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Published: 23rd October, 2026
Contents
New from bpacnz: Managing caustic exposures in primary care
Caustic chemicals can be found in many common household products and in workplaces. While not a common presentation in primary care, exposure to a caustic substance can result in significant injury. Primary care clinicians should be familiar with the decontamination procedures and early management that they should carry out; in most cases, patients who have been exposed to a caustic substance will require hospital referral. All injuries involving exposure to hazardous substances, including caustic chemicals, must be notified to the Medical Officer of Health: a tool is available on practice management systems to do this.
Read the article here. A B-QuiCK summary is also available.
In case you missed it: What your lipid test means for you
What your lipid test means for you is a bpacnz patient information sheet designed to support discussions with patients about lipid testing, cardiovascular health and cholesterol management. This resource explains lipid panel results and their implications for health. It includes space for clinicians to record a patient’s lipid results and targets. Information on the effects that different dietary fats have on lipids and advice on making healthy food choices is included in an optional full version of the sheet.
The bpacnz patient information sheets are designed to support primary care consultations and can be downloaded and printed, or the link sent to patients via text or email. View all available sheets here.
Rewind: Wrap-up of recent key messages
Key dates and updates on news items from recent editions of Best Practice Bulletin:
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.
Pimafucort to go out of stock until 2028
Hydrocortisone + natamycin + neomycin ointment (Pimafucort) is expected to go out of stock from November, 2026, due to manufacturing issues. Re-supply is currently expected in 2028. There is no funded alternative product available that contains the same combination of ingredients, however, other topical corticosteroid, antifungal and antibacterial products are available. Click here for options.
The role of combination topical anti-infective/corticosteroid products in skin infections is unclear; generally, a more pragmatic approach is to treat an underlying inflammatory skin condition with topical corticosteroids and use a topical anti-infective product only if indicated for a small, localised area of infection.
Supply issue affecting pioglitazone
Pioglitazone 15 mg and 30 mg tablets (Vexazone), a thiazolidinedione used for type 2 diabetes, is expected to go out of stock at the supplier level before the end of the year. Stock of the 45 mg tablets is not affected. A re-supply date is currently unknown. An alternative brand (Pioglitazone Rising) will be listed on the Pharmaceutical Schedule from 1st November. This brand is not approved by Medsafe, therefore, will need to be prescribed for supply under Section 29A of the Medicines Act. Reassure patients that there has been no change to the active ingredient, but the shape of the tablets and markings on them will be different.
A patient information sheet about this supply issue is available here
Upcoming medicine discontinuations: Flamazine cream, glibenclamide
The following medicine discontinuations have recently been announced by Pharmac:
Sulfadiazine silver 1% cream (Flamazine), a topical antibacterial used for wound infections. Supply of Flamazine for retail use ended in September, and stock for prescription use is anticipated to stop being supplied to pharmacy wholesalers in December or January. For information on alternative topical antibacterial preparations, see the NZF.
Glibenclamide 5 mg tablets (Daonil), a sulfonylurea used for type 2 diabetes. Supply of glibenclamide is expected to be exhausted in February, 2027. In most cases, prescribers will not have many (if any) patients affected by this discontinuation, as glibenclamide is generally not recommended due to its higher risk of hypoglycaemia than other sulfonylureas. However, there will be some patients for whom glibenclamide is the most suitable treatment option and switching to an alternative glucose-lowering medicine is not clinically appropriate; prescribers can apply for a Named Patient Pharmaceutical Assessment for these patients to access continued funding of glibenclamide.
Keep MMR vaccination front of mind
Health New Zealand, Te Whatu Ora, is reminding secondary school students and their family/whānau to check their protection against measles prior to NCEA examinations starting from next month, given the increased risk of the virus being brought into New Zealand with outbreaks overseas.
Healthcare professionals should consider discussing measles, mumps and rubella (MMR) vaccination with people who do not have documented evidence of previous vaccination or immunity. Two doses of the MMR vaccine are recommended for any person known to be susceptible to measles, mumps or rubella; vaccination is funded for all people aged under 18 years, regardless of immigration status, and all people aged 18 years and over who are eligible for funded healthcare in New Zealand.
