March 2020 updates
Practice-changing updates
The March 2020 release of eTG complete includes a new topic on coronavirus disease (COVID-19), with links to useful resources, and the following practice-changing updates to specific guidelines. With each release, we are also continuing to implement drug name changes in line with the Therapeutic Goods Administration.
Antibiotic guidelines
- To help users navigate the sepsis topics, the categories applied in these guidelines to antibiotic regimens for sepsis or septic shock have been defined. A new table summarises the empirical regimens for sepsis or septic shock when the source of infection is not known. A list summarising the pathogen-specific regimens for bloodstream infections has also been added.
- In the topic on ‘Pneumonia diagnosis and follow-up’, the statement on repeat chest X-ray has been reworded to clarify that a repeat chest X-ray is only recommended 6 to 8 weeks after the episode of pneumonia for patients in whom there is a clinical suspicion of lung malignancy (eg elderly, smokers).
- The intravenous dose of trimethoprim+sulfamethoxazole for add-on empirical therapy for meningitis and encephalitis in patients with risk factors for Listeria infection, and for directed therapy of Listeria meningoencephalitis, has been updated to align with standard references.
- The oral dose of trimethoprim+sulfamethoxazole for extended treatment of Listeria meningoencephalitis has been changed to a 12-hourly dosing schedule to improve patient adherence and avoid tablet splitting.
- All trimethoprim+sulfamethoxazole 5+25 mg/kg doses for adults have been capped at 96 kg to avoid overdosing in obese patients. This equates to a maximum unit dose of 480+2400 mg.
- Isavuconazole is now registered for use in Australia, so the footnote about availability through the Special Access Scheme has been deleted from the Aspergillosis section.
Dermatology guidelines
- The time needed to store clothes, towels and bedding in a sealed plastic bag to prevent transmission of scabies has been increased to 8 days in line with new evidence.
Gastrointestinal guidelines
- Table 6.22 (Oral 5-aminosalicylate preparations and dosages for ulcerative colitis) has been updated to reflect the change in criteria for accessing oral mesalazine on the Pharmaceutical Benefits Scheme (PBS)—for the treatment of ulcerative colitis, oral mesalazine is no longer reserved for patients with a documented history of a hypersensitivity reaction to a sulfonamide, or those intolerant to sulfasalazine.
Psychotropic guidelines
- Contact details for the Psychotropic Drug Advisory Service have been updated.
December 2019 updates
Guidelines reviewed
Practice-changing updates to other guidelines
As well as including a comprehensive update to the Oral and Dental guidelines, the December 2019 release of eTG complete also includes the following practice-changing updates to other guidelines.
Antibiotic guidelines
- A PDF guide for assessing patients with reported penicillin allergy has been added.
- The advice on dosage adjustment of vancomycin in neonates and children has been updated to recommend seeking expert advice if a total daily dose of more than 70 mg/kg is required to achieve the target plasma concentration.
- The maximum unit dose of benzylpenicillin for children with erysipelas or cellulitis with systemic features has been changed from 2 g to 1.2 g to align with the maximum unit dose recommended for adults.
- A footnote has been added to explain the basis for the recommendations for dosage adjustment of oseltamivir for adults with impaired renal function.
Cardiovascular guidelines
- A footnote has been added to acknowledge the recommendation to use the sexless CHA2DS2-VASc score to stratify stroke risk in patients with ‘nonvalvular’ atrial fibrillation in the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand clinical guidelines for the diagnosis and management of atrial fibrillation 2018. <www.heartlungcirc.org/article/S1443-9506(18)31778-5/fulltex>
- The dosing of danaparoid for treatment of heparin-induced thrombocytopenia has been updated to align with the Thrombosis and Haemostasis Society of Australia and New Zealand (THANZ) consensus statement on diagnosis and management of heparin-induced thrombocytopenia. <www.thanz.org.au/resources/thanz-guidelines>
Dermatology guidelines
- The management of primary oral mucocutaneous herpes has been updated to include currently available topical analgesics and anaesthetics. Episodic antiviral therapy for a minor recurrence in immunocompetent adults now includes a single dose of oral famciclovir.
Neurology guidelines
- The rate of infusion of intravenous sodium valproate for the acute management of seizures has been updated in line with evidence.
Psychotropic guidelines
- A footnote to alert users to the discontinuation of trifluoperazine and fluphenazine has been added.
- Sources of information for psychotropic drug use during pregnancy and while breastfeeding have been updated.
