[CARPA] RE: CARPA Digest, Vol 29, Issue 1

Wed Oct 1 14:39:11 EST 2008

In reply to Julie Parras
*	Clostridium difficile diarrhoea is rare in the NT community
setting - it is typically a hospital infection - it is also uncommon in
Northern and Central Australian hospitals
*	The current Antibiotic Guidelines recommend metronidazole for
first line treatment of Clostridium difficile diarrhoea - second line is
oral Bacitracin capsules - third line is oral vancomycin capsules 'only
after consultation with an infectious diseases specialist or clinical
microbiologist'. This would be < 5 % of cases of an already rare
disease. 
*	Oral vancomycin is NOT an emergency drug - it can be
driven/flown out to a community in the extremely unlikely event that it
would be needed
*	People whose Clostridium difficile diarrhoea had not responded
to two courses of first line therapy and a then course of second line
therapy should probably be investigated in hospital anyway 
*	There is a sad history of inappropriate use of vancomycin
capsules for staphylococcal infection in settings where doctors and
nurses have been unfamiliar with the various preparations of the drug
(and oral vancomycin has been in stock). In other words it is
potentially dangerous.   
*	The vast majority of Australian hospitals forbid the use of oral
vancomycin capsules in-house unless first approved by an infectious
diseases specialist or clinical microbiologist - usually by telephone 
*	Most health professionals in remote communities have access to a
telephone

Best wishes
Malcolm 

-----Original Message-----
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Sent: Wednesday, October 01, 2008 11:30 AM
To: carpa at ozdocit.org
Subject: CARPA Digest, Vol 29, Issue 1

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Today's Topics:

   1. RE: CARPA Digest, Vol 28, Issue 1 - Vancocin capsules 
      (Julie Parras)

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Message: 1
Date: Mon, 29 Sep 2008 11:00:13 +1000
From: "Julie Parras" <julie.parras at aspenpharmacare.com.au>
Subject: RE: [CARPA] CARPA Digest, Vol 28, Issue 1 - Vancocin capsules

To: "Central Australian Rural Practitioners Association"
	<carpa at ozdocit.org>
Message-ID:

<F79A83F5F064304790B801155F8D6884CEE1C0 at aspensyd02.AspenDomain.local>
Content-Type: text/plain;	charset="us-ascii"

Dear Malcolm, interested in your comments below regarding Vancomycin
capsules should not be made available in remote communities, is this
because they would not have access to an infectious disease specialist?

Also wondered if patients in remote areas do need Vancomycin capsules
how do they get treatment? Sent to area with specialist or simply used
in last resort cases.

I look forward to your comments.

Kind Regards

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

-----Original Message-----
From: carpa-bounces at ozdocit.org [mailto:carpa-bounces at ozdocit.org] On
Behalf Of Malcolm McDonald
Sent: Friday, 26 September 2008 3:21 PM
To: carpa at ozdocit.org
Subject: [CARPA] CARPA Digest, Vol 28, Issue 1 - Vancocin capsules 

It is important to emphasise that vancomycin capsules are NEVER to be
used for treating staphylococcal infection - vancomycin is not absorbed
from the gut. Vancomycin capsules are reserved for third-line treatment
of Clostridium difficile diarrhoea following consultation with an
infectious diseases specialist. 

Vancomycin capsules should not be made available in remote communities.

Malcolm McDonald
Menzies School of Health Research

-----Original Message-----
From: carpa-bounces at ozdocit.org [mailto:carpa-bounces at ozdocit.org] On
Behalf Of carpa-request at ozdocit.org
Sent: Friday, September 26, 2008 11:30 AM
To: carpa at ozdocit.org
Subject: CARPA Digest, Vol 28, Issue 1

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"Re: Contents of CARPA digest..."

Today's Topics:

   1. Vancocin Capsules now in Stock (Julie Parras)

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Message: 1
Date: Thu, 25 Sep 2008 11:44:16 +1000
From: "Julie Parras" <julie.parras at aspenpharmacare.com.au>
Subject: [CARPA] Vancocin Capsules now in Stock
To: <carpa at ozdocit.org>
Message-ID:

<F79A83F5F064304790B801155F8D6884CEDF52 at aspensyd02.AspenDomain.local>
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