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Identifying the risk of serious illness in young children with fever

Symptoms and signs for assessing the risk of serious illness in children aged under five years presenting with fever. View Article

May 2024

Seasonal influenza and COVID-19 vaccinations: 2024 edition

The Influenza Immunisation Programme has begun for the 2024 season. Influvac® Tetra is the sole funded influenza vaccine for... View Article

April 2024

Cough medicines: do they make a difference?

Over-the-counter cough medicines, although widely used, are not particularly effective at reducing the severity or duration of... View Article

October 2023

Prostatitis: diagnosis and management in primary care

Prostatitis is the collective term for four distinct clinical conditions. Primary care clinicians are likely to be most familiar... View Article

September 2023

Diverticulitis: pockets of knowledge

Diverticulitis occurs when small pockets in the wall of the large bowel become inflamed, usually without a specific identifiable... View Article

March 2023

H. pylori: who to test and how to treat

Helicobacter pylori infection increases the risk of peptic ulcer disease and gastric cancer due to long-term inflammation and... View Article

July 2022

Scabies: diagnosis and management

Scabies is a highly contagious skin infestation that can often rapidly spread through households before it is detected. The characteristic... View Article

May 2022

Otitis media: a common childhood illness

Acute otitis media is the most common reason why children in primary care are prescribed antibiotics, despite guidance recommending... View Article

April 2022

Urinary tract infections (UTIs) – an overview of lower UTI management in adults

Lower urinary tract infection (UTI) is one of the most common community-acquired infections, with more than half of all females... View Article

December 2021

MMR vaccination remains a priority

Measles, mumps and rubella are vaccine-preventable causes of significant morbidity and mortality (particularly for measles), that... View Article

December 2021

Management of impetigo

Impetigo is a highly contagious, bacterial infection of the skin, most commonly seen in children. It is typically diagnosed clinically,... View Article

May 2021

Limiting the use of quinolone antibiotics

Quinolones (e.g. ciprofloxacin, norfloxacin) are associated with increasing antimicrobial resistance and rare, but potentially... View Article

February 2021

The influenza immunisation programme is starting early in 2020

This year’s influenza immunisation programme has the earlier start date of 18th March, 2020, for people eligible for funded vaccines.... View Article

March 2020

Navigating uncertainty: managing respiratory tract infections

With winter upon us, it is timely to reflect on antibiotic prescribing practices for respiratory tract infections (RTIs) and associated... View Article

August 2019

Emerging issues in the management of chlamydia and gonorrhoea

New evidence suggests that a seven-day course of doxycycline may be more appropriate than a stat dose of azithromycin as a first-line... View Article

April 2019

Mycoplasma genitalium: considerations for testing and treatment in primary care

Mycoplasma genitalium infection is a potential cause of urethritis in males and cervicitis and pelvic inflammatory disease in... View Article

April 2019

Syphilis rates continue to rise

New Zealand is in the midst of a syphilis epidemic. Men who have sex with men are at the greatest risk, however, cases among heterosexual... View Article

April 2019

Hepatitis C management in primary care has changed

A new direct-acting antiviral (DAA) oral regimen for the treatment of hepatitis C, glecaprevir + pibrentasvir (Maviret) will be... View Article

January 2019

Testing for hepatitis C virus (HCV) in patients at high risk of infection

Hepatitis C infection occurs through exposure to infected blood or body fluids. The majority of newly acquired infections in New... View Article

January 2019

Pre-treatment assessment for patients with chronic HCV infection

Patients should be assessed for cirrhosis via clinical examination, laboratory tests and an APRI score (or liver elastography... View Article

January 2019

Management and follow-up of patients prescribed glecaprevir + pibrentasvir

Glecaprevir + pibrentasvir is taken once daily for eight weeks. Headache and fatigue are the most likely adverse effects. HCV... View Article

January 2019

Hepatitis C is now curable:
contributed by Dr Tony Farrell

Dr Tony Farrell is a general practitioner in Mount Maunganui and has a Fellowship in Addiction Medicine. He has a special interest... View Article

