Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Additional CKS Update – March 2011

Clinical Knowledge Summaries (CKS) has been further updated in March 2011 for the following clinical areas:

Contraception is now covered in seven separate topics but there are no changes to the recommendations.

Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.

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JCVI advice on the pneumococcal vaccination programme

The Joint Committee on Vaccination and Immunisation (JCVI) has issued advice (PDF) that the routine pneumococcal vaccination programme for adults aged 65 years and older should be discontinued. This advice has also been the subject of a letter from the Department of Health that aims to provide information to help clinicians answer questions from patients.

The 23 valent pneumococcal polysaccharide vaccine was introduced in 2003 with the aim of reducing the incidence of invasive pneumococcal disease in the population aged 65 years and older. At the time it was noted that the effectiveness and duration of cover was uncertain.

A recent review has found no discernable decrease in the incidence of invasive pneumococcal disease in those aged 65 years and older following the introduction of the vaccination programme despite widespread use in this age group. It is additionally noted that since the introduction of a different pneumococcal vaccine into the childhood immunisation programme in 2006 there has been a decline.

JCVI have therefore recommended that the routine pneumococcal vaccination programme for those aged 65 years and older be discontinued but the vaccine should still be offered to those in clinical risk groups as the evidence on efficacy in younger people is more robust.

The Department of Health are seeking the views of professional and patient groups and the vaccine manufacturers before making a final decision.

Action: Clinicians should be aware of this advice and the Department of Health review. In the meantime, clinicians should continue to follow the existing guidance in the Green Book.

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MeReC Bulletin - medicines used for IBD

The National Prescribing Centre (NPC) has published a MeReC Bulletin (PDF) that answer some common questions around medicines used for inflammatory bowel disease (IBD).

The bulletin recommends that drugs to induce or maintain remission should always be started by a specialist but once remission is achieved prescribing can be continued and monitored by a GP.

The bulletin covers aminosalicylates, immunosupressants, corticosteroids and tumour necrosis factor (TNF) inhibitors. The advantages and disadvantages of each class are reviewed in the context of Crohn's disease and ulcerative colitis.

Action: Clinicians will find this bulletin a useful summary of the drug management inflammatory bowel disease.

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Pulmicort pMDI to be discontinued

The manufacturer of budesonide CFC-free (Pulmicort®) pressurised metered dose inhalers (pMDI) has announced that this product will be discontinued.

The manufacturer cites "complex manufacturing issues" that relate exclusively to this product and that they have "exhausted all potential solutions". The company are advising patients to find an alternative medication as soon as possible.

It is unclear from this announcement how long current supplies might last. Patients will need a change of their inhaled corticosteroid or a change in the style of device that they use as this is no direct equivalent.

Action: Clinicians should be aware of this announcement. Patients affected should be identified and invited for a review to discuss the available alternatives.

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NICE Guidance - March 2011

The National Institute of Health and Clinical Excellence has published new guidance for the month of March 2011. This month there are two public health guidelines, one clinical guideline, and one technology appraisal that impact upon primary care.

The public health guidelines both relate to increasing HIV testing uptake in black Africans and men who have sex with men.

The clinical guideline discusses the diagnosis and treatment of active and latent tuberculosis in adults and children and strategies to prevent the spread of tuberculosis.

The technology appraisal is an update to a previous appraisal for the drug treatment of Alzheimer's disease. The review covers donepezil, galantamine, rivastigmine and memantine. Key changes in the update are that donepezil, galantamine and rivastigmine are now recommended in mild as well as moderate disease and memantine is now an option in moderate disease.

Action: Clinicians should be aware of these recommendations and implement any necessary changes to practice.

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