Download Antidote - Hampshire LPC website

Ms Julia Bowey
Head of Medicines
Management
Issue 126
Antidote
Urgent treatment of Croup -consider oral corticosteroid treatment for all
children, and a practice stock of soluble prednisolone for more severe cases.

See local Map of Medicine for Croup (October 2012) for assistance in diagnosing and
classifying the severity of croup on presentation (www.mapofmedicine.com).
October
2012
“Tip of the
Month”
Mild Croup

Consider a single dose of oral dexamethasone in children with mild croup -this reduces
the proportion who re-present with croup in the following 7-10 days, compared with placebo.
Dexamethasone dose for a child; 150 micrograms/kg body weight orally as a single dose:

A 'typical' one-year-old weighing 10kg will require a dose of 1.5mg, which can be prescribed and administered as 3
x 500 microgram tablets
 Dexamethasone is also available as 2mg tablets for heavier children
 Dexamethasone tablets can be dispersed in water prior to administration (see the BNF for Children)
 Avoid prescribing the oral solution which is unlicensed and therefore not routinely stocked in community pharmacies
(If parents/carers provide a good history of croup in the preceding 24 hrs but the child is now well, a dose of
corticosteroid could be prescribed in case the child deteriorates again).
Moderate or Severe Croup (see local Map of Medicine Croup pathway for clinical definitions)


Give oral corticosteroid treatment (single dose) for all children with a diagnosis of moderate croup. If no
corticosteroids are available, refer to the Emergency Department (ED).
Severe croup requires urgent carriage to secondary care services.
Consider soluble prednisolone. Dose for a child; 1-2mg/kg body weight orally as a single dose.


Soluble prednisolone is available as 5mg tablets, which should meet all needs.
Practices may wish to consider keeping a pot of these in stock to administer in moderate to severe cases,
either instead of, or before, urgent transfer to hospital.
For all groups, consider giving a second dose if residual symptoms are still present the following day.
Drug Safety Update (MHRA)
http://www.mhra.gov.uk//Safetyinformation/DrugSafetyUpdate/CON185627
Volume 6, Issue 2 (September 2012)
Drug safety advice of particular relevance to primary care:
Oseltamivir (Tamiflu): changed concentration and dosing dispenser of oral suspension from October 2012
From early October 2012, the strength of oseltamivir (Tamiflu) oral suspension will be 6 mg/mL. A new dosing dispenser,
calibrated in mL, will be introduced at the same time.
Dipeptidylpeptidase-4 inhibitors (‘gliptins’): risk of acute pancreatitis
There have been reports of acute pancreatitis associated with drugs in the dipeptidylpeptidase-4 (DPP-4) inhibitor class of
antidiabetic agents (‘gliptins’). Patients should be informed of the characteristic symptoms of acute pancreatitis – persistent,
severe abdominal pain (sometimes radiating to the back) – and encouraged to tell their healthcare provider if they have
such symptoms.
Levofloxacin: some indications restricted
Levofloxacin (a fluoroquinolone antibiotic) may only be considered in the treatment of acute bacterial sinusitis, acute
exacerbation of chronic bronchitis, community acquired pneumonia or complicated skin and soft tissue infections when
other medicines cannot be prescribed, or have been ineffective.
Long Term Proton Pump Inhibitors (PPIs) and rare reports of
hypomagnesaemia or risk of fracture
http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON149774
Further to the April edition of Antidote where we included the MHRA warnings on
this, further local advice has been agreed as follows:
Hypomagnesaemia

Where possible use PPIs for no longer than one year continuously (e.g. use intermittently
for symptom control at the lowest possible dose). Problems seem to be associated with
long term use (>1 year). Over the counter PPIs should not be used for more than 4 weeks
without medical advice.

In anyone taking a long term PPI with a loop diuretic, thiazide or metalozone, in particular
with digoxin, be extra vigilant of early warning signs of severe hypomagnesaemia and warn
patients of possible insidious symptoms (e.g. fatigue, dizziness, loss of appetite, vomiting,
muscle twitches or tremors)

Measure magnesium if problems are suspected and seek advice from the CCG medicines
management team with respect to correction with magnesium supplements if levels are
very low. Discontinue the PPI if possible.

Magnesium supplements are ‘special order’ products and as such should not be prescribed
without the latest product advice from your CCG pharmacist.
Fracture Risk

Local Osteoporosis Guidelines have been updated to reflect MHRA guidance. PPI’s have
been added to the list of medications associated with a (modest) risk of osteoporosis when
used at high doses for longer than one year. Elderly patients may be particularly
susceptible.

Where possible use PPIs for no longer than one year continuously (e.g. use intermittently
for symptom control at the lowest possible dose). Problems seem to be associated with
long term use (>1 year) at high doses. Over the counter PPIs should not be used for more
than 4 weeks without medical advice.

Avoid PPIs where possible in patients with osteoporosis or with multiple risk factors, and
ensure adequate calcium and vitamin D intake.

Give advice on other lifestyle factors to reduce the risk of osteoporosis and/or fracture.
The Map of Medicine now has over 100 local clinical pathways.
Visit www.mapofmedicine.com to browse what is available locally (Southampton / South
West Hampshire view).
An NHS Athens password is required.
The maps may be helpful both between and during consultations (as they contain patient
information links), and for CPD, appraisals and revalidation purposes