Further information about measles and MMR vaccination is available from the Immunisation Handbook here
October is Breast Cancer Awareness Month
October is Breast Cancer Awareness Month. Breast cancer is the most common cancer diagnosis among females in New Zealand and accounted for more than 700 deaths in 2023. Males can also be diagnosed with breast cancer in rare cases. The overall ten-year survival rate for females diagnosed with breast cancer if a lump is the first sign is 85%, and this rises to 95% if breast cancer is detected via mammogram screening.
This is a timely reminder to encourage patients to perform regular self-checks, and to book a consultation if there are any concerns. Check that your practice has a system in place to invite eligible patients to participate in the national breast screening programme (BreastScreen Aotearoa) and record their breast screening status in their clinical notes. Follow up with patients who are not participating and discuss any concerns they may have about breast screening.
Eligible patients can undergo free mammogram screening every two years. Eligibility is being progressively extended to include females aged up to 74 years (as reported in Bulletin 131). An eligibility calculator is available here; encourage those who are eligible to enrol in the breast screening programme. Patients can call BreastScreen Aotearoa (0800 270 200) to book a mammogram or self-enrol here.
For further information on BreastScreen Aotearoa, see: https://www.healthnz.govt.nz/about-us/what-we-do/programmes-and-initiatives/breastscreen-aotearoa-programme
CPD Corner: Upcoming webinars + latest podcast episodes
Upcoming Goodfellow Unit webinars
The Goodfellow Unit, University of Auckland, is hosting several free access webinars in the coming weeks. Webinars are often recorded and available to watch at a later date. Upcoming webinars include:
- New horizons: BP and lipid update, a Health New Zealand, Te Whatu Ora, Te Tiri Whakāro: Sharing Knowledge session, presented by Nurse Practitioner Lia Shanks and Clinical Pharmacist Linda Bryant. Dr Sue Tutty will provide general updates at the end of the session. This webinar will be held on Tuesday, 27th October, from 7:30 pm. Click here to register.
- Anaphylaxis in practice: Recognition, management and misperceptions, presented by General Practitioner Dr Rebekah Thompson and Rheumatologist, Clinical Immunologist and Allergist Dr Karen Lindsay. This webinar will be held on Tuesday, 3rd November, from 7:30 pm. Click here to register.
- Beyond the CPAP mask: Incretins, obesity and the future of OSA treatment, presented by Professor of Respiratory and Sleep Medicine Dr Brendon Yee. This webinar will be held on Tuesday, 10th November, from 7:30 pm. Click here to register.
- Endometriosis and fertility: The missed diagnosis that delays conception, presented by Specialist Gynaecologist Dr Guy Fisher. This webinar will be held on Tuesday, 17th November, from 7:30 pm. Click here to register.
Latest episodes from The Specialist GP
‘The Specialist GP' is a New Zealand-based podcast for primary care health professionals, created and hosted by Dr Louise Kuegler. Recent episodes include:
Podcast of the Week: Recognising and managing glandular fever
A recent podcast episode from GPnotebook, a clinical education platform for primary care clinicians in the United Kingdom, discusses infectious mononucleosis, a common viral illness also known as glandular fever. The podcast covers presentation, diagnostic workup, including key differential diagnoses, evidence-based management, potential complications and practical advice for patients to support recovery.
Listen to the podcast here (~16 minutes)
And the winner is…
In the last edition of Best Practice Bulletin, we asked whether you preferred our new, more concise Food for Thought segment or the traditional Paper of the Week format. Food for Thought emerged victorious, although it was a close race, with only 29 votes separating the two. For this reason (and due to potential confounding from novelty bias), we have decided to take a “best of both worlds” approach, where we choose the format that best fits the publication we are covering. Thank you to everyone who voted!
Have you found a recent publication that you would like us to discuss in a future Food for Thought or Paper of the Week segment? Email: editor@bpac.org.nz.
Paper of the Week: Backing patients to self-manage acute lumbar pain
Low back pain is a leading cause of morbidity worldwide. Patients with acute low back pain (i.e. pain lasting for < 6 weeks) are frequently seen in primary care and recovery trajectories can be highly variable. In most cases, symptoms resolve relatively quickly, e.g. within seven days, although some people experience prolonged symptoms that can have a significant impact on wellbeing and quality of life. Effective management requires a comprehensive initial assessment to identify potential red flags, proactive identification and management of potential barriers to recovery and familiarity with the available evidence-based treatment options.
