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Published: 13th March, 2026
Contents
New from bpacnz: Managing urinary tract infections in children
Most children aged over three months with mild, uncomplicated lower urinary tract infection (UTI) can be managed in primary care with oral antibiotics. Laboratory urinalysis is required to confirm the diagnosis and determine microbial sensitivity; tips are included for obtaining a urine sample in a child. Timely treatment with antibiotics reduces the risk of acute complications and long-term renal damage. Prevention of future UTIs and the early identification of risk factors for recurrent infections are also key aspects of management.
Read the article here. A B-QuiCK summary is also available.
Rewind: Wrap-up of recent key messages
Key dates and updates on news items from recent editions of Best Practice Bulletin:
- Starting age for bowel screening to be lowered to age 58 years in all remaining regions from late March, 2026
- Stock of nifedipine long-acting 20 mg tablets has arrived in the country but may take up to one to two weeks to reach pharmacies. This follows a period of limited supply (as reported in Bulletin 140).
- A decision has been made to widen access to Trikafta and Kalydeco, and fund Alyftrek for eligible people with cystic fibrosis from 1st April, following consultation on proposed changes (as reported in Bulletin 140)
- A webinar on influenza, COVID-19 and RSV vaccinations was recently held by IMAC and Health New Zealand (as reported in Bulletin 141). If you missed it, view a recording of the webinar here.
Medicine news
The following news relating to medicine supply has recently been announced. These items are selected based on their relevance to primary care and where issues for patients are anticipated, e.g. no alternative medicine available or changing to the alternative presents issues. Information about medicine supply is available in the New Zealand Formulary at the top of the individual monograph for any affected medicine and summarised here.
Supply issue affecting ticagrelor
There is a supply issue affecting ticagrelor 90 mg tablets (Ticagrelor Sandoz), indicated for the prevention of atherothrombotic events and thrombosis. Supply is expected to be exhausted from mid-March due to shipping delays; a re-supply date is yet to be announced.
An alternative brand (Ticagrelor Mylan) has been listed on the Pharmaceutical Schedule since 1st March; the blister package labelling is not written in English and the brand is not approved by Medsafe, so must be prescribed for supply under Section 29A of the Medicines Act 1981. A patient information sheet about the brand change is available here.
Information for pharmacists. Pharmac advises that claims for Ticagrelor Mylan in March will not be processed; pharmacies can either hold any claims until April, or re-claim the dispensings in April, when they are rejected for payment in the March claim.
Locorten-Vioform ear drops to go out of stock
There will be an upcoming supply issue affecting stock of flumetasone pivalate with clioquinol (Locorten-Vioform) ear drops, used in otitis externa and chronic suppurative otitis media. The ear drops are expected to be out of stock from March until at least August, due to a change in the manufacturing processes and source of the active ingredient. Triamcinolone acetonide with gramicidin, neomycin and nystatin (Kenacomb) ear drops may be a suitable alternative (or Sofradex; partly funded), however, a new prescription will be required.
For information about the diagnosis and management of otitis media, see: https://bpac.org.nz/2022/otitis-media.aspx
Latest edition of Prescriber Update released
The March edition of Prescriber Update has been published. Particular items of interest for primary care include:
Medicine-induced gynaecomastia
Medsafe recently issued a Monitoring Communication on atomoxetine (non-stimulant treatment for ADHD) and the potential risk of gynaecomastia (as reported in Bulletin 140). Gynaecomastia refers to the enlargement of breast tissue in males due to increased oestrogen-to-androgen hormone ratio. Medicines are attributed as the cause of gynaecomastia in up to one-quarter of cases; onset can occur immediately after starting the causative medicine or be delayed up to several years in some cases. A wide range of medicines have been associated with gynaecomastia; of the 24 cases reported to the New Zealand Pharmacovigilance Database between 2016 and 2025, atorvastatin (three), finasteride (three), omeprazole (three), isotretinoin (two), risperidone (two) and rosuvastatin (two) were the most frequently implicated medicines. Possible mechanisms for medicine-induced gynaecomastia include inhibiting androgen synthesis or androgen receptor antagonism, increased prolactin synthesis, promoting conversion of androgens to oestrogens or direct oestrogen effects. Consider medicines as a cause in male patients presenting with changes to their breast tissue. Read the full article here.
Fournier’s gangrene can also occur in patients without diabetes
Medsafe highlights that Fournier’s gangrene can occur in people taking empagliflozin with and without type 2 diabetes. This focus comes following two reports to the New Zealand Pharmacovigilance Database of Fournier’s gangrene in patients taking empagliflozin for heart failure. Fournier’s gangrene (necrotising fasciitis of the perineum) is a rare but serious adverse effect associated with empagliflozin; it is more common in males.