January 2019

Hepatitis B: treatments now available for primary care

Tenofovir disoproxil and entecavir are once daily oral antiviral medicines, recommended as first-line treatments for patients... View Article

August 2018

Topical antibiotics: keep reducing use

Encouraging progress has been made by prescribers in New Zealand in reducing the use of topical antibiotics such as fusidic acid;... View Article

July 2018

Cold season: managing without antibiotics

For the majority of people with upper respiratory tract infections symptomatic treatment will offer better outcomes than antibiotics,... View Article

June 2018

Antibiotics: the future is short

In general, the recommended durations of antibiotic treatment regimens are decreasing as evidence for the safety and efficacy... View Article

June 2018

News item: Discussion on Zostavax

Since publication of our article on Zostavax vaccine in March, 2018, we have received feedback from several readers seeking clarification... View Article

April 2018

Seasonal influenza vaccination: update for 2018

Two subsidised seasonal influenza vaccines, Influvac Tetra (for adults and children aged three years and over) and Fluarix Tetra... View Article

March 2018

Zostavax vaccine: now fully subsidised

Zostavax is a herpes zoster (shingles) vaccine that will become fully subsidised from 1 April, 2018 for people aged 65 years.... View Article

March 2018

The bpacnz antibiotic guide: 2017 edition

The 2017 edition of the bpacnz antibiotics guide; "Antibiotics: choices for common infections", is now available online. There... View Article

July 2017

Antibiotics: choices for common infections

The following information is a consensus guide. It is intended to aid selection of an appropriate antibiotic for typical patients... View Article

July 2017

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... View Article

February 2017

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... View Article

February 2017

Treatment of hepatitis C (HCV) has changed

Three new oral medicine regimens for the treatment of hepatitis C, known as directly acting antivirals (DAAs), are fully subsidised... View Article

September 2016

Rosacea: seeing red in primary care

Rosacea is an inflammatory facial skin disease that can cause patients embarrassment and reduce their quality of life. There are... View Article

May 2016

Travel consultation essentials: for departures and arrivals

Travel consultations involve assessing the risks that may occur during a journey and helping the traveller minimise them. This... View Article

December 2015

An update on the use of nitrofurantoin in patients with renal impairment

The Medicines and Healthcare products Regulatory Agency (MHRA) in the United Kingdom (UK) have updated their guidance to allow... View Article

October 2015

The New Zealand Laboratory Schedule and Test Guidelines: Immunology Tests

Over the last few editions of Best Tests we have outlined the various sections of the New Zealand Laboratory Schedule. The aim... View Article

July 2015

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... View Article

June 2015

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... View Article

June 2015

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... View Article

June 2015

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... View Article

June 2015

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... View Article

June 2015

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... View Article

June 2015

The Year in Review - What did we learn in 2014?

In 2014 we published over 60 medical education articles in Best Practice Journal, spanning more than 450 pages. Context is crucial... View Article

February 2015

Tinea pedis: not just the curse of the athlete

Tinea pedis is a common fungal foot infection that is often associated with high rates of treatment failure or recurrence. This... View Article

December 2014

Plantar warts: a persistently perplexing problem

Plantar warts, also known as plantar verrucae, are manifestations of infection with human papillomavirus. They can be painful... View Article

December 2014

Exposure to body fluids: keeping the primary healthcare team safe

Providing a safe working environment involves both minimising the risk of transmission of infectious pathogens and dealing with... View Article

November 2014

Topical antibiotics: very few indications for use

Topical antibiotics in general have been excessively used in New Zealand in recent years. The increasing prevalence of resistance... View Article

October 2014

Measles: what to be aware of during an outbreak

The current measles outbreak in New Zealand highlights the importance of maintaining high measles mumps and rubella (MMR) immunisation... View Article

