Prescribing Advice for GPs

Unexplained infertility treatment challenged

August 11, 2008 on 10:10 am | In Prescribing Extra - Other |  Print | No Comments

The British Medical Journal has published the results of a randomised controlled trial that aimed to compare the effectiveness of clomifene citrate and unstimulated intrauterine insemination with expectant management for the treatment of unexplained infertility. The study has been reported in the general media (BBC).

580 women were recruited to the study with a primary outcome measure of live birth. In addition data were collected to assess how acceptable the method of treatment was to the patient. The women were well matched in terms of age, body mass index, duration of infertility and partners’ sperm concentration and motility.

• 32/193 (17%) of those women in the expectant management arm gave birth to a live child
• 26/192 (14%) of those women in the oral clomifene citrate arm gave birth to a live child
• 43/191 (23%) of those women in the unstimulated intrauterine insemination gave birth to a live child

There were no statistical differences when comparing either active treatment arm with expectant management. However, a greater proportion of women in the treatment arms (94% for clomifene citrate and 96% for intrauterine insemination) found the treatment method acceptable compared to those in the expectant management arm (80%).

The authors conclude that active treatment is “unlikely to offer superior live birth rates compared with expectant management“. They also point out “women with infertility are reassured by active treatment and are less satisfied with an expectant approach“.

Action: This study may start to challenge current practice in the treatment of unexplained infertility. It may be appropriate to find another way of reassuring couples who are trying to start a family rather than resorting to ineffective treatments.

Azithromycin OTC for chlamydia

August 7, 2008 on 10:31 am | In Prescribing Extra - Drugs |  Print | 3 Comments

The Medicines and Healthcare products Regulatory Agency has issued a press release advising that azithromycin is to be made available to purchase in pharmacies. This press release has been reported in the general media (BBC).

The product will be called Clamelle^® and will be licensed for people over 16 year old who have tested positive for the infection and have no symptoms, and for their sexual partners.

Proof of infection, or contact with an infected individual, is likely to be through documentary evidence of a positive test result or a tear-off handed to a sexual contact by the individual who has tested positive.

This product is not currently available but is expected to be in pharmacies later this year. Patients will need to pay for this product themselves and therefore demand for this item is likely to depend upon the price point. This is expected to be £20, as confirmed by the manufacturer and therefore demand is expected to be low.

Action: Clinicians should be aware of the availability of this product. It is likely to drive consultations but could be a useful route of supply for some patients.

Seasonal ‘flu update

August 6, 2008 on 9:59 am | In Prescribing Extra - Other |  Print | No Comments

The Department of Health has written to healthcare professionals to provide an update (PDF) of the current situation regarding the seasonal influenza campaign for 2008/09.

The update states that there are currently no known problems with vaccine production this year, however it is recommended that individual surgeries confirm delivery schedules before starting to book clinics.

The update also advises that supporting materials will be available again this year and that order forms will be distributed later this year. Finally, the update encourages greater focus upon targeting under 65 clinical risk groups in order to achieve an improvement in overall vaccination rates.

Action: Clinicians involved in the delivery of influenza vaccination clinics should be aware of the current production situation to allow for clinic planning.

MeReC Bulletin - CV Risk

August 5, 2008 on 1:30 pm | In Prescribing Extra - Other |  Print | No Comments

The National Prescribing Centre (NPC) has published a MeReC Bulletin (PDF) that summarises the current recommendations for assessing and communicating the risk of cardiovascular disease (CVD).

The bulletin aids the implementation of the recent Lipid Modification issued by the National Institute for Health and Clinical Excellence (NICE). It covers the following:

• Which CVD risk prediction tool to use
• Identification of individuals appropriate for risk assessment
• How to formally assess CV risk
• How to calculate CV risk for patients with type 2 diabetes
• How to communicate the calculated CV risk to patients

Action: Any clinician involved in calculating and communicating CV risk to patients will find this summary useful. It also contains pointers to resources that will make the risk prediction process and communication of that risk easier.

Drug Safety Update - August 2008

August 4, 2008 on 11:24 am | In Prescribing Extra - Other |  Print | No Comments

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for August 2008 (PDF).

This issue includes the following drug safety advice articles:

• Antiepileptics: suicidal thoughts and behaviour
• Recombinant human erythropoietins: new recommendations for treatment of anaemia in cancer

In addition, this issue contains a hot topic containing information about thalidomide and lenalidomide for multiple myeloma. The stop press section contains several reminders of developments in the last month including the prescribing restrictions imposed for moxifloxacin and using oral metronidazole (not intravenous) to treat Clostridium difficile-associated diarrhoea unless advised otherwise by a specialist.

Action: Clinicians will find this publication to be a useful review of current issues in drug safety.