Latest edition of Australian Prescriber out now
3 February 2014
The latest edition of Australian Prescriber is out now and looks at the following topical issues:
Antibiotic resistance is having an impact on the way urinary tract infections are treated, according to Thomas Jarvis, Lewis Chan and Thomas Gottlieb from the University of Sydney. Management is usually simple but certain infections require further evaluation. Uncomplicated infections should almost always be treated with antibiotics to decrease duration and severity of symptoms, but formal microscopy, culture and susceptibility testing can be performed to ensure appropriate therapy. If the patient has no symptoms, bacteria in urine should only be treated in certain cases such as pregnant women and those undergoing an invasive procedure. The article outlines strategies to prevent recurrent infections, and guidance on treating complicated infections.
Drugs for incontinence only have modest efficacy, and can have adverse effects away from the urinary tract, write Shannon Kim, Shuo Liu and Vincent Tse from Concord Hospital, Sydney. This may be problematic in older people. The authors outline the drug and non-drug treatments for urgency incontinence, which can be managed with bladder training and antimuscarinic drugs. Pelvic floor muscle training is useful for treating stress incontinence, but if this fails, surgical treatment is often required as drug treatment has a limited role.
Paracetamol has a good safety record when used appropriately. However, since intravenous paracetamol has become widely available there have been multiple inadvertent overdoses in infants. Madlen Gazarian, from the University of New South Wales and NSW Therapeutic Advisory Group, and Anna Drew and Alexandra (Sasha) Bennett, from the NSW Therapeutic Advisory Group, review cases involving small babies inadvertently given up to ten times the recommended dose of paracetamol.
The authors give recommendations for safe use of paracetamol in paediatric patients, including guidance about when and how to use it intravenously. They suggest reserving intravenous paracetamol for acute, short-term treatment of mild-moderate pain, undertaking a comprehensive risk assessment before starting treatment, and reviewing patients daily. They also recommend following general principles for safe paediatric prescribing, especially those to do with correct dose choice and calculations, using accurate weights and standard dose units, and double-checking calculated doses.
Other articles in this edition of Australian Prescriber include
- Safe prescribing of metformin in diabetes
- Sodium-glucose co-transporter inhibitors: Mechanisms of action
- Sodium-glucose co-transporter inhibitors: Clinical applications
To read the full articles and more visit www.australianprescriber.com
Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals, particularly doctors in general practice. It is published every two months and distributed to health professionals free of charge, and is also available online at www.australianprescriber.com
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