September 2014

Vulvovaginal health in post-menopausal women

Age-related changes in women can result in an increased occurrence of vulvovaginal dermatological conditions such as vulval dermatitis... View Article

September 2014

News Updates

Reminder: Most broad-spectrum antibiotics do not interact with combined oral contraceptives | Oseltamivir (Tamiflu) and Zanamivir... View Article

June 2014

Rising antimicrobial resistance

Associate Professor Mark Thomas from the University of Auckland, in conjunction with Dr Alesha Smith and Professor Murray Tilyard... View Article

June 2014

Rural infections series: Rural round up

In the final instalment of the rural series we present a round-up of infections that may be seen in patients living in, working... View Article

May 2014

The New Zealand Laboratory Schedule and Test Guidelines: Microbiological and Serological Tests

In October, 2013, the New Zealand Laboratory Test Schedule was published to provide consistent guidance and ensure uniform availability... View Article

May 2014

The changing face of Helicobacter pylori testing

A more recent article has been published on this topic: click here There is ongoing debate in the literature about which is... View Article

May 2014

Upfront: Azithromycin: use it wisely

Growing use of azithromycin in New Zealand means that we are in danger of increasing bacterial resistance to macrolide antibiotics,... View Article

April 2014

Pertussis immunisation in pregnancy

New Zealand is slowly emerging from its most recent outbreak of pertussis. The highest-risk period for pertussis in infants is... View Article

April 2014

Seasonal influenza vaccination: 2014 update

The vaccine for the 2014 influenza season is now available. This year, the vaccine has been updated with two new strains, as well... View Article

March 2014

The diagnosis and management of herpes zoster and its complications

Herpes zoster (shingles) is a self-limiting condition caused by reactivation of the Varicella zoster virus. Shingles most frequently... View Article

March 2014

Meningococcal disease: Always consider in a patient with flu-like illness

Patients with meningococcal disease can initially present with non-specific influenza-like symptoms. More specific signs and symptoms... View Article

March 2014

The year that was: Key messages from Best Practice Journal 2013

2013 began with publication of the 50th issue of Best Practice Journal. In this edition we focused on the topic at the heart of... View Article

February 2014

Rural infections series: Investigating and managing people with diarrhoea

Campylobacter, Salmonella, Cryptosporidium and Giardia cause diarrhoeal illnesses in thousands of people annually in New Zealand.... View Article

February 2014

Rural infections series: Leptospirosis

This article is the first in a series addressing the diagnosis and management of infections that predominantly occur in people... View Article

November 2013

Appropriate use of amoxicillin clavulanate

Amoxicillin clavulanate is a broad spectrum antibiotic which is used frequently in New Zealand general practice. The proportion... View Article

August 2013

Causes, complications and treatment of a red eye

Most cases of “red eye” seen in general practice are likely to be conjunctivitis or a superficial corneal injury, however, red... View Article

August 2013

Upfront: Antimicrobial Resistance in New Zealand: What is my role in primary care?

This month marks the launch of our 2013 revised edition of “Antibiotic choices for common infections”. The guidance supports the... View Article

August 2013

Antibiotics Guide

Tip: Bookmark this page or add to your home screen on your smartphone for your mobile pocket handbook View Article

July 2013

Upfront: Is the cupboard bare? The threat of antimicrobial resistance

Antimicrobial resistance is one of the greatest threats to health that we have faced in recent history. As the rate of resistance... View Article

June 2013

Microbiological assessment of infected wounds: when to take a swab and how to interpret the results

Identifying and managing infection in wounds is an important aspect of primary care practice. However, many issues relating to... View Article

June 2013

Interpreting urine dipstick tests in adults: a reference guide for primary care

A urine dipstick positive for haematuria or proteinuria is a relatively common occurrence in primary care. For many patients there... View Article

June 2013

A “how-to guide” for a sexual health check-up

Good sexual health is about achieving both physical and psychological wellbeing, free from disease, coercion or abuse. Reaching... View Article

