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August 2022 updates

Other practice-changing updates:

Antibiotic guidelines

  • The Australasian consensus guidelines for the management of invasive fungal disease and use of antifungal agents in the haematology/oncology setting were updated in 2021; all links to these guidelines have been updated.
  • All mentions of the bacterium, Clostridium difficile, have been updated to its new name, Clostridioides difficile.
  • In response to user feedback, summary tables of the indications and regimens for surgical antibiotic prophylaxis have been developed for most groups of procedures. A link to the summary table is included in each relevant section of the Surgical antibiotic prophylaxis for specific procedures topic, and a collation of all the summary tables is available via ‘Quick links’.
  • Advice on diagnosing and managing COVID-19 changes frequently. To improve access to the most up-to-date advice, a list of the most relevant Australian resources has been collated.
  • Primary prophylaxis for Mycobacterium avium complex (MAC) is no longer recommended for adults with HIV infection who immediately start antiretroviral therapy. See here for further information.
  • The section on Management of neonates born to mothers with tuberculosis (TB) has been extensively revised following updates to a number of key state and international guidelines. Presumptive therapy for latent TB is now only recommended for neonates born to mothers with pulmonary TB if the mother is still considered infectious at the time of birth. Presumptive therapy for latent TB now includes the option of a 4-month rifampicin regimen.
  • Flucytosine injection is no longer available for induction therapy of cryptococcal meningitis and pulmonary cryptococcosis. Recommendations for these conditions have been updated—use oral flucytosine (or consider administration via a nasogastric tube), or seek expert advice for other treatment options.

Pain and Analgesia guidelines

  • The modified-release morphine recommendation for chronic noncancer pain has been updated to clarify dosing for the 12-hour and 24-hour formulations.
  • Following updates to international guidelines, duloxetine is now the preferred drug for the management of painful chemotherapy-induced peripheral neuropathy.
  • Paracetamol is a first-line analgesic in children. Information on paediatric-specific formulations has been added to support paracetamol use in this group.

Respiratory guidelines

  • The new combination inhaler, fluticasone furoate+umeclidinium+vilanterol, has been added to the stepwise maintenance management of asthma for adults and adolescents for patients who continue to have uncontrolled asthma despite optimised dual therapy with an inhaled corticosteroid plus long-acting beta2 agonist. In these patients, therapy consists of either increasing the inhaled corticosteroid dose or adding a long-acting muscarinic antagonist. The role of type 2 airway inflammation in selecting appropriate therapy has been updated.

Rheumatology guidelines

  • Advice on NSAID use during the perinatal period has been updated to reflect current evidence. In general, NSAIDs should be avoided in pregnancy and must be avoided after 30 weeks’ gestation.

Toxicology and Toxinology guidelines

  • Updated intravenous calcium drug recommendations throughout Therapeutic Guidelines to address change in labelling of calcium gluconate and to emphasise mmol dosing.