Practice-changing updates in the August 2020 release

As well as including a comprehensive revision of the Toxicology and Toxinology guidelines, the August 2020 release of eTG complete also includes the following practice-changing updates to other guidelines. With each release, we are also continuing to implement drug name changes in line with the Therapeutic Goods Administration.

Antibiotic guidelines

  • Tinidazole was discontinued in Australia in February 2020. A footnote about this has been added to tinidazole drug recommendations; metronidazole is recommended as an alternative when an oral nitroimidazole is required.
  • Amphotericin B lipid complex is no longer registered for use in Australia, but is available via the Special Access Scheme. A footnote about this change in availability has been added to amphotericin B lipid complex drug recommendations.
  • The empirical recommendations for sepsis and septic shock from a biliary or gastrointestinal tract source have been updated to ensure patients with acalculous cholecystitis who have penicillin hypersensitivity receive antibiotic therapy with activity against Pseudomonas aeruginosa.
  • New data are available on the safety of erythromycin use in early pregnancy. The erythromycin entry in ‘Drug use in pregnancy and breastfeeding’ has been updated to include links to the relevant publications.
  • Combination therapy with flucloxacillin and vancomycin was observed in a recent randomised controlled trial to be associated with nephrotoxicity. Despite this, combination therapy continues to be recommended for initial therapy for Staphylococcus aureus bacteraemia to ensure adequate treatment of both methicillin-susceptible and methicillin-resistant strains. New advice is included to limit the duration of combination therapy to 48 hours.
  • Vancomycin dosage adjustments should be made in a linear manner. Updated guidance on the practical application of linear dosage adjustments is included.
  • A recent randomised controlled trial showed that a single dose of amoxicillin+clavulanate reduced the incidence of maternal infection after assisted (vacuum or forceps) vaginal delivery. Advice on which women should receive prophylaxis and what drug should be used has been added.

Cardiovascular guidelines

  • A comment has been added to ‘Venous thromboembolism: prophylaxis’ topic to clarify that optimal prophylaxis in obese patients has not been fully determined. Expert advice is recommended for drug choice and dosing.

Dermatology guidelines

  • The ‘Vulvovaginitis in girls’ topic has been updated to reflect that candidal vulvovaginitis occurs very rarely in prepubertal girls, rather than not occurring in this patient group.

Diabetes guidelines

  • Dapagliflozin has now been approved by the Australian Therapeutic Goods Administration (TGA) for use in patients with a creatinine clearance of 45 mL/min or more (previously 60 mL/min or more), as for all other sodium-glucose co-transporter 2 (SGLT2) inhibitors available in Australia. The drug recommendation for dapagliflozin for patients with type 2 diabetes has been updated.
  • The Lantus brand of insulin glargine 100 units/mL has been discontinued in Australia and replaced by the Optisulin brand, which is made by the same drug company and is therapeutically identical. Optisulin has been added to the list of available insulin formulations in Table 18.4.