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Antibiotics. Medicines Management Team October 2008. Antibiotics – Good news. Trafford 4 th lowest frequency prescriber of antibiotics in the NW SHA. Antibiotics – Bad news. Trafford is expensive - 3 rd highest costs for antibiotics in the NWSHA. TSC – Main Culprits. Azithromycin

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Antibiotics

Antibiotics

Medicines Management Team

October 2008


Antibiotics good news
Antibiotics – Good news

  • Trafford 4th lowest frequency prescriber of antibiotics in the NW SHA


Antibiotics bad news
Antibiotics – Bad news

  • Trafford is expensive - 3rd highest costs for antibiotics in the NWSHA


Tsc main culprits
TSC – Main Culprits

  • Azithromycin

  • Quinolones

  • Minocycline

  • Clindamycin

  • Cefalexin




Azithromycin
Azithromycin

  • On Trafford guidelines as treatment for Chlamydia only

  • Although, recommended by SMUHT respiratory physicians for some patients with Bronchiectasis

  • Need to ensure appropriate indications




Quinolones
Quinolones

  • On Trafford guidelines for;

    • 1st line – Acute prostatitis

    • 2nd line with Metronidazole – Acute or chronic rhinosinusitis

    • Only if patient allergic to penicillin – Acute pyelonephritis

    • Only if patient allergic to penicillin with Metronidazole – Pelvic Inflammatory Disease


Quinolones1
Quinolones

  • Trafford are the No 1 prescribers in NWSHA!

  • Associated with the virulent 027 strain of C Difficile

  • Need to ensure used for appropriate indications only




Minocycline
Minocycline

  • No longer recommended in Trafford guidelines

  • Minocycline can cause hepatotoxicity and pigmentation (sometimes irreversible) when used long term. If it is to be used for more than six months then three-monthly monitoring for hepatotoxicity, pigmentation and systemic lupus erythematosus is recommended.


Minocycline1
Minocycline

  • A meta-analysis of tetracycline efficacy in the treatment of acne showed no difference in efficacy between first generation tetracyclines, Doxycycline, Minocycline and Lymecycline. Using a tetracycline with a low acquisition cost first line would therefore appear to be a reasonable strategy for treatment of acne – Lymecycline now considered tetracycline of choice for acne

  • Review any person currently taking Minocycline and change to a more appropriate therapy




Clindamycin
Clindamycin

  • Only recommended as a second line therapy or if patient has spreading cellulitis

  • If Clindamycin is prescribed please ensure that patient is counselled that if they experience any abdominal pain or diarrhoea that they should stop treatment and seek advice immediately

  • Seek microbiology advice if needed


Clindamycin1
Clindamycin

  • However, clindamycin is strongly associated with antibiotic‑associated colitis (C. difficile) infections and therefore high prescribing rates of clindamycin may be associated with C. difficile rates. Information on local (hospital) MRSA and C. difficile rates can be found on the Health Protection Agency website. (www.hpa.org.uk)





Cephalosporins tsc1
Cephalosporins - TSC

  • On Trafford guidelines only for;

    • 2nd line – Uncomplicated UTI, depending on susceptibility

    • 2nd line – UTI in pregnancy or men

    • After Trimethoprim or Nitrofurantion in UTIs in children

  • The HPA has recommended that broad spectrum antibiotics, including co-amoxiclav, quinolones and cephalosporins, are best avoided when narrow spectrum antibiotics remain effective, because they increase the risk of C. difficile, MRSA and resistant urinary tract infections.

  • Hospital lab no longer reporting on Cefalexin


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