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Published: 12 November, 2021


World Antimicrobial Awareness Week (WAAW) – 18 – 24th November

The theme for this year’s WAAW is “Spread Awareness, Stop Resistance”. Details of this global initiative from the World Health Organization are available here.

WAAW is a chance for healthcare professionals to reflect, and act, on the multidisciplinary responsibility for antimicrobial stewardship (AMS), including the role of patient education. The overarching goal of AMS is to improve the appropriate use of antimicrobials and minimise antimicrobial-related harms, including resistance and adverse effects. AMR is a global crisis and disproportionately impacts our most vulnerable populations.

General principles of antimicrobial stewardship include:

  1. In most cases, only prescribe antibiotics if symptoms are likely to be due to a bacterial infection and:
    • Are significant or severe; or
    • Have a high risk of complications; or
    • Are not resolving or are unlikely to resolve
  2. Follow local guidelines and select the recommended antibiotic, dose, route and duration
  3. Reserve broad spectrum antibiotics for when narrower spectrum options are not appropriate
  4. Talk with patients about responsible use of antibiotics, including the potential harms of using an antibiotic when it is not indicated

A New Zealand initiative to raise awareness about incorrect penicillin allergy labelling

District Health Boards (DHBs) across New Zealand are working collaboratively via Antimicrobial Stewardship and Infection Pharmacists to raise awareness about the potential for incorrect penicillin allergy labelling and the associated harms. DHBs are inviting patients who think that they have penicillin allergy to talk to their healthcare team – so be prepared!

For resources and 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.

End of Life Choice Act 2019

With the introduction of the End of Life Choice Act 2019 on 7 November, 2021, many clinicians will be considering how these regulatory changes will affect them and their patients. The Medical Council of New Zealand has published a resource that aims to provide further understanding of key provisions in the Act. The Council has summarised some of the relevant sections of the Act and alongside these they have applied the existing Council statements and standards. The aim of this document is to help clinicians understand the Act and their potential role. The Medical Council caution that the resource document is a summary only - to access and read the full text of the Act click here.

Further information on the assisted dying service is available from the Ministry of Health. This link takes you to the “landing page” which is a good place to start when looking for information for both health professionals and patients. N.B. this page also includes instructions on how to lodge a conscientious objection.

Baclofen oral suspension – HQSC Medication Alert

Baclofen is a muscle relaxant used in both adults and children for conditions related to spasticity. Only injectable* and tablet forms are funded in the community. This means that if a child requires an oral liquid, this must be extemporaneously compounded by a pharmacist. Until recently, the concentration of the standardised batch sheet for compounded baclofen was 10 mg/mL. Doses for paediatric patients can be small (less than 10 mg), translating to very small volumes of the 10 mg/mL suspension. As a result, the concentration may have been adjusted to make it easier for caregivers to measure and administer a dose. Thus, concentrations compounded have ranged from 1 mg/mL to 10 mg/mL. The differences in concentration have caused medicine errors when transitioning between hospital and community treatment and between pharmacies.

As of 1 November, 2021, the standardised batch sheet for compounded baclofen suspension is 1 mg/mL. This will align with the concentration of the proprietary oral liquid (1 mg/mL) available in hospitals and therefore reduce the potential for medicine errors. N.B. baclofen tablets can alternatively be crushed and dispersed in water immediately before administration if the prescribed dose would necessitate a large amount of oral suspension or liquid.

Read more about the alert and actions to take here.

* Funded by endorsement only when used in a programmable pump

Brand change for long-acting diltiazem

PHARMAC has advised that the current brand of long-acting diltiazem (Apo-Diltiazem) will be delisted from the Pharmaceutical Schedule on 1 February, 2022. An alternative brand of diltiazem 120 mg, Accord, will be listed from 1 December, 2021, however, it does not have Medsafe approval and will need to be prescribed and supplied under Section 29. An alternative brand of 180 mg and 240 mg diltiazem tablets (Cardizem) has been available and funded since October, 2021.

N.B. As covered in Bulletin 18, 30 mg and 60 mg diltiazem tablets (Dilzem) were discontinued earlier this year; stock of 30 mg tablets has now run out and they have been delisted, 60 mg tablets will be delisted by 1 January, 2022.

Prazosin supply issue

PHARMAC advise that supply of the new funded brand of prazosin, Apo-Prazosin S29, has been delayed, but is expected to arrive shortly. We reported on prazosin in Bulletin 29, where it was announced that all formulations of Apo-Prazosin were to be discontinued and delisted from the Pharmaceutical Schedule in May, 2022; doxazosin may be a suitable alternative. PHARMAC has since secured 18 months’ supply of Apo-Prazosin S29 and are working to secure longer-term supply. Previously, prazosin was restricted to people who had been taking it before 1 August, 2021, however, this restriction has now been removed. Apo-Prazosin S29 does not have Medsafe approval and will need to be prescribed and supplied under Section 29.

PHARMAC funding treatments for COVID-19

There have been several recent announcements regarding medicines that PHARMAC is funding for treatment of patients with COVID-19. While some of these treatments will not be used in a community setting, they may be of interest to our audience:

Paper of the Week: Improving the early identification of COVID-19 pneumonia

This week in the BMJ, Dr Dan Goyal and colleagues from the United Kingdom have contributed a review of clinical studies on the early detection of symptoms and signs likely to lead to COVID-19 pneumonia, when monitoring patients in the community. The growing global body of evidence and experience in treating COVID-19 is helping researchers develop clinical methods to limit progression and severity of infection. So far, interventions with the most evidence include timely and optimal oxygen treatment and the administration of steroids. The authors of this BMJ review have searched the evidence to identify clinical parameters that are early indicators of a patient with COVID-19 who is likely to deteriorate. These assessments can be carried out with basic clinical questions and measurements.

Read the full article here: Goyal D, Inada-Kim M, Mansab F, et al. Improving the early identification of COVID-19 pneumonia: a narrative review. BMJ Open Respiratory Research 2021;8:e000911. doi: 10.1136/bmjresp-2021-000911

This Bulletin is supported by the South Link Education Trust

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