Published: 10 December, 2021
What’s the latest?
A new edition of Best Practice Journal (eBPJ) is now available online. In this third edition of eBPJ we take a closer look
at the evidence for when and how gabapentinoids should be prescribed, update the management of urinary
tract infections in adults and highlight MMR vaccination to ensure it also remains a priority
in a COVID-19 dominated world. We also discuss the evidence for plant-based diets in children and take
a fresh look at diagnosing and managing lactose intolerance. As usual, continuing professional development
activities have been produced with this edition, including a quiz, a clinical audit and a peer group discussion. All articles
are now also available to individually view and download on our website.
Coming soon: as part of our ongoing focus on cancer care with Te Aho o Te Kahu, the Cancer Control
Agency, we will be publishing a series on early identification of melanoma, including guidance on dermatoscopy,
and post-treatment follow-up and surveillance. We will also be shortly publishing the first of our series of resources
on prescribing medicinal cannabis, in conjunction with the Ministry of Health.
IMAC clarifies aspects of AstraZeneca vaccine use
The Immunisation Advisory Centre (IMAC) has provided some
information on certain aspects of the AstraZeneca
vaccine. The AstraZeneca vaccine is available for people aged over 18 years who are unable to, or do not want to, have
the Pfizer vaccine. It is only available at certain vaccination sites which can be identified on the Book
my vaccine website.
IMAC advise that:
- Vaccination with the AstraZeneca vaccine requires written consent. A Ministry of Health-developed consent form for
any COVID-19 vaccine is
- A prescription is required if the AstraZeneca vaccine is given as part of a mixed schedule* with other COVID-19 vaccines,
e.g. given after a first or second dose of Pfizer vaccine, because this reflects off-label use. Some vaccination clinics
may be able to provide a prescription and consent on-site, but some people may need to see their General Practitioner
or Nurse Practitioner to request these.
- A prescription is not required for the Pfizer vaccine if it is used after the AstraZeneca vaccine (or any other COVID-19 vaccine)
*A “mixed schedule” refers to anyone requesting an AstraZeneca vaccination for a second or booster dose when the previous
dose(s) administered were not the AstraZeneca vaccine.
Cancer Society SunSmart website launch
The Cancer Society of New Zealand has partnered with Te Hiringa Hauora/Health Promotion Agency to take over the delivery of
www.sunsmart.org.nz and associated campaigns. The new
look website launched on 1 December, 2021, and includes patient information and resources on how to check for and detect skin cancers and how to be SunSmart,
along with a training
module for nurses.
Reminder about nitrofurantoin
Modified release (MR) nitrofurantoin 100 mg capsules (Macrobid) have been fully funded on prescription since March, 2021. The standard dose of Macrobid for urinary
tract infection (UTI) is 100 mg MR, twice daily. As previously reported, most recently
in Issue 27, this medicine should be prescribed by brand name so it is not
confused with the 50 mg or 100 mg immediate release (IR) formulations (Nifuran), which are prescribed four times daily for UTI. It is also important to ensure that
any personalised prescribing "shortcuts" are updated to avoid inadvertent errors, e.g. prescribing Nifuran 100 mg IR, twice daily instead of Macrobid 100 mg MR,
twice daily. Pharmacists should also query any nitrofurantoin prescriptions they receive that are not a standard dose, to ensure that this was intentional.
Invitation to join new Public Health group
The Public Health Observatory New Zealand (PHONZ) has been established to provide a forum for people interested in public health intelligence to collaborate, exchange
ideas, and meet other people locally, nationally and internationally with similar interests and passions. It will be a repository for news, data, analytical tools,
information about public health intelligence and provide workforce development opportunities. Further information is available on the
website (this is an
interim home while a dedicated website is under development). To
sign up, click here.
The New Zealand health system is undergoing great change which presents an ideal opportunity for PHONZ. Vast
quantities of data are being collected and collated and rapidly turned into information through various types of analysis, "dashboards" and
other visual aids. These stages are essentially computer or "machine-driven" and underpin much of our current
decision-making. In contrast, our health system has a limited and fragmented health intelligence (i.e. human) capacity
and capability. Intelligence involves the interpretation, communication and dissemination of information. PHONZ will
address these deficiencies by providing a forum for "intelligence-driven" decision making, resulting in
enhanced knowledge and understanding of our health system and improved health outcomes for all people in New Zealand.
