Category Hospital practice

Viral Hepatitis and HIV Prescribing Summary

Guest posting from A/Prof Josh Davis, Newcastle.  Image credit: https://www.hepatitisc.uw.edu/go/treatment-infection/treatment-genotype-3/core-concept/all 2020

How long should that antibiotic course last?

Guest posting from Ms Kristi Kozierowski, AMS and ICU pharmacist, John Hunter Hospital, NSW, Australia. This is a useful evidence-based summary produced for AAW 2019 – Duration FINAL Kozierowski 2019.  Usage welcome with acknowledgement. References Shorter is better : evidence review by Brad Spellberg  

Smartphone website for local guidelines including pneumonia (HNELHD)

The  Quality Use of Medicines smartphone-enabled website has been updated to include changes to hospital acquired pneumonia guidelines. With this site, you are only three clicks away from a treatment recommendation!  See below for the range of guidelines available. Note that whilst Therapeutic Guidelines: Antibiotic remains the main resource, HNE guidelines, where approved, take precedence- […]

Acute piperacillin+tazobactam shortage – important advice – JHH and HNELHD

Currently (still in Feb 2018) there is a worldwide shortage of piperacillin+tazobactam , an additional issue to the shortage earlier in 2017 . Appropriate substitutions – see – HNELHD advice (November 2017)  JHH_Pip_Taz_Fact_Sheet_Oct_2017 . This includes new dosage recommendations for IV amox+clavulanate for intra-abdominal infection (6 -hrly rather than 8- hrly dosing). For further advice, please contact the […]

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, […]

Overuse => global shortage! Let’s conserve what piperacillin+tazobactam we have left

Piperacillin+tazobactam (Tazocin) is one of our most important broad spectrum agents and is in short supply. Please conserve it by avoiding use in these common situations: Uncomplicated biliary sepsis  (Use ampicillin+gentamicin(max 48hrs) OR if allergic, ceftriaxone) Urinary tract infection with sepsis (Use ampicillin+gentamicin(max 48 hrs) OR if allergic, ceftriaxone) Early onset (< 5d after admission) […]

IV amoxycillin+clavulanate available – uses in intra-abdominal infection – new guideline

We’ve previously counselled against augmentin overuse in a number of conditions which did not, however, include intra-abdominal infection where the new availability of an IV preparation offers us a way of reducing the use of the workhorse antibiotic piperacillin+tazobactam. Here is our freshly minted guideline which also provides more explicit advice about short or no […]

2016 Hunter New England LHD Cumulative Antibiograms just released

Cumulative antibiograms provide a summary of current bacterial antimicrobial susceptibility for key pathogens in urine and non-urine specimens.  Treatment recommendations based on Therapeutic Guidelines, Antibiotic, Edition 15, 2014 are included in each report. These are prepared by Pathology North, Microbiology for Hunter, New England and Lower Mid-north coast regions. The antibiogram reports include analyses of […]

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).