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Is MenW becoming resistant to penicillin?
RADA ROUSE REDUCED susceptibility to penicillin is emerging in meningococcal serogroup W, which is causing a large proportion of invasive meningococcal disease, microbiologists have found.
Creeping resistance is being monitored closely in Australia as benzylpenicillin remains the first-line treatment. The doctor’ s bag has benzyl penicillin“ which should be given in suspect cases because it’ s almost certainly going to be effective, and early treatment is important”, says Dr David Speers, an infectious diseases physician and microbiologist in WA.
Dr Speers and colleagues investigated the penicillin susceptibility of 19 clinical isolates of MenW from WA across three years and found that penicillin susceptibility varied, with eight being susceptible, two less susceptible and nine being resistant.
Dr Speers and colleagues found nine MenW isolates were resistant to penicillin, while eight were susceptible.
All the isolates that had some resistance to penicillin were identified in 2016, the year when the proportion of MenW cases shot up to nearly 70 % in WA, compared with the previous year when it was under 30 %.
The researchers said they had identified a cluster of low-level penicillin-resistant isolates with a particular genetic variant, which spread throughout the state in 2016. They have urged other jurisdictions to monitor for the emerging strain.
Meningococci have been more susceptible to penicillin than gonococci, but now some meningococcal strains were moving away from full susceptibility, said Dr Speers.
“ Ceftriaxone is recommended empirically for meningitis, but if the organism is penicillin susceptible, you can change down to penicillin,” he said.
“ In the setting of someone with meningococcal meningitis where you thought that the organism was highly penicillin resistant … you would stay on the ceftriaxone.”
A 2015 national report on resistance when B serogroups dominated showed that of 117 isolates tested, 10 % were fully sensitive to penicillin, 86 % had reduced sensitivity and four were resistant.
All were susceptible to ceftriaxone and ciprofloxacin, and there was one resistant to rifampicin. Emerging Infectious Diseases 2017; online.
Transfusions backed for palliative care patients
MICHAEL WOODHEAD RED blood cell transfusions are effective against anaemiarelated symptoms in palliative care patients, SA researchers have shown.
While transfusions are often used late in life to treat symptoms such as fatigue and breathlessness due to anaemia, there has been little
research into the efficacy of this expensive and often finite resource, according to Dr Timothy To and colleagues from the palliative services department at Flinders University, Adelaide.
They therefore conducted a prospective study of 100 transfusions performed in 17 hospices and palliative care
units to assess the impact on symptoms and possible harms.
Patients received an average of two transfusions costing around $ 700 all together. After seven days, almost half( 46 %) showed benefits in the main symptom of fatigue, and 78 % showed a benefit in any of the target symptoms( breathlessness, weakness and dizziness). Harmful effects, such as infusion-related reactions, were mild and seen in 12 % of patients.
The researchers said their findings backed the use of transfusions in palliative care. But they also suggested that clinicians first perform basic investigations of treatable causes of anaemia, such
Genomic screening comes at a price
JOCELYN WRIGHT WITH a price tag of $ 6400, whole genome sequencing is now being offered to the Australian public by the Garvan Institute’ s Genome. One lab in NSW.
The Sydney clinic has launched a commercial service that claims to provide genetic insights into a person’ s responses to 220 medications as well as their future risk of developing 31 types of cancer and 13 heart conditions.
The genome sequencing will look at variants of 230 genes( humans have about 20,000) linked to increased risk for malignancies including bowel, prostate, breast, ovarian and pancreatic cancers, meningioma and retinoblastoma. It also looks for genes that may increase risk of cardiovascular conditions such as AF, pulmonary hypertension and familial hypercholesterolaemia.
According to Genome. One, the $ 6400 fee will also cover genetic counselling and a comprehensive health assessment under the guidance of a GP to look for other risk factors.
“ These factors together with the added genetic insight provide a more complete picture than has previously been possible and can empower individuals to take control and more proactively manage their health,” says John Hall, CEO of Life First, a private health assessment clinic that is working in conjunction with Genome. One.
However, the launch follows warnings by public health experts that so-called‘ retail’ genetic tests may be causing unnecessary anxiety and overinvestigation.
Writing in Australian Prescriber, Associate Professor Ken Harvey of Monash University, Victoria, said consumers should think carefully before paying for genetic tests.
“ The genetic profiles produced may impact on family members, potential employment and life insurance,” he warned.
as tests for B12, folate and ferritin.
“ In palliative care patients, clinicians believed that red blood cell transfusion gave subjective improvement to three-quarters of patients, with minimal harm,” they concluded. Journal of Palliative Medicine 2017; online.