Patients taking empagliflozin for any indication should be informed of this rare adverse effect and advised to seek immediate medical attention if they have pain, tenderness, erythema or swelling of the genital or perineal area, fever or malaise. Stop treatment immediately if Fournier’s gangrene is suspected. Read the full article here.
Zoledronic acid may be less tolerable in older patients
Zoledronic acid is a bisphosphate that is administered via intravenous infusion for a range of conditions, including osteoporosis, Paget’s disease and tumour-induced hypercalcaemia. Older patients (i.e. aged ≥ 65 years) are at increased risk of experiencing adverse reactions to zoledronic acid infusions than those who are younger. This includes acute phase reactions (e.g. fever, joint pain and swelling, myalgia, influenza-like illness and gastrointestinal symptoms), renal impairment, hypocalcaemia and hypophosphataemia.
Prior to a zoledronic acid infusion:
- Inform the patient that acute phase reactions are common and usually resolve in a few days, but they should seek medical attention if symptoms are serious or prolonged
- Check the patient’s serum creatinine and ensure they are sufficiently hydrated. Adequate hydration should also be maintained following the infusion.
- Treat pre-existing hypocalcaemia with adequate intake of calcium and vitamin D
Read the full article here.
GLP-1 receptor agonists and altered skin sensations
Prescribers are advised to consider the GLP-1 receptor agonists, semaglutide (Wegovy) and tirzepatide (Mounjaro; a dual GIP/GLP-1 receptor agonist), as a cause in patients reporting altered skin sensations, e.g. dysaesthesia, allodynia, burning, tingling, numbness or a cold sensation. This comes following nine reports to the New Zealand Pharmacovigilance Database of altered skin sensations (particularly allodynia) with semaglutide.
Altered skin sensations are possible adverse effects with the use of semaglutide and tirzepatide; they are not listed as adverse effects in the data sheets for other GLP-1 receptor agonists available in New Zealand (i.e. dulaglutide or liraglutide), but given the rapid introduction and high uptake of these medicines, it may be reasonable for prescribers to monitor patients taking any GLP-1 receptor agonist for altered skin sensations. Read the full article here.
View the full edition of Prescriber Update here
Topical corticosteroid potency labelling to be introduced
Medsafe has introduced new package labelling requirements for topical corticosteroids, following consultation (as reported in Bulletin 126). By mid-March, 2028, single and combination products containing a topical corticosteroid for treating inflammatory skin conditions (excluding combination products for cold sores that contain a corticosteroid) must have information about its potency on the container/packaging. Specifically:
- Mild steroid, e.g. hydrocortisone
- Moderate steroid, e.g. clobetasone, hydrocortisone butyrate, triamcinolone acetonide
- Strong steroid, e.g. betamethasone valerate, betamethasone dipropionate, mometasone furoate, methylprednisolone aceponate
- Very strong steroid, e.g. clobetasol propionate, betamethasone dipropionate (in an optimised vehicle)
Labelling of potency is expected to help to prevent inappropriate overuse when multiple topical corticosteroid products are prescribed, e.g. accidental use of more potent products on delicate areas of skin such as the face. It may also make it easier for patients to identify that the product is a topical corticosteroid in the first place, if they are prescribed multiple different skin products.
Medical Council guidance on the use of artificial intelligence in patient care
The Medical Council of New Zealand has developed guidance on using artificial intelligence (AI) in patient care, following consultation on this topic (as reported in Bulletin 133). The Medical Council acknowledges that AI is becoming widely used across healthcare, but that it must be used in ways that ensure quality of care and patient safety and privacy.
The guidance includes 14 statements across five key areas that should be considered when using AI in patient care:
- Accountability and duty of care
- Transparency
- Informed consent
- Patient privacy, data security and patient safety
- Continuing professional development
The guidance applies to AI embedded into medical devices and existing technology, AI scribing tools involved in clinical notes and AI tools that manage clinical inboxes. It does not cover business or administrative AI tools that are not directly related to patient care, although the cautions included are likely to relate to any application of AI in medicine.
In brief: Consultation on proposed changes to the classification of vitamin D
The Ministry of Health, Manatū Hauora, is seeking feedback on a proposal to increase the permitted quantity of vitamin D in general sale medicines, from 25 micrograms (1,000 IU) to 50 micrograms (2,000 IU) per daily dose.
Consultation closes Thursday, 2nd April. Feedback can be submitted here. The RNZCGP is also collecting responses from members to inform a College submission (due by 25th March).
Upcoming webinars: GI conundrums, ADHD, abnormal uterine bleeding, MMR
The Goodfellow Unit, University of Auckland, is hosting several free access webinars in the coming months. CPD points are also available. Webinars are often recorded and available to watch at a later date. Upcoming webinars include:
A webinar on the role of GLP-1 receptor agonists, including tirzepatide (a dual GIP/GLP-1 receptor agonist), in diabetes and weight management was recently held by the Goodfellow Unit. If you missed it, view a recording of the webinar here.
