Memos and Alerts
Chief Medical Officer Letters to High Antibiotic Prescribers
Improving antibiotic stewardship is a priority for Public Health England due to the continuing threat of antimicrobial resistance. The Chief Medical Officer for England is sending her annual feedback letter on antibiotic prescribing rates to GPs in April 2017.
The feedback letters are being sent to over 6,300 individual GPs in over 1,400 different GP practices with high antibiotic prescribing rates. Practices were selected based on their level of prescribing per STAR-PU and in comparison with the England average used by the Quality Premium. The letters are tailored according to GP practice prescribing rate, change in prescribing over time, and whether they were previously sent feedback. While many GPs are already reducing their usage of antibiotics, the letters are intended to support GPs to reduce their prescribing further by providing feedback on practice prescribing rates, offering encouragement and suggesting practical actions in a clear and succinct manner.
Resources To Support The Safety Of Girls And Women Who Are Being Treated With Valproate
It is vital where valproate is prescribed to girls and women of childbearing potential that they are made aware of the risks of taking the medication in pregnancy. The need for effective contraception planning must also be emphasised, along with the requirement for specialist oversight to safely change their medication if planning a pregnancy. MHRA have updated its valproate toolkit, providing a range of resources to support providers, staff and patients in the safe use of valproate. This alert asks all providers to undertake systematic identification of girls and women who are taking valproate, and to ensure the MHRA resources are used to support them to make informed choices.
SGLT2 inhibitors: updated MHRA advice on increased risk of lower-limb amputation (mainly toes)
Canagliflozin may increase the risk of lower-limb amputation (mainly toes) in patients with type 2 diabetes. Evidence does not show an increased risk for dapagliflozin and empagliflozin, but the risk may be a class effect. Preventive foot care is important for all patients with diabetes.
Harm reporting system for new psychoactive substances (NPS) launched
Public Health England have launched a new online system to report illicit drug reaction, to improve knowledge of the harmful effects of new psychoactive substances.
The ban on these new substances has been successful in reducing their easy availability but there are still many new ones circulating. The chemical content of these substances frequently changes and their effects can be dangerous and unpredictable. That is why they are so risky. This information – reported directly and easily onto the system by those at the frontline dealing with the casualties – will help shed more light on both the immediate and longer term harms of these new drugs.
NHS Prescription Charges from April 2017
The government has announced an increase to the NHS prescription charge of 20 pence, to £8.60 per prescription item. This change will come into effect from 1 April 2017.
Cochrane review of long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA) versus LABA plus inhaled corticosteroid (ICS) for stable chronic obstructive pulmonary disease (COPD)
In a Cochrane review of 11 studies, which included 9839 participants with stable chronic COPD, LAMA+LABA treatment had fewer exacerbations, […]
Ensuring appropriate polypharmacy: Patients with frailty or moving towards end of life care
This PrescQIPP bulletin focuses on frailty and end of life and the specific considerations that would apply to this group of patients when reviewing medicines or considering stopping medicines. Medicines that should usually be continued and those with increased potential to cause harm are highlighted in the full bulletin with evidence-based tools to help the review process.
Q&A Is there an interaction between erythromycin and statins?
This updated Medicines Q&A evaluates the evidence for an interaction between erythromycin and statins. It concludes that if co-prescription with a drug that increases systemic exposure to statins is unavoidable, it is particularly important to start on the lowest statin dose.
Q&A Is there an interaction between bisphosphonates and proton pump inhibitors?
This updated Medicines Q&A concludes that whilst there is not a recognised interaction between bisphosphonates (B) and PPIs, a common side effect of bisphosphonates is gastro-intestinal disturbance. Additionally the SPCs for B and PPIs highlight an increased risk of fractures.