[CARPA] Bicillin Feedback Requested

[Rosalie.Schultz at nt.gov.au]

Hi all CARPA mob:

Julie I'm a bit confused about the paediatric dose. I understand the adult dose
is 2.3mL. If 1mL is a paed dose, does this mean that there is routine loss of
0.3mL - not unreasonable but I just want to confirm?

Providing the benzathine penicillin in larger  volumes has been shown in studies
to be less painful - Chris this may explain some of your observations of less
pain with Pan-Benzathine. Counterintuitive but evidence-based.

Local anaesthetic does reduce the pain. Prior to the Pan-Benzathine release the
RHD program was suggesting use of 1-2mL of 1% lignocaine with a 27G needle prior
to the benzathine penicillin, although this does mean giving 2 needles.

Pain is not the only reason for poor uptake and we need to provide the right
environment, attention to all aspects of the person's well-being, good reminders
and cues, a dedicated provider, minimal waiting time, pressure on the site etc.

Regards
Rosalie


                                                                                
             Chris Wilson                                                       
             <cccoco at bigpond.com                                                
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                                                                        Subject 
             19/06/2008 07:45 PM         Re: [CARPA] Bicillin Feedback          
                                         Requested                              
                                                                                
              Please respond to                                                 
             Central Australian                                                 
             Rural Practitioners                                                
                 Association                                                    
             <carpa at ozdocit.org>                                                
                                                                                
                                                                                




As a remote area nurse just completing a 6 week stint in Central Australia after
a 3 year absence I am struck with the difference in discomfort in giving the
Benzathine penicillin preparation when mixed with 1% lignocaine. Even though 2
injections are required for syphilis treatments they are far less painful,
immediately afterwards as well as the next day, although needle blockage does
occur fairly frequently. Is it not possible to have a depot penicillin that has
a lignocaine or procaine added to minimise discomfort and therefore improve
acceptance, especially in children? And yes a paediatric dose is very desirable,
although we RAN's are used to titrating out of whatever glass syringe
formulation is available even though that may not be ideal practice. Better to
give the dose than not at all.

Unfortunately there seemed to be no real progress in ensuring that RHF & RHD
patients were getting their prophylaxis on time, hopefully the introduction of
PICAS into remote clinics may assist with this vital program.

Cheers,

Chris Wilson
On 19/06/2008, at 10:04 AM, Julie Parras wrote:

      Dear CARPA,

      As you are aware we now have the new Bicillin back in stock. One of the
      areas that we are looking at for the future is the possibility of having a
      pediatric dose syringe.

      It is very early days yet but we at Aspen would like some feedback from
      you as the main users of this product. Our understanding is that at
      present you simply adjust the dosage for use in pediatrics, and this would
      be based on weight?

      If a pediatric dose was looked it it would be probably be 1ml (half the
      adult dose) but we are unsure if this would fulfil the majority of
      pediatric patients. The other area that we would like some feedback on is
      the percentage of pediatirc use of Bicillin - it may not be financially
      viable if this percentage is low.

      I look forward to any feedback/thoughts you can give me in this
      preliminary phase of discussion on a pediatric dose for Bicillin.

      Kind Regards

      Julie Parras
      Senior Product Manager
      Aspen Pharmacare
      PH: 61 2 8436 8300
      FAX: 61 2 9901 3540

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