HealthPathways is hosting a webinar on abnormal uterine bleeding. This free webinar is expected to cover topics including the new national guidelines, understanding the difference between normal and abnormal menstrual bleeding, early detection of endometrial cancer, risk assessment and the impact of co-morbid conditions and primary care procedures, e.g. pipelle biopsy, Mirena insertion. The webinar will be held on Tuesday, 31st March, from 7 pm – 8 pm. Click here to register (a certificate of attendance and CPD points are available). A recording will be available at a later date. N.B. This webinar was postponed after being scheduled for October, 2025 (as reported in Bulletin 133). Those registered at the time have been sent a reminder and do not need to re-register.
The Immunisation Advisory Centre (IMAC) is hosting an upcoming webinar on understanding the role of MMR0 in a measles outbreak. This free webinar will be held on Wednesday, 1st April, from 12:30 pm. Click here to register.
A case of measles has been reported in New Zealand, related to overseas travel. Locations of interest are available here. Be alert for symptoms and signs of measles, particularly in patients who are not vaccinated or are immunocompromised and have a history of recent overseas travel.
NZF updates for March
Significant changes to the NZF in the March, 2026, release include:
- New monograph for tirzepatide (not funded), indicated for type 2 diabetes and adjunctive treatment for weight management in people with a BMI ≥ 30 kg/m2, or in people with a BMI ≥ 27 kg/m2 who have at least one weight-related co-morbidity
- New monograph for fremanezumab (not funded), indicated for prophylaxis of migraine
- Updated therapeutic notes for diverticular disease, including revised antibiotic recommendations
- Indications and dosing regimen for amoxicillin + clavulanic acid and metronidazole (systemic) updated to align with Te Whata Kura – National Antibiotic Guidelines
- Full revision of the atomoxetine monograph
- Contraindications, cautions, pre-treatment screening, monitoring, adverse effects and patient advice updated for isotretinoin (systemic)
- Cautions and adverse effects for warfarin updated
You can read about all the changes in the March release, here. Also read about any significant changes to the NZF for Children (NZFC), here.
Paper of the Week: Comprehensible contact is critical for clear clinician communication (CCCCCC)
A letter to the editor in the March issue of the Australian Journal of General Practice generated substantial discussion in our office this week, specifically around the use of abbreviations. The letter highlighted the importance of clear communication between hospitals/tertiary care and primary care. An extreme example of a hospital discharge summary was provided, relating to a female patient aged 80 years with a scaphoid facture: “change to BEFGC; opc 5w for cc and rop”. The recipient of this coded message conducted an informal survey among colleagues; only one of 14 other doctors at the practice was able to decipher these instructions (and they were previously an orthopaedic registrar). Want to know what it means? Click the read more button below to find out.
Abbreviations are used widely throughout medicine. This conversation came up during our weekly clinical meeting where we discussed our upcoming topics: ADHD, UTI, CKD, COPD, SGLT-2 and ADR. Established abbreviations are useful tools to help clinicians save time, however, it is only helpful when the person reading them knows what you mean. For example, writing CP, RA, MS, ASD or CHD without appropriate context may lead to some serious miscommunications. Resource and time constraints mean that shortcuts are often welcomed when it comes to writing notes, but this cannot come at the expense of clear and concise health information, which is crucial for patient safety. The use of artificial intelligence for note taking and discharge letters puts a whole other spin on this also, where the clinician must take additional care to ensure that what is produced is accurate. AI software claims to translate general conversations into professional notes and match the clinician’s writing style, therefore the quality (and clarity) of information provided impacts how much time is spent reviewing and fixing clinical documents, e.g. because AI software misinterpreted abbreviations or used them without clinical context.
If in doubt, spell it out…. if you take the time to write an instruction or phrase out in full, you may save time later by avoiding a follow-up email or phone call, or at the very worst, dealing with a clinical error.
What style note-writer are you? Do you get your notes done ASAP so you can BRB to your patients? Or do you prefer a more eloquent description of events? Can you think of some examples of letters or instructions you have received where you needed a code breaker to interpret the meaning? If you are using AI for your notes, have you experienced many misinterpretations due to your medical jargon shorthand?
Read more
The abbreviated discharge summary that was received:
Plan:
change to BEFGC
opc 5w for cc and rop
Safety netted
No contact sport or high risk activities for 3 months from injury
The translation:
Change to a below-elbow fibreglass cast.
Outpatient clinic in five weeks for clinical check and removal of plaster.
And the last two lines – well they are more straightforward in terms of the language, but the context remains questionable for an 80-year-old patient!
Did you get it?
Binns C. Abbreviations still spell confusion. Aust J Gen Pract 2026;55:87.
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