Category General Practice
Can I safely delabel a patient with a penicillin “allergy” history? The HNE PEN-fast scoring approach
Further to Professor Jason Trubiano’s instructive post last year concerning penicillin allergy and its risks of recurrence, here is the HNE approach to using the PEN_fast score (that his team developed and validated). This approach is increasingly used across Australia and the world to screen patients and determine whether an allergy alert can be safely […]
Non-pharmacological prevention of UTI for older people: what is the evidence base?
Guest posting: Dr Penny Webster, Staff Specialist Geriatric Medicine, Hunter New England Health Hydration Increasing fluid intake (by 1.5 litres per day) was shown in an RCT to reduce the incidence of urinary infections in premenopausal women (Hooton et al 2018 JAMA Int Med). The effect size was considerable – during the 12-months, the mean […]
Staphylococcus aureus bloodstream infection epidemiology (2022) – Hunter New England Health
Case load, mortality and relapse Healthcare-associated cases Community acquired cases N=83 (0.9 / 10,000 inpatient bed-days) 8% MRSA 9% Age-adjusted 30-day mortality (c.f. 9% in 2018) Relapse within 15-90 days (2019 – 2022): – 1.8% of adult events – 0% of paediatric events N=264 (2.8 / 10,000 population) 12% MRSA 7% Age-adjusted […]
Acute rheumatic fever and heart disease in regional NSW: risk, rates and recognition
Guest posting: Peter Massey and Julie Kohlhagen, Hunter New England Population Health. Much of the media and health service attention on Acute Rheumatic Fever (ARF) & Rheumatic Heart Disease (RHD) are rightly focused on the top end and desert communities in Australia. In a prospective screening survey of RHD in northern Australia Roberts et al […]
Treating Mycoplasma genitalium urethritis in primary care
Guest posting: Dr Nathan Ryder, Clinical Director Sexual Health, Hunter New England Local Health District. Mycoplasma genitalium is an emerging sexually transmitted pathogen. While testing is now widely available in Australia, treatment is becoming increasingly complex. M. genitalium resistance is increasing rapidly and a small but significant proportion of cases are currently untreatable. The benefit of treatment in […]
Do we need to cover ‘atypical’ community acquired pneumonia?
Guest posting: Dr John Burston, Staff Specialist, Infectious Diseases, Calvary Mater Hospital, Newcastle. Most antibiotic guidelines1-3 , including the HNELHD Community Acquired Pneumonia (CAP) guideline, suggest empirically treating community acquired pneumonia (CAP) with a macrolide or tetracycline to cover ‘atypical’ organisms. But is this necessary and what should be our approach? Beta-lactam monotherapy was non-inferior […]
Small joint septic arthritis: a different management paradigm
Guest posting: Dr Jonathan Ash, Infectious Diseases Registrar, John Hunter Hospital, Newcastle, NSW. A recent single centre retrospective case series from Switzerland examined the clinical characteristics, microbiology and treatment of 97 patients with small native joint septic arthritis. The paper highlights significant differences in the pathogenesis of small joint septic arthritis compared to large joints, […]
“UTI” – Requiem for a Heavyweight – a landmark paper
A recent paper, “Urinary Tract Infection”-Requiem for a Heavyweight by Dr Thomas Finucaine skillfully unpacks many key issues, coupling this with a consideration of the emerging knowledge of the urinary microbiome and virome, suggesting that the term “UTI” might better be referred to as a “urinary dysbiosis”. The paper is worth a detailed read – here […]
The old antibiotics are still useful – Fosfomycin
The Special Access Scheme (SAS) allows practitioners to import/gain access to therapeutic goods currently not registered on the Australian Register of Therapeutic Goods (ARTG) for a single patient on a case by case basis. Fosfomycin (one such SAS drug) is a broad spectrum antibiotic belonging to the phosphonic acid derivative drug class (other examples in this drug class include foscarnet and adefovir).
Q3 Tragedy of the commons and antimicrobial stewardship
Question 3 of our JMO pre-test survey asked about the aims of antimicrobial stewardship (yes, better ‘antimicrobial’ than ‘antibiotic’- antiviral, antifungal, antiparasitic resistance are issues as well). We gave you three options and all except one responded with the correct answer – all three! The order is important – treatment of the individual patient comes first: Optimise the effectiveness […]
AIMED - Let's talk about antibiotics 