The Society of Hospital Pharmacists of Australia
Recommendations from The Society of Hospital Pharmacists of Australia on end-of-life care, antibiotics, antipsychotic drugs, NSAIDs & codeine. The Society of Hospital Pharmacists of Australia (SHPA) is the national professional organisation for more than 3,000 pharmacists, pharmacists in training, pharmacy technicians and associates working across Australia’s health system.
2.
Don’t initiate an antibiotic without an identified indication and a predetermined length of treatment or review date.
Antibiotics may be prophylactic, empirical or targeted against a known organism.
Prolonged duration of antibiotics is associated with: an increased risk of adverse reactions, Clostridium difficile infection, candidiasis, selection of antibiotic resistant organisms as well as unnecessary cost. Therefore the shortest possible duration of therapy should be used. For the majority of infections treatment should not exceed 7 days.
The most appropriate duration of therapy may be difficult to identify in some circumstances. In these instances treatment duration must be individualised for the patient on the basis of clinical, microbiological or radiological parameters. If ongoing treatment is required a date for review should be identified.
Patients should be advised that using antibiotics when they don’t need them can contribute to the problem of antibiotic resistance. They should be advised, when the antibiotic is prescribed and dispensed, when the antibiotic is to finish, or the date to be reviewed.
Supporting evidence
- File TM Jr. Duration and cessation of antimicrobial treatment. J Hosp Med 2012;7(1) suppl 1:S22-S33.
- Havey TC, Fowler RA, Daneman N. Duration of antibiotic therapy for bacteremia: a systematic review and meta-analysis. Crit Care 2011;15:R267.
- Brown K, Valenta K, Fisman D, Simor A, Daneman N. Hospital ward antibiotic prescribing and the risks of Clostridium difficile infection. JAMA Internal Medicine 2015;175(4):626-33.
- Stuart RL, Wilson J, Bellaard-Smith E, Brown R, Wright L, Vandergraaf S et al. Antibiotic use and misuse in residential aged care facilities. Intern Med J 2012;42(10):1145-9.
- Australian Commission on Safety and Quality in Health Care. Antimicrobial prescribing practice in Australian hospitals: results of the 2014 National Antimicrobial Prescribing Survey. Sydney: ACSQHC; 2015.
- Antibiotics Expert Groups. Therapeutic guidelines: antibiotics. Version 15. Melbourne: Therapeutic Guidelines Limited; 2014.
How this list was made
A working party was formed and they sought suggestions from SHPA’s Committees of Specialty Practice, Reference Groups, State and Territory branches and Federal Council. More than 40 proposed statements were considered by the working party. A shortlist of 10 statements was identified for consideration by the SHPA’s membership through an online survey. All members were invited to comment on each proposed statement, specifically: whether it related to the practice of pharmacy, related to medicines that are frequently used, and if a significant cost. Members were also invited to rate the statements in order of preference. The survey results were used by the working party to identify the final six statements which were presented to SHPA’s Federal Council who ratified the choice of the five final statements.
Related recommendations
- 1 Don’t initiate and continue medicines for primary prevention in individuals who have a limited life expectancy.
- 2 Don’t initiate an antibiotic without an identified indication and a predetermined length of treatment or review date.
- 3 Don’t initiate and continue antipsychotic medicines for behavioural and psychological symptoms of dementia for more than 3 months.
- 4 Don’t recommend the regular use of oral non-steroidal anti-inflammatory medicines (NSAIDs) in older people.
- 5 Don't recommend the use of medicines with sub-therapeutic doses of codeine (<30mg for adults) for mild to moderate pain.