The American Academy of Pain Medicine has published a clinical practice guideline (accepted manuscript; typeset version to follow in due course) on the assessment and management of acute low back pain in adults. While the guideline does not reveal any new treatments, it does include evidence-based recommendations to support shared decision-making and emphasises the importance of patient engagement in self-care interventions for optimal recovery outcomes.
What is your usual approach to managing patients with acute low back pain? In your experience, what patient factors are associated with an increased risk of progression to chronic low back pain? What are the most common barriers to recovery you encounter and how do you address them?
Read more
- Routine imaging is not recommended for patients with non-specific or uncomplicated atraumatic acute low back pain, as in many cases an underlying cause is not identified and there is evidence that early imaging does not improve outcomes, but may cause harm
- A focused history and physical evaluation are essential for identifying serious spinal causes of pain and red flag conditions, e.g. infection, fracture, cancer, neurological conditions, cauda equina syndrome, that indicate a need for acute assessment and management
- Diagnostic imaging is recommended for patients with red flags, or persistent (lasting > 4 – 6 weeks) or progressive symptoms, e.g. worsening neurological deficit, increasing pain intensity
- Self-care interventions have a key role in reducing pain and disability associated with acute low back pain, both prior to and alongside clinical management. For all patients with acute low back pain without red flags:
- Provide education and realistic expectations about their expected recovery trajectory and the symptoms and signs that indicate a need to seek further medical attention
- Explain that movement is safe and supports recovery; advise continuation of usual low-impact activities, with adjustments to intensity, frequency and duration, as required, according to pain tolerance
- Suggest the use of superficial heat and/or oral NSAIDs (short-term, standard doses) for symptomatic relief, if clinically appropriate (paracetamol is an alternative if NSAIDs are contraindicated)
- Clinical management is recommended if symptomatic improvement is not achieved with self-care interventions after 1 – 2 weeks, including: NSAID optimisation (e.g. increasing dose, trialling short-term round-the-clock dosing), prescription of a skeletal muscle relaxant (although not included in the guideline, orphenadrine is often the first-line choice in New Zealand), referral for exercise-based physiotherapy, spinal manipulation and mobilisation or acupuncture, where appropriate
- Which interventions(s) are trialled, and in what order, will depend on patient-specific factors and availability
- When prescribing medicines, consider contraindications and potential harms (e.g. the risk of falls in older or frail patients with medicines with CNS adverse effects), and use the lowest effective dose
- Some patients may benefit from earlier referral for exercise-based physiotherapy, e.g. those with severe functional limitations, psychosocial risk factors for progression to chronic low back pain or who have already experienced 1 – 2 weeks of pain at presentation despite engaging with self-care interventions
- In patients with radiculopathy (i.e. radiating pain, weakness and/or sensory changes in a nerve root distribution), in addition to standard clinical management, prescription of a systemic corticosteroid (e.g. oral, intramuscular) or referral for epidural steroid injections may be considered, after discussing benefits and risks. Corticosteroids are more effective for improving function rather than reducing pain, and are not recommended in patients with acute low back pain without radiculopathy.
- Routine use of opioids for initial treatment is not recommended. However, cautious short-term use (i.e. 3 – 7 days) of a short-acting opioid may be considered in specific clinical situations, e.g. patients with severe incapacitating pain or intolerance to other analgesia, only if the benefits are likely to outweigh potential risks. Re-evaluation is required if symptoms persist after the initial short course.
- The use of benzodiazepines, antidepressants, gabapentinoids or cannabidiol is not recommended in patients with acute low back pain
- Patient engagement and adherence to self-management interventions are essential. Clinicians can support recovery by proactively addressing patient concerns, particularly regarding the safety of movement, and directing them towards reliable sources of information.
A range of patient resources that have been developed to complement the guidelines are available here
Skelly AC, Kansagara D, Oswald J, et al. Assessment and treatment of acute low back pain: A multidisciplinary clinical practice guideline. 2026; pnag110 [Epub ahead of print]. doi: 10.1093/pm/pnag110.
This Bulletin is supported by the South Link Education Trust
If you have any information you would like us to add to our next bulletin, please email:
editor@bpac.org.nz
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