Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

July NICE Guidance

The National Institute of Health and Clinical Excellence has published new guidance for the month of July.

There is one clinical guideline that impacts on primary care. The when to suspect child maltreatment guideline (PDF) provides an extensive list of alerting features in children and young people (under 18 years) that could indicate:

  • physical, sexual and emotional abuse
  • neglect
  • fabricated or induced illness

The guidance does not cover risk factors, training of healthcare professionals or child protection procedures.

Action: Clinicians who see children and young people should consider this guideline to be required reading.

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Swine 'flu in pregnancy advice

The Department of Health (DH) has reissued advice for pregnant women and parents after a women died of swine 'flu shortly after giving birth.

The existing hygiene advice has been re-stated with the public urged to remember to Catch it, Bin It, Kill It. Coughs and sneezes should be caught in a tissue, put quickly in a bin and hands and surfaces washed regularly to kill the virus.

The advice also states that most cases of swine 'flu, including those in pregnant women, are likely to be mild. There is a higher risk of developing complications during pregnancy. Some organisations, such as the Royal College of Obstetricians and Gynaecologists are advising pregnant women to avoid crowded places when possible.

The DH also provides some reassurance about the availability of antiviral medication for use during pregnancy and breast feeding.

Action: Clinicians should be aware of this advice. Pregnant women should be reassured that swine 'flu is mild in most cases. Avoiding situations where contracting the virus is more likely (such as crowded places) is a common sense approach to reducing the risk of infection and therefore complications.

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Increase in presentation of flu-like illness

The Health Protection Agency (HPA) released a weekly pandemic update earlier this week that shows increasing levels of individuals presenting with flu-like illness in primary care settings.

Individual clinicians and healthcare provider organisations are likely to be responding to demand and activating pandemic influenza plans. The HPA also notes that the vast majority of cases are mild with the 5-14 year old age group being predominantly affected.

Action: Clinicians are likely to be very busy coping with demand. Prescriber.org.uk will be operating at a restricted level in the coming weeks, normal service will resume once demand abates.

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New GLP analogue launched

Liraglutide (Victoza®) has been launched for the treatment of patients with type 2 diabetes. This new drug is a glucagon-like peptide (GLP-1) analogue and is in the same class as exenatide (Byetta®).

There are slight differences between the two products in terms of the product licence. Exenatide is licensed for combination use with metformin and/or a sulphonylurea in patient not achieving adequate glycaemic control. Liraglutide is licensed in these same combinations and also in combination with metformin and a glitazone.

Exenatide has been considered in the most recent NICE Diabetes guidance but specific advice from NICE for liraglutide is not due until June 2010.

Action: Clinicians should be aware of this new drug, the licensed indications and status of the current NICE guidance.

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Calorie restriction may prolong life

Science has published the results of a study that aimed to assess the impact of calorie restriction on ageing and ill-health in monkeys. The study has also been reported in the general media (BBC).

Researchers have conducted prolonged studies (20 years) on two cohorts of monkeys. One group has been allowed unrestricted access to food while the other group has been provided with a calorie restricted diet (30% fewer calories compared to the former group) with additional vitamin and mineral supplements to avoid malnutrition.

In the calorie restricted group 63% of the animals are still alive compared to 45% in the unrestricted group. Age-related deaths cause by illnesses such as cardiovascular disease or cancers were three times higher in the unrestricted group. Such studies are unlikely to ever be conducted in humans but this model of 'healthy living' indicates that there are benefits.

Action: Clinicians may find this information useful when advising patients on the benefits of a healthy lifestyle.

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