- Guidelines published for:
- Antimicrobial prescribing for impetigo
- Neonatal parenteral nutrition.
- Polatuzumabvedotin in combination not recommended for relapsed or refractory diffuse large B-cell lymphoma (draft.)
- Intrapartum care: existing medical conditions and obstetric complications quality standard.
- Draft interventional procedures guidance published:
- Transcranial magnetic stimulation for auditory hallucinations – research only
- Swallowable gastric balloon capsule for weight loss – research only
- Low energy contact X-ray brachytherapy for locally advanced rectal cancer – research only
- Intravascular lithotripsy for calcified coronary arteries during percutaneous coronary intervention – special arrangements only.
- NHS publishes statement on home testing for coronavirus.
- Medical device alerts:
- Various Olympus duodenoscope models: do not use if elevator wires are frayed or damaged as these may cause lacerations to patients and users
- Tympanic thermometers – revision of the calibration frequency of Cardinal Health Genius 2 and Genius 3 models.
- Supply disruption alert: Diamorphine hydrochloride powder for reconstitution and injection 5mg and 10mg ampoules.
- Supply Disruption Alert: Phenytoin (Epanutin®) 30mg/5ml Oral Suspension.
- Shortage of penicillamine 125mg and 250mg tablets.
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE
ANTIMICROBIAL PRESCRIBING GUIDANCE: IMPETIGO
The National Institute for Health and Care Excellence (NICE) has published a guideline which sets out an antimicrobial prescribing strategy for adults, young people and children aged 72 hours and over with impetigo. This guideline includes recommendations on:
- advice to reduce the spread of impetigo
- initial treatment
- reassessment and further treatment
- referral and seeking specialist advice
- choice of antimicrobial
NICE has also produced a 2-page visual summary of the recommendations, including tables to support prescribing decisions, as well as guidelines on antimicrobial prescribing for cellulitis and erysipelas and antimicrobial stewardship: systems and processes for effective antimicrobial medicine use.
The guideline committee has recommended that research should be conducted comparing the use of antiseptics with antibiotics for impetigo.
NEONATAL PARENTERAL NUTRITION GUIDELINE
NICE has published a guideline which covers parenteral nutrition for babies born preterm, up to 28 days after their due birth date and babies born at term, up to 28 days after their birth. The guideline includes recommendations on:
- indications for, and timing of, neonatal parenteral nutrition
- administration of neonatal parenteral nutrition
- energy needs of babies on neonatal parenteral nutrition
- neonatal parenteral nutrition volume
- constituents of neonatal parenteral nutrition
- standardised neonatal parenteral nutrition formulations (‘standardised bags’)
- monitoring neonatal parenteral nutrition
- stopping neonatal parenteral nutrition
- service design
- information and support for parents and carers
NICE has also produced algorithms on: neonatal parenteral nutrition for preterm babies, up to 28 days after their due birth date and neonatal parenteral nutrition for term babies, up to 28 days after their birth.
POLATUZUMABVEDOTIN IN COMBINATION NOT RECOMMENDED FOR RELAPSED OR REFRACTORY DIFFUSE LARGE B-CELL LYMPHOMA - DRAFT GUIDANCE
NICE has published draft guidance which does not recommend polatuzumabvedotin with rituximab and bendamustine, within its marketing authorisation, as an option for treating relapsed or refractory diffuse large B-cell lymphoma in adults who cannot have a haematopoietic stem cell transplant.
Although clinical evidence shows that people having polatuzumab vedotin plus rituximab and bendamustine have more time before their disease gets worse than people having rituximab and bendamustine alone, it is not known by how much because the final data from the trial are not available yet. The cost-effectiveness estimates for polatuzumab vedotin with rituximab and bendamustine are also very uncertain because of limitations in the data and methods. Therefore, it cannot be recommended for routine use in the NHS or for use in the Cancer Drugs Fund.
INTRAPARTUM CARE: EXISTING MEDICAL CONDITIONS AND OBSTETRIC COMPLICATIONS QUALITY STANDARD
NICE has published a quality standard which covers care during labour and birth for women who need extra support because they have a medical condition or complications in their current or previous pregnancy.
The quality standard says pregnant women with heart disease should have regular risk assessments to help plan for birth and to agree any additional management needs.
The quality statement also says women in labour with sepsis should be reviewed by a senior clinical decision maker immediately and if antibiotics are advised, they should be given within one hour.
In addition, the standard says some women may present in labour having had no prior care during pregnancy which puts them and their baby at an increased risk of complications. Midwives or obstetricians should assess the woman’s medical, psychological and social history, as far as possible, as well obstetric assessment and medical examination.
All care should be carried out by a multidisciplinary team and led by a named healthcare professional to promote a personalised, holistic approach and to help reduce the risk of adverse outcomes for the woman and her baby.
NICE says that in all situations, healthcare professionals should ensure that women are involved in developing and reviewing their care plan.
TRANSCRANIAL MAGNETIC STIMULATION FOR AUDITORY HALLUCINATIONS – RESEARCH ONLY
NICE has published draft interventional procedures guidance on the evidence regarding the safety of transcranial magnetic stimulation for auditory hallucinations. NICE says the evidence is adequate and raises no major safety concerns. However, evidence on its efficacy is inadequate in quantity and quality. Therefore, NICE recommends that this procedure should only be used in the context of research.