April 2013

Cold season in primary care

A newer article is available on this subject: Cold season: managing without antibiotics Every year New Zealanders spend significant... View Article

April 2013

Managing acne in primary care

Acne is a common dermatological condition that affects most people at some stage in their life. Because acne is regarded as “normal”... View Article

March 2013

Norovirus: Sydney 2012

In late 2012, there was a global increase in norovirus notifications, due to the spread of a novel norovirus, referred to as Sydney... View Article

March 2013

The 2013 influenza season: new strains, new vaccines

The dominant influenza virus to circulate in New Zealand this “flu season” is likely to be an A(H3N2) virus, similar to the virus... View Article

March 2013

Pertussis: halting the epidemic by protecting infants

Infants who have not yet completed the National Immunisation Schedule and children who are not immunised, or only partially immunised,... View Article

March 2013

Appropriate use of sulfonamides

What are sulfonamides and how do they work? | Prescribing co-trimoxazole | Adverse effects of co-trimoxazole | Medicine interactions... View Article

December 2012

News and updates: Update on azithromycin

This article has been archived. If you would like access to the original article please contact: editor@bpac.org.nz View Article

November 2012

Laboratory investigation of infectious diarrhoea

This report discussus how testing behaviour in New Zealand has changed over the past five years and includes feedback on the testing... View Article

October 2012

Appropriate use of tetracyclines

What are tetracyclines and how do they work? | Which infections should tetracyclines be used for? | First-line indications for... View Article

October 2012

Sick and tired of being tired and sick: laboratory investigation of glandular fever

Glandular fever (infectious mononucleosis) is a common, potentially debilitating illness that is most frequently seen in adolescents... View Article

October 2012

Otitis media: a common childhood illness

This article has been replaced with an updated version. View new article View Article

September 2012

Bronchiectasis: rates still increasing among Pacific peoples

Bronchiectasis is a lung disease characterised by irreversible bronchial dilation and chronic inflammation, resulting in chronic... View Article

September 2012

Bronchiolitis in infants

Bronchiolitis is the most common lower respiratory tract infection in infants, and between 2006 and 2010 accounted for almost... View Article

September 2012

Managing skin infections in Māori and Pacific families

Compared to other developed countries, New Zealand has one of the highest rates of serious skin infections, particularly among... View Article

August 2012

Pertussis: an avoidable epidemic

This article is out of date. Please see: Pertussis: halting the epidemic by protecting infants for updated information New... View Article

August 2012

The management of community acquired pneumonia

Pneumonia is a significant cause of hospitalisation and mortality among both children and adults in New Zealand. Māori and... View Article

August 2012

Syphilis: testing for “the great imitator”

Over one hundred people per year in New Zealand are diagnosed with syphilis. While this only represents a small number of patients,... View Article

June 2012

The appropriate use of macrolides

Macrolides are a class of antibiotic that includes erythromycin, roxithromycin, azithromycin and clarithromycin. First-line indications... View Article

May 2012

Managing urinary tract infections in children

Although relatively uncommon in children, urinary tract infection (UTI) should be considered when assessing a young child with... View Article

May 2012

Appropriate use of metronidazole

How does metronidazole work? | Which infections should metronidazole be used for? | First line indications for metronidazole... View Article

April 2012

Seasonal influenza vaccinations: the 2012 edition

The 2012 seasonal influenza vaccine contains the same strains as in previous years, however, annual vaccination is still necessary.... View Article

April 2012

Looking back, looking forward: key messages 2005 – 2011

This report highlights four key prescribing and laboratory testing recommendations covered over the past five years. Over this... View Article

March 2012

Providing medical advice to travellers

New Zealanders love to travel. It is important that travellers visit their general practice (or travel medicine clinic) at least... View Article

December 2011

Vulvovaginal health in premenopausal women

Symptoms relating to the vulvovaginal area such as abnormal discharge, itch and pain are common, particularly for women of reproductive... View Article

December 2011

Appropriate use of amoxicillin clavulanate

Amoxicillin clavulanate is an important and effective medicine but its use must be reserved for specific indications in order... View Article

September 2011

Rheumatic fever in Māori: what can we do better?