Delivered in the Respimat Soft Mist ™ Inhaler 1, 2
Transfused patients had improved fatigue symptoms.
1,2
SPIRIVA Respimat PBS Information: Restricted benefit. Chronic obstructive pulmonary disease.
SPIOLTO Respimat PBS Information: Authority required( STREAMLINED). Code 5763. Chronic obstructive pulmonary disease( COPD). Refer to PBS schedule for full authority information.
Please review Product Information before prescribing. Full Product Information is available at www. boehringer-ingelheim. com. au / PI. Further information is available from Boehringer Ingelheim Pty Ltd.
MINIMUM PRODUCT INFORMATION( COMBINED – COPD). SPIRIVA ® RESPIMAT ®( tiotropium bromide) solution for inhalation 2.5 microgram / actuation and SPIOLTO ® RESPIMAT ® [ tiotropium( as bromide monohydrate)/ olodaterol( as hydrochloride)] solution for inhalation 2.5 micrograms / 2.5 micrograms. INDICATIONS: SPIRIVA RESPIMAT: Long term maintenance treatment of bronchospasm and dyspnoea associated with chronic obstructive pulmonary disease( COPD). Prevention of COPD exacerbations. SPIOLTO RESPIMAT: Once-daily maintenance bronchodilator treatment to relieve symptoms in adult patients with COPD. CONTRAINDICATIONS: SPIRIVA RESPIMAT and SPIOLTO RESPIMAT: Hypersensitivity to tiotropium bromide, olodaterol( SPIOLTO only), atropine or its derivatives, or to any of the excipients. PRECAUTIONS: SPIRIVA RESPIMAT and SPIOLTO RESPIMAT: Should not be used: more frequently than once daily; for relief of acute symptoms, treatment of acute episodes of bronchospasm, immediate hypersensitivity reactions, paradoxical bronchospasm, narrow-angle glaucoma, prostatic hyperplasia, bladder neck obstruction, urinary retention, micturition diffi culties, recent myocardial infarction(< 6 months for SPIRIVA, < 12 months for SPIOLTO), unstable or life-threatening cardiac arrhythmia within past year, hospitalisation for heart failure within past year, moderate to severe renal impairment( CrCL ≤ 50 mL / min), pregnancy, lactation and children. Avoid solution or mist entering eyes. SPIRIVA RESPIMAT: Should not be used for: fi rst-line treatment for asthma, dry mouth. SPIOLTO RESPIMAT: Should not be used: in treatment of asthma( LABAs may increase the risk of asthma-related hospitalisations and death); initiated in acutely deteriorating COPD, severe hepatic impairment, convulsive disorders, thyrotoxicosis, QT interval prolongation, unusual responsiveness to sympathomimetic amines; increases in pulse rate, blood pressure and / or symptoms of clinically signifi cant cardiovascular effect, paroxysmal tachycardia(> 100 beats per minute), hypokalaemia, hyperglycaemia. INTERACTIONS: SPIRIVA RESPIMAT and SPIOLTO RESPIMAT: Co-administration with anticholinergic drugs. SPIOLTO RESPIMAT: Co-administration with adrenergic agents, xanthine derivatives, steroids, non-potassium sparing diuretics, beta-blockers, MAO inhibitors, tricyclic antidepressants, QTc interval prolonging drugs, LAMAs, LABAs. ADVERSE EFFECTS: SPIRIVA RESPIMAT: Common: Dry mouth, usually mild. SPIOLTO RESPIMAT: Very common: nasopharyngitis. Common: pneumonia, bronchitis, infl uenza, urinary tract infection, sinusitis, cough, dyspnoea, back pain, dry mouth. Others, see full PI. DOSAGE: SPIRIVA RESPIMAT: For oral inhalation. 5 μg tiotropium given as two puffs once daily, at the same time each day. SPIOLTO RESPIMAT: For oral inhalation. 5 μg tiotropium and 5 μg olodaterol given as two puffs once daily, at the same time each day. Do not exceed recommended dose. Cartridges to be used only with RESPIMAT inhaler. January 2017. References: 1. SPIRIVA Respimat approved Product Information( 13 September 2016). 2. SPIOLTO Respimat approved Product Information( 10 June 2015). TM Trademark. ® Registered trademark. Boehringer Ingelheim Pty Ltd. ABN 52 000 452 308. 78 Waterloo Road, North Ryde, NSW 2113. AUS / SPRES-171036. McCann Health 10724474. MARCH 2017.
10 | Australian Doctor | 30 June 2017 www. australiandoctor. com. au