Australian Prescriber最新文献

Many errors can occur in the pre-analytical phase of laboratory testing, such as during patient preparation, sample collection, handling, storage and transport. Minimisation of errors during this phase is key to optimising the usefulness of laboratory tests and may reduce the need for repeat sampling. Various patient factors can affect laboratory test results, including posture, fasting status, circadian variation, medications and other interfering agents. Clinicians should be aware of these factors and advise patients on the necessary preparation before testing. Patient identification, collection timing, haemolysis, contamination and sample volume are important considerations when collecting and handling a sample. Individuals should consult their local laboratory for specific test instructions or protocols, as these can vary.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are useful for many conditions, frequently in preference to other therapies such as opioids. They play an important role in osteoarthritis, headache disorders, acute musculoskeletal injury, dysmenorrhoea and dental pain. In axial spondyloarthritis, they can modify disease and represent first-line therapy. Most NSAIDs have comparable efficacy for most conditions, despite their different pharmacodynamic effects. The pharmacokinetic profile of different NSAIDs might confer varying risks and advantages for acute or chronic conditions that influence their selection. NSAIDs have well-recognised adverse effects, including cardiovascular, renal and gastrointestinal risks. While these risks vary between NSAIDs, all of them confer some increased risk. Proton pump inhibitors reduce upper gastrointestinal complications but not lower gastrointestinal ones. Other important precautions relate to pregnancy and hypersensitivity reactions.

Older people, especially with multimorbidity and polypharmacy, are at higher risk of adverse medication outcomes compared with younger adults. To guide safer prescribing for older people, several lists of 'potentially inappropriate medicines' (PIMs lists) have been developed. Prominent PIMs lists include the Beers Criteria (USA) and the Screening Tool of Older People's Prescriptions (STOPP) (Europe). A new Australian PIMs list was published in 2024. PIMs are medicines for which there is evidence or consensus expert opinion that the potential risks usually outweigh the clinical benefits in a specific patient cohort. The Australian PIMs list outlines medicines that should be avoided in all older people, and medicines that should be avoided in certain clinical contexts. It also provides guidance on potentially safer alternatives to the listed medicines. Importantly, medicines included in PIMs lists are not always inappropriate. There may be clinical scenarios where a PIM is appropriate for an individual patient (hence the term potentially inappropriate). Prescribing decisions should always be individualised, considering the patient's clinical status and goals of care.

Aminoglycosides (gentamicin, tobramycin and amikacin) are highly effective parenteral drugs commonly used as initial empirical therapy of serious Gram-negative infections. They have rapid bactericidal activity and relatively low rates of resistance in Australia compared with other antibiotics used to manage Gram-negative infections. Therapeutic Guidelines: Antibiotic was updated in March 2025 and provides new guidance on the role of aminoglycosides, optimised dosing, and drug selection. The guidelines now recommend that dosing in adults is based on lean body weight, and provide calculators to assist with dose calculations. Therapeutic drug monitoring is required when aminoglycoside therapy is expected to continue beyond 48 hours; monitoring the area under the aminoglycoside concentration-time curve is recommended in adults.

Glucocorticoids can be stopped abruptly, without tapering, in patients prescribed them for less than 3 to 4 weeks. Prolonged glucocorticoid use (more than 3 to 4 weeks) can cause hypothalamic-pituitary-adrenal (HPA) axis suppression, necessitating gradual stopping (tapering) to prevent the consequences of adrenal insufficiency. For some patients on prolonged glucocorticoids, the dosage can be tapered and stopped without testing serum cortisol concentrations. For some patients on prolonged glucocorticoids, morning serum cortisol testing can be used to assess HPA axis recovery and guide glucocorticoid cessation. Further testing of the HPA axis, with an adrenocorticotrophic hormone stimulation test, and referral to endocrinology services may be required in patients with repeated low cortisol concentrations despite a prolonged period at a physiological glucocorticoid dose.

Long-acting reversible contraceptive methods, including the contraceptive implant and intrauterine devices, are highly effective and cost-effective options for women who have no specific contraindications. Long-acting reversible contraceptives are more effective at reducing unintended pregnancy than short-acting contraceptives. Short-acting contraceptive methods consist of combined hormonal contraception (e.g. the combined oral contraceptive pill, vaginal ring), progestogen-only pills, and the progestogen-containing contraceptive injection. Choice of contraception is based on factors such as medical eligibility (i.e. precautions, contraindications), patient preference and reproductive life stage. Counselling patients on the benefits and risks of all contraceptive methods is important for informed decision-making. Regular contraceptive review can allow for patient education and monitoring of adverse effects.