‘ Don ’ t wait to treat heavy periods ’

	Rachel Fieldhouse WOMEN with heavy menstrual	the focus on immediate medical therapy on first presentation with heavy	alongside new data from the Australian Commission on Safety and Qual-	“ encouraging ”. But they reported higher rates of both hysterectomy
	bleeding should be offered hormonal	menstrual bleeding was a key change	ity in Health Care that showed a 20 %	and endometrial ablation in regional
	or non-hormonal oral treatment “ at	from the 2017 standards .	drop in the rate of hysterectomy for	areas compared with major cities and
	first presentation ” rather than wait-	“ We should not wait to do all our	non-cancer diagnoses over the past	remote areas , plus a 9 % higher hyster-
	ing until investigations are complete ,	investigations before we actually	eight years .	ectomy rate in Indigenous women .
	according to updated guidance .	offer oral treatments ,” the former	At the same time , there was a 10 %	This was partly a result of “ limited
	The 2024 Heavy Menstrual Bleed-	RACGP president said .	increase in the number of women	numbers of clinicians with the knowl-
	ing Clinical Care Standard also sug-	“ We can give them tranexamic	receiving the less invasive and uter-	edge , skills and equipment , or will-
	gests that patients could be offered a	acid or NSAIDs … That will hopefully	ine-preserving endometrial ablation	ingness to deliver services , such as
Associate Professor Liz Marles .					52mg levonorgestrel-releasing IUD , provided there is no malignancy or other significant pathology . Associate Professor Liz Marles said	decrease their bleeding while we go through the process of working out what is going on .” The standards were published	since 2014-15 . Professor Marles , clinical director of the commission , and her colleagues said these findings were	[ IUD ] insertion , endometrial ablation or uterine artery embolisation ”. Heavy Menstrual Bleeding Clinical Care Standard , 2024 : bit . ly / 3ztAmyd
	NOW PBS LISTED FOR CHRONIC KIDNEY DISEASE 2			Antibiotic oral liquid shortages

Not an actual patient .

Chronic Kidney Disease

to reduce the risk of kidney disease progression in adults with chronic kidney disease §

JARDIANCE ® is indicated for : 1

Type 2 Diabetes

to prevent CV death in patients with T2D and established CV disease † ; Glycaemic control in T2D

BEFORE PRESCRIBING , PLEASE REVIEW THE FULL PRODUCT INFORMATION AVAILABLE FROM BOEHRINGER INGELHEIM AT WWW . BOEHRINGER-INGELHEIM . COM . AU / PI OR BY SCANNING THE QR CODE .

Eli Lilly Australia Pty Limited , ABN 39 000 233 992 . Level 9 , 60 Margaret Street , Sydney ,

Heart Failure

treatment of symptomatic HF independent of LVEF ‡

†

CAD , PAD , MI or stroke on top of standard of care . 1 ‡ As an adjunct to standard of care therapy . 1 § CKD Stages 2 and 3A with urine ACR ≥30 mg / g , or CKD Stages 3B , 4 and 5^ irrespective of urine ACR . ^Due to limited experience , it is not recommended to initiate treatment with JARDIANCE ® in patients with an eGFR < 20 mL / min / 1.73 m 2 . 1

PBS Information : JARDIANCE ® : Authority Required ( STREAMLINED ). Type 2 Diabetes . Heart Failure with Reduced Ejection Fraction ( LVEF ≤40 %). Heart Failure with LVEF > 40 % ( including Heart Failure with Preserved Ejection Fraction ). Chronic Kidney Disease . Refer to PBS Schedule for full Authority Required Information .

JARDIANCE ® has a consistent and established safety profile across T2D and CKD indications . Very common adverse reactions : hypoglycaemia ( combination with metformin and an SU ; insulin ). Common : hypoglycaemia ( combination with metformin ; pioglitazone with or without metformin ; metformin and linagliptin ); hypoglycaemia ( T2D patients with HF ); UTIs ; increased urination ; vaginal moniliasis , vulvovaginitis , balanitis and other genital infections ; volume depletion ( T2D patients aged ≥75 years ); thirst ; pruritis ; serum lipids increased ; constipation . Precautions include patients with type 1 diabetes ; ketoacidosis ; surgery ; not recommended to initiate treatment in patients with eGFR < 20 mL / min / 1.73 m 2 . Please refer to the full JARDIANCE ® Approved Product Information for information on other precautions and adverse reactions .

Abbreviations : CAD , coronary artery disease ; CKD , chronic kidney disease ; CV , cardiovascular ; eGFR , estimated glomerular filtration rate ; HF , heart failure ; LVEF , left ventricular ejection fraction ; MI , myocardial infarction ; PAD , peripheral artery disease ; T2D , type 2 diabetes ; uACR , urinary albumin to creatinine ratio .

References : 1 . JARDIANCE ® Product Information . 2 . Pharmaceutical Benefits Scheme . Available at : www . pbs . gov . au . Accessed April 2024 .

Rachel Fieldhouse GPs are being urged to limit scripts for azithromycin and clarithromycin oral liquids , which are currently in short supply owing to a spike in pertussis and Mycoplasma pneumoniae infections in children .

NSW Health has written to GPs in the state asking them to “ carefully consider the need for antibiotic treatment ” and to consult their local pharmacy to determine availability before prescribing .

It has also provided paediatric dose information for alternative options , including trimethoprim and sulfamethoxazole for pertussis and erythromycin for M . pneumoniae .

Nationally , nearly 11,000 pertussis cases have been reported so far this year , compared with 2400 notifications in total last year .

About two-thirds of cases have been in children aged 14 and under , with over-65s representing just 4 % of cases .

Although M . pneumoniae is not a notifiable condition , health authorities in Victoria , NSW and Queensland have reported an increase in cases , particularly in young children and adolescents .

Dr Rebekah Hoffman , chair of the RACGP ’ s NSW & ACT faculty , said : “ That is quite historically normal : we see a spike in M . pneumoniae about every 7-10 years .

“ But with the increased demand of pertussis on top of that , we have not been able to keep up with the antibiotic demand .

“ For pertussis , we often do not just treat the patient , but the household contacts too , because we want to stop the spread .”

The TGA said azithromycin powder for oral suspension ( Zithromax ) would be in short supply until 29 November , while the shortage of clarithromycin powder ( Klacid ) would last until 31 August .

Australian Doctor 12th July Issue 2024 | Page 12

12 NEWS

12 NEWS

‘ Don ’ t wait to treat heavy periods ’

Antibiotic oral liquid shortages