Published: 13 November, 2020
Contents
World Antimicrobial Awareness Week (WAAW) - 18 - 24th November
The theme for this year’s WAAW is “United to preserve antimicrobials”. Details of this global initiative from the World Health Organization
are
available here (and yes, the week runs from Wednesday to the following Tuesday, that is not a typo!).
WAAW is a timely reminder that antimicrobial stewardship (AMS) is an interprofessional, multidisciplinary responsibility, including patient/consumer education.
AMS is a collective set of strategies to improve the appropriate use of antimicrobials and minimise antimicrobial-related harms including resistance and adverse effects.
WAAW is an opportunity to reflect on your use of antibiotics and consider practice updates and reviews to apply the principles of AMS.
Make it meaningful: A New Zealand initiative encourages all prescribers to document a meaningful (specific) indication for antimicrobial use within the prescription,
e.g. trimethoprim + sulfamethoxazole, 960 mg (two tablets), twice daily, for ten days, for pyelonephritis. Adding the indication justifies the reason for using an
antibiotic and selecting this particular antibiotic and duration of treatment. For resources and
further information about this collaborative DHB initiative, click here.
A nationwide AMS initiative to improve meaningful documentation of indications within antimicrobial prescriptions
DHBs around New Zealand are working collaboratively to improve meaningful documentation of indications within antimicrobial prescriptions.
Understanding the indication for antimicrobial use underpins all assessments of the quality (appropriateness) of antimicrobial prescribing,
including guidelines compliance. Although this initiative has been initially implemented for hospital prescriptions, the same principles can be applied in primary care.
Inclusion of a meaningful indication for antimicrobial use in the prescription is a key quality indicator for AMS as it:*
- Promotes thoughtful antimicrobial prescribing
- Facilitates communication between healthcare providers, and with patients
- Supports timely reassessment of the ongoing appropriateness of antimicrobial use
- Provides justification for non-guideline compliant prescribing
- Reduces patient harm from inappropriate antimicrobial use and prescription misinterpretation
- Assists quality improvement auditing
* From CDHB Antimicrobial
Stewardship Bulletin, November, 2020.
For further information on this initiative, click here.
Local resources for antibiotic awareness including posters and patient education are available from the Ministry
of Health website.
Article for reflection "Antibiotics: the future is short", written by bpacnz.
Read more
"Antibiotics: the future is short", explains the principles of appropriate use
of antibiotics in primary care and focuses on the increasing evidence in support of shorter courses of antibiotics. For many infections, short courses are
at least as effective as longer courses and are associated with a reduced risk of adverse effects and antimicrobial resistance.
The key practice points from this article are:
- Using antibiotics only when needed, and using short courses when appropriate, will avoid unintended adverse consequences for
individuals and reduce the burden of antimicrobial resistance in the long-term
- Based on evidence of comparable clinical outcomes, shorter antibiotic courses are indicated for many conditions
- Clear communication is crucial when antibiotics are prescribed and dispensed to ensure that the patient knows why and how they should be taken
- Occasionally an antibiotic regimen may need to be individualised, e.g. a longer treatment course for patients who are immunosuppressed
Modified-release nitrofurantoin capsules to be funded from 1 March, 2020
PHARMAC
has announced a decision to fund a new modified-release formulation of nitrofurantoin for the treatment of uncomplicated urinary tract infections.
The Macrobid brand of nitrofurantoin modified-release 100 mg capsules will be funded from 1 March, 2021.
Nitrofurantoin is currently recommended
as the first-line treatment for symptomatic cystitis in adults. The recommended dose is 50 mg, four-times daily for five days,
or for seven days in males or pregnant women. When available, an alternative regimen of 100 mg modified-release capsules, twice daily, would be a suitable treatment.
A twice-daily regimen is likely to improve treatment adherence.
As Macrobid has only recently received Medsafe approval,
a datasheet is not yet available, but is expected to be listed on the Medsafe website prior to 1 March.
The standard-release 50 mg and 100 mg nitrofurantoin tablets will remain available and funded.
Decision on funding of new medicines for type 2 diabetes delayed
In Bulletin 10 we reported that PHARMAC was consulting on a proposal to fund two new medicines for diabetes – a sodium-glucose co-transporter 2 (SGLT2) inhibitor,
empagliflozin (with and without metformin) and an injectable glucagon-like peptide 1 (GLP-1) receptor agonist, dulaglutide. It was initially proposed that, if implemented,
these medicines could be funded from 1 December, 2020. However, PHARMAC
has announced that they require additional time to consider the feedback that was received
during the consultation period. Therefore, a decision will not be made in time for the medicines to be available from December. There is no indication when
the decision on funding will be made.
Zostavax catch-up to end soon
Zostavax (shingles vaccine) is funded on the National Immunisation Schedule for people aged 65 years. People who turned 65 years before the vaccine was funded on 1 April,
2018, have been eligible for a funded catch-up vaccine. This was due to end in March, 2020, however, the catch-up programme has been extended until 31 December, 2020.
This means that people aged between 67 and 80 years who have not yet received Zostavax, can receive a funded vaccine until the end of this year. People who turned 65
years on or after 1 April, 2018, do not have a time limit to receive a funded dose of Zostavax, however, it is recommended to be given as close to age 65 years as possible.
Read further information from the Immunisation
Advisory Centre.
Paper of the week: Latest report released on cardiac surgeries in New Zealand
For the past five years, the New Zealand National Cardiac Surgery Clinical Network has been collating data on publicly funded cardiac surgeries performed at five
hospitals across the country. The latest national report includes data on demographics, risk factors and outcomes for all 2,625 patients who underwent surgery in 2018.
The report contains some very thought-provoking findings and is likely to be of interest to all healthcare professionals who have a role in caring
for patients with cardiovascular disease.
Key findings
- The two most common procedures were coronary artery bypass graft (CABG) and aortic valve replacement (AVR),
together accounting for 60% of cases
- The largest proportion of patients were aged between 50-69 years and 74% were male
- Females were more likely to be aged over 70 years
- Most people were overweight or obese (77%), and just under half were current (10%) or ex-smokers (35%)
- Hypertension was the most common co-morbidity (71%), followed by diabetes (22%), and approximately one-third
of patients had a previous myocardial infarction (21% within the 30 days prior to surgery)
- Approximately seven in ten surgeries were performed in people of European ethnicity (70%), compared to one in
ten in Māori (11%) and Pacific Peoples (9%). This highlights a significant inequity as Māori represent approximately
16% of the population of New Zealand, and Pacific Peoples 8%, and both groups have higher rates of cardiovascular
disease than the general population.
Read the full report for more details on these findings, including surgery outcomes.
The New Zealand National Cardiac Surgery Clinical Network. Cardiac surgery in New Zealand public hospitals. 2018 Annual Report;
Report Number 4. Available from:
https://www.health.govt.nz/system/files/documents/publications/new-zealand-cardiac-surgery-national-report-2018-nov20.pdf
This Bulletin is supported by the South Link Education Trust
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