In New Zealand, acute rheumatic fever is now almost exclusively a disease affecting Māori and Pacific peoples. The majority of... View Article

August 2011

News in brief: Dabigatran; Antibiotics and COC; Prescription kitchen

Dabigatran to be listed | Most broad spectrum antibiotics do not affect the combined oral contraceptive | Prescription kitchen View Article

June 2011

Norfloxacin Prescribing Update

Looks at Norfloxacin prescribing for urinary tract infections. View Article

May 2011

Managing urinary tract infections in pregnancy

Urinary tract infections (UTIs) occur commonly during pregnancy. UTIs are managed more aggressively in pregnant women than in... View Article

April 2011

Quinolone antibiotics - limit use

Quinolones are associated with increasing antimicrobial resistance. Their use needs to be reserved for specific indications involving... View Article

April 2011

Pneumococcal vaccine for adults: Pneumovax23

Invasive pneumococcal disease caused by Streptococcus pneumoniae can result in life-threatening pneumonia, meningitis and septicaemia.... View Article

April 2011

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... View Article

April 2011

Should I still use both CRP and ESR when investigating temporal arteritis?

CRP alone is the best test for temporal arteritis. This article is out of date. Please see updated information here: Giant... View Article

March 2011

Collecting specimens for the investigation of fungal infections

Fungal infections of the skin, nails and hair are caused by dermatophytes. In many cases, diagnosis of infection is made by clinical... View Article

March 2011

Upfront: Antimicrobial resistance - the way forward

In this final article in the series on antimicrobial resistance, we look at the way foward. Lessons learned from international... View Article

February 2011

Antimicrobial resistance: where are we now?

This article reviews the data currently available, which enables interventions to be targeted towards issues which are local and... View Article

December 2010

Close contact infectious diseases: an increasing concern for Pacific peoples

Pacific peoples have poorer health status than other New Zealanders, including higher rates of infectious diseases. View Article

November 2010

The burden of bronchiectasis in Pacific peoples

In most developed countries the incidence of bronchiectasis has declined over the years. View Article

November 2010

Skin infections in Pacific peoples

Serious skin infections such as cellulitis, abscesses and impetigo are an increasingly common reason for hospital admission in... View Article

November 2010

Rheumatic fever - the neglected disease

New Zealand continues to have high rates of rheumatic fever, particularly among Pacific peoples. View Article

November 2010

ANTIMICROBIALS how should they be used in primary care?

Ideally antibiotics should be reserved for the treatment of known bacterial infection but it is well recognised that they are... View Article

October 2010

Upfront: Resistance to antimicrobials - an increasing problem in our community

The threat of multiple drug resistant organisms in New Zealand. The first article in a series on antimicrobial resistance. View Article

August 2010

Quinolone prescribing

Data report on quinolone prescribing, national data only. View Article

July 2010

Cough in children

Children who cough are frequently seen in general practice. The challenge is to determine what is “normal” cough from... View Article

July 2010

Do cough and cold medicines work in children?

The short answer is no. There is little evidence that cough and cold preparations have any clinically significant effect on reducing... View Article

July 2010

Identifying the risk of serious illness in children with fever

A “traffic light” approach to assessing the risk of a serious illness in a child with fever. View Article

July 2010

Investigating the Gut: Helicobacter pylori

A more recent article has been published on this topic: click here The choice of test for initial testing for H. pylori, is... View Article

March 2010

Testing for enteric pathogens: Follow up report

This web version is a sample only, all data below the national level has been omitted. View Article

March 2010

Non-occupational exposure to Human Immunodeficiency Virus

Rates of HIV infection are increasing in New Zealand, especially among men who have sex with other men. GPs are often the first... View Article