SWALLOWABLE GASTRIC BALLOON CAPSULE FOR WEIGHT LOSS – RESEARCH ONLY
NICE has published draft interventional procedures guidance on the use of swallowable gastric balloon capsule for weight loss. Evidence on its safety shows infrequent but potentially serious adverse events. Evidence on its efficacy shows that there is some weight loss in the short-term but evidence for sustained weight loss is inadequate in quality and quantity. Therefore, NICE says this procedure should only be used in the context of research.
LOW ENERGY CONTACT X-RAY BRACHYTHERAPY FOR LOCALLY ADVANCED RECTAL CANCER – RESEARCH ONLY
NICE has published draft recommendations which finds the current evidence on the safety and efficacy of low-energy contact X-ray brachytherapy (the Papillon technique) for locally advanced rectal cancer is inadequate in quantity and quality. Therefore, NICE says this procedure should only be used in the context of research.
INTRAVASCULAR LITHOTRIPSY FOR CALCIFIED CORONARY ARTERIES DURING PERCUTANEOUS CORONARY INTERVENTION – SPECIAL ARRANGEMENTS ONLY
NICE has published draft interventional procedures guidance on the evidence on the safety and efficacy of intravascular lithotripsy for calcified coronary arteries during percutaneous coronary intervention, which has been found to be limited in quantity and quality. Therefore, NICE says the procedure should only be used with special arrangements for clinical governance, consent, and audit or research.
NHS PUBLISHES STATEMENT ON HOME TESTING FOR CORONAVIRUS
The NHS has announced it has started pilots of home testing for coronavirus where NHS staff, including nurses and paramedics, will visit people in their own homes rather than them having to travel.
NHS England advises anyone who is concerned they have signs and symptoms of coronavirus, should continue to use NHS 111 as their first point of contact, and that people should also play their part by following public health advice – washing hands, covering the mouth and nose with a tissue or sleeve when coughing or sneezing, and putting used tissues in the bin immediately.
MEDICINES AND HEALTHCARE PRODUCTS REGULATORY AGENCY
VARIOUS OLYMPUS DUODENOSCOPE MODELS: DO NOT USE IF ELEVATOR WIRES ARE FRAYED OR DAMAGED AS THESE MAY CAUSE LACERATIONS TO PATIENTS AND USERS
The Medicines and Healthcare products Regulatory Agency (MHRA) has issued a medical device alert for various Olympus duodenoscope models. Olympus Medical Systems Corp has issued instructions for use, advising healthcare professionals to inspect for frayed elevator wires before and after use to improve the detection of damage.
TYMPANIC THERMOMETERS – REVISION OF THE CALIBRATION FREQUENCY OF CARDINAL HEALTH GENIUS 2 AND GENIUS 3 MODELS
The MHRA has issued a medical device alert for Cardinal Genius 2 and Genius 3 models of tympanic thermometers. Cardinal Health have advised that the calibration period should be revised to 25 weeks instead of yearly to ensure these thermometers remain within their accuracy range and reduce the risk of misdiagnosis or delay in treatment.
DEPARTMENT OF HEALTH AND SOCIAL CARE
SUPPLY DISRUPTION ALERT: DIAMORPHINE HYDROCHLORIDE POWDER FOR RECONSTITUTION AND INJECTION 5MG AND 10MG AMPOULES
The Department of Health and Social Care (DHSC) has issued a supply disruption alert for Diamorphine hydrochloride powder for reconstitution and injection 5mg and 10mg ampoules: there are two suppliers of diamorphine hydrochloride 5mg and 10mg in the UK. One supplier is currently out of stock and one is expected to be out of stock shortly. The alert contains advice on the management of affected patients and includes an additional document from UK Medicines Information.
PHARMACEUTICAL SERVICES NEGOTIATING COMMITTEE
SUPPLY DISRUPTION ALERT: PHENYTOIN (EPANUTIN®) 30MG/5ML ORAL SUSPENSION
The Pharmaceutical Services Negotiating Committee has reported that the DHSC has issued a medicine supply disruption alert for Phenytoin (Epanutin®) 30mg/5ml Oral Suspension (Pfizer). Pfizer have limited supplies of Phenytoin (Epanutin®) 30mg/5ml Oral Suspension and anticipate going out of stock w/c 2nd March 2020. The anticipated re-supply date is late June 2020.
The Canadian brand of Phenytoin 30mg/5ml oral suspension – ‘Dilantin-30®’ (imported equivalent to Epanutin® 30mg/5ml oral suspension) is available from specialist importers on an ‘unlicensed’ basis.
SPECIALIST PHARMACY SERVICE
SHORTAGE OF PENICILLAMINE 125MG AND 250MG TABLETS
The Specialist Pharmacy Service has issued a memo reporting that Mylan are out of stock of penicillamine 125mg tablets until late March 2020 and 250mg tablets until end of February 2020. Kent also market the 250mg tablets but are currently only supplying to secondary care. The memo advises on alternative management options.