19.09.2015
Amoxicillin discount
May staff have been diverted from their specialist duties to the “ frontline ”. There have been many examples in the news of patient dissatisfaction due to the suspension of “Modern Medicine”, but little thought has been given to the impact of drug-resistant infections caused by antibiotic resistance on the future of “Modern Medicine”. There is now evidence that 15% of deaths in Wuhan were due to opportunistic or secondary bacterial infections. Antibiotics do not kill viruses but they should be effective against bacterial infections. Yet, the global public health crisis of drug- resistant infections has not yet been recognised as being worthy of not-for-profit collaborations such as the WWII Penicillin Project or the current coronavirus projects. Antibiotics and coronavirus research is just as important to continued global health as the penicillin project. Research into new treatments for drug-resistant infections is critical to the future of “Modern Medicine”. Antibiotic Research UK is a respected medical research charity currently funding a significant number of research projects to combat drug-resistant infections. You can read more about our research successes to date here. So here at Antibiotic Research UK we are working hard to overcome and prevent deaths from drug-resistant infections. Together we can close the door on COVID-19 opportunistic infections and keep antibiotics working to save Modern Medicine. Please support us in our fight and DONATE to help us fund our research. Zhou et al (2020) Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Benzathine penicillin G (BPG) has been in use since the 1950s for treatment of skin infections, bacterial pharyngitis, syphilis and prevention of recurrent episodes of acute rheumatic fever (ARF). Current guidelines recommend BPG every 4 weeks for a minimum of 10 years to prevent the progression to rheumatic heart disease (RHD). Our program of work has the ultimate aims of improving quality, supply and acceptability of existing formulations of BPG, and of developing a novel long-acting penicillin formulation. Some of the substudies in this program include: Penicillin Levels for Rheumatic Heart Disease - WA Urban Site : This recently completed cohort study involved participants at Princess Margaret Hospital who were prescribed BPG for secondary prophylaxis of RHD. Dry blood spot (DBS) samples & throat swabs were collected from each child. DBS samples were used to measure plasma penicillin levels & group A streptococcal antibody titres immediately prior to BPG administration & at pre-specified time points within each BPG cycle. Throat swabs were also cultured to determine the presence of Strep A infection. Penicillin Levels for Rheumatic Heart Disease - Darwin Remote Site : This 6-month cohort study was also completed recently involving participants at Danila Dilba Health Service. This study followed the same process and collected the same samples as the urban study above. Pharmacokinetics of intramuscular versus subcutaneous administration of Benzathine Penicillin G : The results of this trial will assist in: Determining if the route of administration of BPG has significant impact on pharmacokinetic properties of the medication. Ability to guide clinicians as to whether benzathine penicillin G should be delivered to an IM or SQ site, or either. Better understanding whether there is a difference in injection related pain between IM and SQ injections. Determining if a future reformulated long-acting penicillin should be delivered preferentially at an intramuscular or subcutaneous site. Research shows children's penicillin prescriptions are below recommended doses. Penicillin prescriptions for millions of children over the age of five could be below the recommended doses. A collaborative study conducted by Imperial College London, King's College London and St George’s, University of London found that 40 per cent of 6-12 year olds and 70 per cent of 12-18 year olds are prescribed doses below current national guidelines. If penicillin doses are below those needed to effectively treat bacterial infections they could result in infections that get worse in some children, increase the demand on health services and increase bacterial resistance to treatment. Published in British Journal of General Practice, the study is the first to examine actual prescriptions of oral penicillins by GPs in the UK. It reported on the most commonly prescribed penicillin, amoxicillin, and compared actual doses to the doses recommended by the British National Formulary for Children (BNFC). Analysing data from the IMS Disease-Analyzer database, researchers found there was a wide variation in prescribing practices. None of the children under the age of one year amoxicillin 250g received BNFC's recommended dose of 62.5 mg per unit. In fact, the majority of children under the age of one received double this recommended dose (125 mg). In comparison, 96 per cent of children aged 1-5 received amoxicillin 150 mg the recommended dose for their age group but the picture was different for older children. 40 per cent of 6-12 year olds and 70 per cent of 12-18 year olds were prescribed unit-doses below the BNFC guidelines. Similar patterns of prescribing were also found for penicillin V and flucloxacillin. The first author of the study, Dr Sonia Saxena from Imperial's School of Public Health and a GP said: "It's not clear why there is such widespread under dosing. It may be that GPs are unaware of the recommended doses or that we err on the side of caution in our prescriptions for fear of overdosing. Alternatively some GPs may aim to limit possible side effects such as diarrhoea. "However there are significant harms in under dosing children with penicillin. Firstly, bacterial infections can become resistant and fight back rendering any treatment ineffective in the community. Although the majority of children will still get better, using too low a dose can sometimes result in some children getting more serious infections.For example if the dose of penicillin to treat tonsillitis or a serious ear infection is too low this can reduce the effectiveness of the treatment so these children may get worse and either have to return for another GP appointment or in some cases could require treatment or even admission to hospital." The BNFC guidelines currently recommend dosing oral penicillins in children accordingly to age-bands, weight-bands or weight-based calculations but many UK GPs routinely use only age-bands. In 2013 there was a change to the guidelines specifically for amoxicillin but the researchers suggest this may in fact have worsened the situation because it introduced a wider age-band from 5 to 18 years. This is likely to increase the under dosing for older ages from 12 to 17 years in whom the pre 2013 dose was equivalent to an adult dose of 500mg. "The guidance needs to be urgently reviewed and recalculated so we move away from an age-based system to a weight-based system," said Dr Saxena. "The ideal situation would be for us to actually weigh children and then prescribe doses accordingly but we know there are difficulties with this including GPs being short of time and introducing a more complex system could actually result in more prescribing errors. However we can consider other options such as providing scales in the waiting room or encouraging pharmacists to double-check the dose against the child's actual weight when people collect prescriptions." Even if weight-bands from the BNFC guidelines were used, the researchers point out another problem with the current guidelines: that the average weight of children has changed over time and the guidelines do not take this into account. Due to the rising prevalence of childhood obesity, prescriptions could lead to doses prescribed at too low a level to produce a therapeutic effect. Dr Sonia Saxena is funded by a National Institute for Health Research (NIHR) Career Development Fellowship. Comparison of UK oral penicillin prescribing for children with British National Formulary for Children age-band recommendations: a descriptive analysis. Article text (excluding photos or graphics) © Imperial College London. Photos and graphics subject to third party copyright used with permission or © Imperial College London. Franca Davenport Communications and Public Affairs. Oral semisynthetic aminopenicillin similar to ampicillin; not stable to beta-lactamases of either gram-positive or gram-negative bacteria; more stable to gastric acid than penicillin; more bioavailable than oral ampicillin; commonly used to treat otitis media, bronchitis, sinusitis; also used in combination regimens for H.
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