July 2021 updates
The following practice-changing updates were included in eTG complete in July 2021.
Antibiotic guidelines
- The empirical antibiotic regimens for children 2 months or older with community-acquired sepsis or septic shock have been updated in line with current Australian practice. The addition of gentamicin is recommended for children with septic shock to ensure adequate treatment of bacteria not susceptible to cefotaxime and ceftriaxone, but is not required for children with sepsis. Vancomycin has been added to ciprofloxacin for children with severe penicillin hypersensitivity to ensure adequate treatment of Gram-positive bacteria.
- The nitazoxanide drug recommendation for children with recurrence of or ongoing refractory Clostridium difficile infection has been updated to include specific dosing for children 12 years or older.
- Separate advice is given for dilution of benzylpenicillin for intramuscular and intravenous administration for management of suspected meningococcaemia in the community setting.
- The graphic to support shared decision making discussions for patients with acute rhinosinusitis has been updated to clarify that decongestants should not be used for children younger than 6 years.
Sexual and Reproductive Health guidelines
- Rhesus antibody testing and anti-D immunoglobulin use is no longer recommended for medical abortion before 10 weeks’ gestation based on updated advice from the National Blood Authority and RANZCOG.
March 2021 updates
Guidelines reviewed
Practice-changing updates to other guidelines
As well as including a comprehensive update to the Developmental Disability and Psychotropic guidelines, the March 2021 release of eTG complete also includes the following practice-changing updates to other guidelines. With each release, we are also continuing to implement drug name changes in line with the Therapeutic Goods Administration.
Antibiotic guidelines
- In patients undergoing surgical abortion, age is one of several criteria for assessing the risk of concurrent sexually transmitted infection. Criteria have been amended in the topic ‘Surgical antibiotic prophylaxis for specific procedures’ to clarify that individuals aged 20 years or younger are at higher risk than those older than 20 years.
Gastrointestinal guidelines
- Patients taking an SGLT2 inhibitor are at increased risk of euglycaemic diabetic ketoacidosis (DKA) when undergoing a procedure, and this risk is increased if the patient has been fasting, has very restricted dietary intake or has undergone bowel preparation. The topic ‘Preparation for gastrointestinal procedures’ has been updated to highlight this risk; it now includes links to the Diabetes guidelines for more detail on management, and links to alerts issued by the Australian Diabetes Society and Australian Therapeutic Goods Administration.
Respiratory guidelines
- Beclometasone+formoterol has now been approved by the Australian Therapeutic Goods Administration (TGA) for use in adults with asthma who require Step 3 maintenance and reliever therapy, or Step 3 or Step 4 maintenance therapy. Drug recommendations for beclometasone+formoterol have been added.
- A link has been added to the recently published Thoracic Society of Australia and New Zealand position statement on diagnosis and management of connective tissue disease–associated interstitial lung disease.
Sexual and Reproductive Health guidelines
- Serum human chorionic gonadotrophin (hCG) measurement helps guide the timing of an ultrasound scan to confirm intrauterine pregnancy before medical abortion. Detail has been added to clarify how to use hCG measurements to guide timing of ultrasound for very early gestations (less than 5 to 6 weeks).
December 2020 updates
Guidelines reviewed
Practice-changing updates to other guidelines
As well as including a comprehensive update to the Liver Disorders, Pain and Analgesia, Respiratory and Sexual and Reproductive Health guidelines, the December 2020 release of eTG complete also includes the following practice-changing updates to other guidelines. With each release, we are also continuing to implement drug name changes in line with the Therapeutic Goods Administration.
Cardiovascular guidelines
- Combination therapy with an endothelin receptor antagonist and a phosphodiesterase type 5 (PDE5) inhibitor is now available on the Pharmaceutical Benefits Scheme for pulmonary hypertension.
- The immediate-release formulation of nifedipine was discontinued in Australia in October 2020. A footnote has been added to drug recommendations for immediate-release nifedipine to explain this.
