Australian Doctor Australian Doctor 7th July 2017 | Page 6

News
Antibiotic warning letters are
medicine we must swallow
Comment
Dr Justin Coleman
IN case you missed it, more than
5000 high-prescribing GPs around
Australia have received a letter from
Australia’s Chief Medical Officer
encouraging them to prescribe anti-
biotics wisely.
Some saw this as an insult; others
as merely a waste of time.
I must confess, I like the idea.
When I announced as much on an
online GP chatroom, the 150-plus
responses reflected views as dispa-
rate as general practice itself.
As so often happens, the opposing
views broadened my understanding
of the issues, and I drifted towards
the middle ground. But middle
ground doesn’t make for a punchy
read, so let me sock it to you instead:
if you received a letter, it was good
for you, so like it or lump it.
There, I’ve said it. Or actually, the
Chief Medical Officer said it, and
I’ve just bobbed up beside him, nod-
ding. My argument is as follows: we
prescribe too many antibiotics. Not
all of us, but many do. This remains
true, regardless of agricultural farm-
ing practices, over-the-counter sales
in Asia and all the other fellow sin-
ners we can point the finger at.
A letter informing you that you
are in the top centiles of antibiotic
prescribers is not an insult, a threat
or an affront. It’s a transfer of infor-
mation, not a conspiracy.
General practice consultations are
usually solitary affairs, so a bit of
feedback about how we compare to
our peers can be handy.
And there are ways to deal with it.
Explain to yourself how the percen-
tile data was applied in your case.
The calculation involved the ratio
of PBS-subsidised antibiotic pre-
scriptions to the number of Medi-
care consultations you bill. This has
inherent inaccuracies, but remem-
ber, it’s not a legal investigation, and
no one is punishing you. If the data
are wrong, no problems; bin them.
We can also ask ourselves whether
our patients need more antibiotics
than most other patients. Again, this
may be quite justifiable in your case,
but probably only applies to some of
the 5000 doctors. The majority are
probably genuine high-prescribers.
The desired response then is to
shift towards middle-of-the-pack
prescribing rates. There is good evi-
dence this does not expose patients
to any excess risk of complications,
hospitalisations or prolonged ill-
nesses. Patients of high-prescribing
doctors run exactly the same risk of
secondary bacterial mastoiditis and
meningitis as everyone else, so don’t
kid yourself that another thousand
scripts will save someone.
Even if only one in 10 or 20 letter
recipients reflects on their practice
and reduces their prescription rates,
these letters will have been a worth-
while exercise.
CHAMPIX
STREAMLINED
(varenicline tartrate)
AUTHORITY
Now there is no need to seek telephone approval when prescribing CHAMPIX ® , simply quote the
streamlined authority code below on each authority script to confirm the PBS restriction criteria are met. 1
Streamlined Authority Codes:
Initiation of 12-week course: 6871
Continuation of 12-week course: 6864
Additional 12-week course: 6885
Refer to the PBS schedule for full information. 1
Nicotine-free quit 2
| Australian Doctor | 7 July 2017
www.australiandoctor.com.au
GEIR O’ROURKE
THE Chief Medical Officer says
he doesn’t blame the 5000 GPs
being targeted by his office for
their antibiotic prescribing.
Professor Brendan Murphy is
sending out 5000 letters to GPs
to inform them they are in the top
30% of antibiotic prescribers in
their area.
The sternly worded letters
list the types and numbers of
antibiotics prescribed by each
individual GP and then ranks
them against their colleagues, but
Professor Murphy denies he is
engaging in doctor-bashing.
“We are not blaming anyone,
we are not saying they are wrong.
We are just telling them what the
data shows,” he says. “If there
isn’t a good reason for [that level
of prescribing], you should reflect
on what you are doing.”
The nephrologist says the
letters are a necessary first step
against looming antimicrobial
resistance because Australia’s
community prescribing rate is
above the OECD average.
Dr Coleman is a GP in Brisbane, Qld.
®
6
No blame
here, says
CMO
PBS Information: Authority
required (STREAMLINED).
Refer to PBS schedule
for full authority information.
BEFORE PRESCRIBING, PLEASE
REVIEW FULL PRODUCT INFORMATION
AVAILABLE AT WWW.PFIZER.COM.AU
CHAMPIX ® (varenicline as tartrate) 0.5 mg and 1 mg Tablets. INDICATIONS:
Aid to smoking cessation in adults (≥ 18 years). CONTRAINDICATIONS:
Hypersensitivity to varenicline or excipients. PRECAUTIONS: Serious
neuropsychiatric symptoms including changes in behaviour or thinking,
agitation or depressed mood, suicidal ideation or suicidal behaviour which
patients and families should be instructed to monitor. Patients are to stop
taking CHAMPIX at the first sign of any of these symptoms and contact
a health care professional immediately. Alcohol may increase the risk of
experiencing neuropsychiatric events. Seizures, hypersensitivity reactions,
skin reactions, cardiovascular events, somnambulism, driving or operating
machinery, pregnancy, lactation, severe renal impairment. See PI for details.
ADVERSE EFFECTS: Smoking cessation/nicotine withdrawal symptoms. Most
common: nausea, headache, insomnia, nasopharyngitis, abnormal dreams,
abdominal pain upper, constipation, fatigue, diarrhoea, flatulence, influenza,
upper respiratory tract infection, anxiety, irritability, sleep disorder, dizziness,
vomiting, dyspepsia, dysgeusia, dry mouth, back pain, increased appetite,
somnolence, weight increased, depression, disturbance in attention and
cough. Post-marketing reports of neuropsychiatric symptoms, myocardial
infarction, stroke. See PI for details. DOSAGE AND ADMINISTRATION: Days
1 to 3: 0.5 mg once daily. Days 4 to 7: 0.5 mg twice daily. Day 8 to end of
treatment: 1 mg twice daily. Patients should set a date to quit smoking and
start taking Champix 1 to 2 weeks before this date. Alternatively, patients
can begin Champix dosing and then quit smoking between days 8 and 35 of
treatment. Patients should be treated for 12 weeks. An additional 12 weeks
of treatment can be considered for patients who have successfully stopped
smoking at the end of 12 weeks. A gradual approach to quitting can be
considered for pa