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BPJ 78 April 2017

Best Practice Journal

Topical antibiotics for skin infections: should they be prescribed at all?

Clinical indications for the use of topical antibiotics are continuing to narrow, driven by increasing resistance rates in New Zealand. View Article

Topical antibiotics for skin infections: when are they appropriate?

In the community, many patients have skin and soft tissue infections that are relatively minor, e.g. scrapes and scratches or mild folliculitis. These types of infections do not usually require antibiotic treatment as they will generally improve with good skin hygiene measures, e.g. cleaning and covering the lesion. A prescription for a topical antiseptic (rather than a topical antibiotic) is a pragmatic next step if hygiene interventions are not sufficient. View Article

Oxycodone prescribing: New Zealand solutions to a global problem

Inappropriate prescribing of opioids for non-cancer pain is an international problem. In this article we examine an initiative that was launched by the Capital and Coast District Health Board (CCDHB) to reduce prescribing of oxycodone. The clinical champion of the programme, Dr Peter Moodie, provides insights into how the strategy was implemented and what was achieved. View Article

1. Chronic plaque psoriasis: an overview of treatment in primary care

Most patients with psoriasis have chronic plaque psoriasis, the majority of whom can be managed in primary care. Emollients can reduce pruritus, plaque scale and restore skin pliability. Additional topical medicines include intermittent courses of topical corticosteroids, topical calcipotriol, or both in combination. Patients with psoriasis require life-long treatment and are at increased risk of cardiovascular disease, depression, inflammatory bowel disease and diabetes. View Article

2. Choosing a topical treatment for patients with chronic plaque psoriasis

Finding a treatment that works for patients may require trial and error. Topical medicines include emollients, potent or very potent topical corticosteroids, topical calcipotriol, or a combination of these medicines. Keratolytics such as topical salicylic acid or products containing coal tar may reduce scaling and be beneficial for patients who have responded poorly to other topical medicines. View Article

3. Monitoring patients with moderate to severe psoriasis

Patients with moderate to severe psoriasis are usually managed in secondary care with treatments including phototherapy, methotrexate, ciclosporin, acitretin or TNF inhibitors. Clinicians in primary care may provide repeat prescriptions for these treatments. There needs to be a clear understanding between the dermatologist and general practitioner regarding the responsibility for monitoring patients and requesting blood tests; adverse effects of these medicines can be serious and potentially fatal. View Article

Access to HPV vaccine widened

The human papillomavirus virus (HPV) vaccine reduces the incidence of HPV-related diseases, including genital warts and cervical cancer, as well as anogenital and oropharyngeal cancers. It is most effective if it is given before sexual activity begins. View Article

Childhood eczema: improving adherence to treatment basics

Emollients form the basis of treatment for all patients with eczema. Emollients and topical corticosteroids are effective at preventing and treating flares of eczema and can reduce Staphyloccus aureus colonisation. Poor adherence, however, often reduces their effectiveness. View Article

Topical corticosteroids for childhood eczema: clearing up the confusion

Topical corticosteroids are one of the key medicines used in the management of childhood eczema. However, adherence is typically poor, often due to “corticosteroid phobia”. View Article

Amiodarone brand-change and a reminder on patient monitoring

The funded brand of amiodarone has now changed, see: Antiarrhythmic medicine brand changes: flecainide and amiodarone

Two brands of amiodarone are currently subsidised in New Zealand; Aratac (a generic brand) and Cordarone-X (the innovator brand).

 View Article

Prescribing isotretinoin for patients with acne in primary care

Isotretinoin is recommended for patients with moderate acne that produces scarring or distress, or for acne that persists following other treatments. Low-dose isotretinoin, e.g. 10 mg per day, is effective for most patients. View Article

Oestradiol patches now fully subsidised: what is their place in the treatment of menopausal symptoms?

Transdermal oestradiol patches are now fully subsidised, without the need for Special Authority approval, for the treatment of menopausal symptoms.

For more recent recommendations, please see: "Menopausal hormone therapy: where are we now?"

 View Article

How to use fluorouracil and imiquimod for non-melanoma skin cancer in a general practice setting

Fluorouracil and imiquimod creams are fully subsidised topical treatments, suitable for some patients with non-melanoma skin cancers; Special Authority approval is no longer required for subsidy. Their place in treatment depends on the type, severity and location of the lesion(s), as well as the expertise and experience of the prescribing clinician (in terms of other treatments which can be offered) and the patient’s preference. View Article

Targeted testing for abdominal aortic aneurysm

A recently published study from the University of Otago provides clarity as to which patients in general practice would benefit most from opportunistic investigation for abdominal aortic aneurysms (AAA). View Article