Rotherham Area Prescribing Committee

ROTHERHAM AREA PRESCRIBING COMMITTEE NEWSLETTER

BULLETIN NO 22 December 2007

Following meeting on the 21 November 2007

HOT TOPIC 13: Aliskiren for Uncontrolled Hypertension

Novel type of agent which has been Traffic Lighted as amber as it is still triangled. There is no evidence that it is more beneficial than the preferred therapies; however specialists already using this may ask to continue prescribing this drug if the patient is resistant to routine medication.

HOT TOPIC 14: Confusion Between mg & ml Following a recent critical incident in the Paediatric Department that has been brought to the Area Prescribing Committee where the consultants in Paediatrics have asked that the GPs are made aware of the various strengths of liquid preparations which could lead to confusion around the dose of these medications. Diana Mowbray has asked that she be contacted if there is any uncertainty around the dosage of babies and infants.

01709 820000 ext 8151 Dispensary

HOT TOPIC 15: C Difficile and Cephalosporin Prescribing

What can we do to reduce this and reduce the risks to patients from broad spectrum antibiotics?

Locally 15% of C Difficile cases admitted into Rotherham hospital are community acquired. The most important actions prescribers can take is to reduce broad spectrum antibiotic prescribing. Choice of antibiotic is a significant factor, Cephalosporins in particular have been shown to increase the risk of a patient developing C Difficile.

Latest figures indicate wide varieties in the level of Cephalosporin prescribing nationally, regionally and locally. South Yorkshire spends considerably more than the Strategic Health Authority median of £103.7 (per 1000Antibacterial STAR Pus), driven partially by higher levels of Cefaclor prescribing than elsewhere, making it the third highest spender nationally. As a PCT, Rotherham sits just above the Northern PCT median spend, but this is itself a quarter higher than the National Median.

Locally, expenditure practice by practice varies from £1.45 to £57.88(NIC/ STARPU) with Items/STARPu also showing a large variation 1.37 to 33.01. With prescription of Cephalosporins implicated in the development of Clostridium Difficile revised antibiotic prescribing guidance planned for the New Year will recommend more conservative use of broad spectrum antibiotics.

Specifically, prescribers should reserve Cephalosporins for second or third line use only, particularly in those aged 65+.

Variation Between Midlands and the East Primary Care Trusts in Spending on Cephalosporins (April 2005 - March 2006) 250

Cefaclor Cefalexin Cefradine Others

M idlands and the East PCT m edian 90.8 National PCT m e dian 102.3 s U P - ) 1

0 150 ( R A T S

l a i r e t c a b i t 100 n A

0 0 0 1

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