PHONZ will be a collective platform of support to develop strategies on how public health intelligence can be used
to drive planning and commissioning within the system. PHONZ aims to provide intelligence for equitable health outcomes.
There are over 100 people currently on the PHONZ membership list, including people from government agencies, District Health
Boards, Public Health Units, Primary Health Organisations, universities and the private sector. A PHONZ tab has been created
on the EHINZ website
as an interim measure until a dedicated website is available. Social media pages for PHONZ can be found
on LinkedIn (Public Health Observatory NZ) and Twitter (@PHObservatoryNZ).
Virtual meetings and presentations will take place for members on various topics to share information and connect people;
the first virtual meeting is scheduled for early in 2022. Workforce training courses and the creation of special interest
groups within PHONZ, such as Geospatial, Māori and Pacific, are under development. Communications will be limited to a newsletter
and invitations for joining virtual presentations and contributing items related to news, work and studies in the field of
public health intelligence. There is no cost for joining.
If you would like to become a member of PHONZ you can sign up here.
New Zealand Formulary updates for December
Changes to the NZF in the December, 2021, release include updated monographs for rosuvastatin*,
levetiracetam and the mRNA
COVID-19 vaccines. The New Zealand Formulary for Children (NZFC) includes new monographs for clopidogrel
and fosfomycin for multi-resistant urinary tract infection.
information leaflets on NZFC for ibuprofen and macrogol have been updated.
- Changes to medicine monographs include an update for rosuvastatin*
(now available funded under Special Authority
criteria for specific groups) and levetiracetam.
Several other monographs have had updates to cautions and contra-indications,
monitoring requirements and dosing regimens, e.g. dexamethasone is now listed in both NZF and NZFC with an unapproved
indication for the adjunctive treatment of suspected bacterial meningitis caused by pneumococcal or H. influenzae infection,
starting before or with the first dose of antibiotics.
- A new monograph for lenvatinib has been added. This oral
chemotherapy medicine (not funded) works to inhibit
angiogenesis, tumour growth and metastatic progression in patients with advanced or metastatic refractory differentiated
thyroid cancer, advanced renal cell carcinoma or unresectable hepatocellular carcinoma.
- A new monograph has been added for clopidogrel
in the NZFC. Although not approved for use in children, clopidogrel
can be prescribed for its antiplatelet effect in those with cardiovascular and cerebrovascular disease and also
in children with Kawasaki disease.
- Examples have been added to the calculators and formulas
page for calculating ideal and adjusted body weight
- Changes to therapeutic notes include a section update for parental anticoagulants
*Watch out for an upcoming article by bpacnz on rosuvastatin, the Special Authority criteria and its place in treatment
PHARMAC medicine funding and supply issues
The following issues relating to medicine funding and supply have recently been announced by PHARMAC
PHARMAC has been advised that although stocks
of all presentations of losartan and losartan with hydrochlorothiazide are available, supply may be limited and therefore from 1 December,
2021, all-at-once (stat) dispensing will be removed and monthly dispensing initiated.
Kenacomb ear drops and Kenalog in Orabase paste
The supplier of both kenacomb
ear drops and kenalog
in orabase paste has previously advised PHARMAC that these medicines have been in short supply due to a manufacturing issue. The issue has now
been resolved and re-supply is expected during early December. Kenacomb has been the funded alternative while flumetasone pivalate
(Locorten-Vioform) ear drops remain out of stock (see Bulletin
25 for more information on this).
Paper of the Week: Smokefree Aotearoa 2025 Action Plan
The Ministry of Health has just released their latest iteration of the plan to ultimately eliminate smoking, and
therefore smoking-related morbidity and mortality, from New Zealand. The plan contains several bold interventions designed
to collectively move the country towards the goal of being smokefree by 2025. Many aspects of the framework are related
to policy and public health measures, but primary care health professionals have an important role in helping individuals
to quit smoking and remain smokefree.
The three key outcomes of the Action Plan are:
- Eliminate inequities in smoking rates and smoking-related illness
- Ensure young people never start smoking
- Increase the number of people who successfully quit smoking
Read more about the Action Plan here
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