Diabetes guidelines
- Dulaglutide is now indicated as an adjunct to standard of care therapy to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes who have established cardiovascular disease or multiple cardiovascular risk factors. The drug recommendation for dulaglutide for patients with type 2 diabetes has now been updated.
Oral and Dental guidelines
- Advice on using paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with cirrhosis has been updated in line with new advice in the Pain and Analgesia guidelines.
Rheumatology guidelines
- Advice on using paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with cirrhosis has been updated in line with new advice in the Pain and Analgesia guidelines.
Toxicology and Toxinology guidelines
- Additional information has been added about avoiding adrenaline in most antipsychotic drug poisonings, as it can worsen hypotension.
- A dose of sodium thiosulphate can be used as part of the management of cyanide poisoning. Sometimes a repeat dose is needed. Based on feedback and current references, the repeat dose has been reduced to half of the first dose (rather than the same as the first dose).
August 2020 updates
Guidelines reviewed
Practice-changing updates to other guidelines
As well as including a comprehensive revision of the Toxicology and Toxinology guidelines, the August 2020 release of eTG complete also includes the following practice-changing updates to other guidelines. With each release, we are also continuing to implement drug name changes in line with the Therapeutic Goods Administration.
Antibiotic guidelines
- Tinidazole was discontinued in Australia in February 2020. A footnote about this has been added to tinidazole drug recommendations; metronidazole is recommended as an alternative when an oral nitroimidazole is required.
- Amphotericin B lipid complex is no longer registered for use in Australia, but is available via the Special Access Scheme. A footnote about this change in availability has been added to amphotericin B lipid complex drug recommendations.
- The empirical recommendations for sepsis and septic shock from a biliary or gastrointestinal tract source have been updated to ensure patients with acalculous cholecystitis who have penicillin hypersensitivity receive antibiotic therapy with activity against Pseudomonas aeruginosa.
- New data are available on the safety of erythromycin use in early pregnancy. The erythromycin entry in ‘Drug use in pregnancy and breastfeeding’ has been updated to include links to the relevant publications.
- Combination therapy with flucloxacillin and vancomycin was observed in a recent randomised controlled trial to be associated with nephrotoxicity. Despite this, combination therapy continues to be recommended for initial therapy for Staphylococcus aureus bacteraemia to ensure adequate treatment of both methicillin-susceptible and methicillin-resistant strains. New advice is included to limit the duration of combination therapy to 48 hours.
- Vancomycin dosage adjustments should be made in a linear manner. Updated guidance on the practical application of linear dosage adjustments is included.
- A recent randomised controlled trial showed that a single dose of amoxicillin+clavulanate reduced the incidence of maternal infection after assisted (vacuum or forceps) vaginal delivery. Advice on which women should receive prophylaxis and what drug should be used has been added.
Cardiovascular guidelines
- A comment has been added to ‘Venous thromboembolism: prophylaxis’ topic to clarify that optimal prophylaxis in obese patients has not been fully determined. Expert advice is recommended for drug choice and dosing.
Dermatology guidelines
- The ‘Vulvovaginitis in girls’ topic has been updated to reflect that candidal vulvovaginitis occurs very rarely in prepubertal girls, rather than not occurring in this patient group.
Diabetes guidelines
- Dapagliflozin has now been approved by the Australian Therapeutic Goods Administration (TGA) for use in patients with a creatinine clearance of 45 mL/min or more (previously 60 mL/min or more), as for all other sodium-glucose co-transporter 2 (SGLT2) inhibitors available in Australia. The drug recommendation for dapagliflozin for patients with type 2 diabetes has been updated.
- The Lantus brand of insulin glargine 100 units/mL has been discontinued in Australia and replaced by the Optisulin brand, which is made by the same drug company and is therapeutically identical. Optisulin has been added to the list of available insulin formulations in Table 18.4.