December 2009

Assessment and management of infectious gastroenteritis

Every year around 200,000 New Zealanders acquire a food associated illness. Gastrointestinal diseases account for the majority... View Article

December 2009


A guide focusing on some of the situations GPs face in day-to-day practice with practical advice for initial testing. View Article

July 2009

Fluoroquinolone-associated tendon disorders

The use of oral fluoroquinolones is associated with increased risk of tendinitis and tendon ruptures. View Article

June 2009

Diagnosing and managing influenza

In healthy people influenza is usually self-limiting and uncomplicated however for some groups of people it can be a significant... View Article

June 2009

Bronchiolitis update

Bronchiolitis is the most common lower respiratory tract infection seen in infants aged less than one year. The bronchiolitis... View Article

April 2009

How to treat acne

Acne is a common skin condition that affects most people at some stage in their life. The aims of acne treatment are to reduce... View Article

April 2009

Influenza vaccine

Influenza is a highly infectious acute respiratory disease. Influenza vaccination is the most effective protection. The vaccine... View Article

April 2009

Treatment of sexually transmitted and other genital infections

A summary of pharmacological treatment and management of common sexually transmitted and other genital infections including chlamydia,... View Article

April 2009

Testing for STIs - four case scenarios

A series of four case studies that illustrate the importance of patient history and background when testing for STIs. View Article

March 2009

Sexually transmitted infections - what testing is needed and when?

This article provides an overview of some infections affecting the genital area, including some non-sexually transmitted infections.... View Article

March 2009

Sexually transmitted infections in New Zealand

Chlamydia remains the most commonly diagnosed STI in New Zealand, according to the annual STI Surveillance Report. Although not... View Article

February 2009

Scabies - diagnosis and management

Scabies manifests as an itchy skin rash, as a result of an allergic reaction to the female scabies mite. Infection is easily spread... View Article

February 2009

Management of fungal nail infections

Fungal nail infection (onychomycosis) accounts for around 50% of all nail disease. Laboratory diagnosis is recommended before... View Article

February 2009

Management of impetigo

Impetigo is a highly contagious, bacterial infection of the skin, most commonly seen in children. It is typically diagnosed clinically... View Article

February 2009

Mastitis and sore nipples while breastfeeding

The management of two conditions that commonly, but unnecessarily, lead to discontinuation of breastfeeding are outlined. View Article

December 2008

Acute monoarthritis: differentiating between crystals sepsis and trauma

Acute monoarthritis is characterised by pain and swelling of a single joint. There are a number of causes, with crystals, trauma... View Article

November 2008

Why we still need to think of rheumatic fever

Māori living in the upper North Island have one of the highest rates of acute rheumatic fever in the world. This disease... View Article

May 2008

Snippets: NSAIDs dextropropoxyphene and antibiotic resistance

Drug information of topical interest View Article

February 2008

Dear Dave

Does the "seven day rule" still apply with the concomitant use of combined oral contraceptives and all antibiotics? Serotonin... View Article

September 2007

Upfront: The Augmentin-free office

Practical advice on reducing the use of augmentin View Article

August 2007

Upfront: Infectious disease patterns a major concern

An Interview with Professor Diana Lennon on infectious disease patterns. View Article

May 2007

Remembering respiratory infections

Revisits the main points of our respiratory infections campaign with feedback on its impact and discusses the question ‘Is... View Article

May 2007

Winter Ills

Bronchiolitis | Cough in children | Fever in children | Acute gastroenteritis in children | Acute asthma in children aged 1-15... View Article

May 2007


Resurgence of syphilis in NZ? Syphilis had been considered a rarity in New Zealand, but over the last few years the ESR Annual... View Article

March 2007

Laboratory investigation of UTI

For up to date recommendations for antibiotic choice for UTI, refer to the Antibiotics Guide . This resource focuses on the... View Article

July 2006

Appropriate use of cephalosporins

There are very few indications for the use of cephalosporins as first-line antibiotic treatment. Ceftriaxone is used for the treatment... View Article

December 2011