious Diseases (ASID) annual scientific meeting | Discontinuation of topical erythromycin View Article