Tablet Press
The prescribing newsletter for GPs, nurses and pharmacists in
Northamptonshire Primary Care Trust
Issue 25
October 2008
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Nurse Prescribers
If you are a nurse prescriber and change your employer (e.g. from one GP practice to another or from
the PCT to a GP practice) please advise Sue Barron, Pharmacy and Prescribing Administrator, so that
your details can be amended with the Prescription Pricing Division and prescription costs can be
allocated to the correct practice. We have had a number of cases recently in which costs have been
wrongly allocated as a result of nurses being registered with the incorrect practice.
Additionally, GP practices are requested to advise Sue if a nurse prescriber leaves their employment.
01536 480446
xxxxx.xxxxxx@xxxxxxxxx.xxx.xx
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Antibiotic prescribing
At this time of year we ask prescribers to consider their antibiotic prescribing and the Prescribing
Advisers are currently busy with many practices to implement delayed antibiotic prescribing, as endorsed
by the recent NICE guidance. A number of practices remain “red” within the incentive scheme despite a
lot of focus on antibiotic prescribing over the years.
Community pharmacists can help by advising patients of the expected duration of colds, coughs and
sore throats and that antibiotics are unlikely to be necessary in otherwise healthy adults and children.
See http://www.nice.org.uk/nicemedia/pdf/CG69FullGuideline.pdf
We would also ask that practices consider their use of quinolones and cephalosporins (your Prescribing
Adviser can give you a breakdown from epact) in light of the link between the use of these agents and
the incidence of C.difficile.
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ARB maybe less effective than ACE-inhibitors for reducing adverse CV events?
The results of a large controlled trial (The Lancet 2008; 372: 1174 – 1183) suggest that telmisartan, and
by implication other angiotensin-2 receptor blockers (ARB), may be less effective in reducing CV events
in high-risk patients.
There is robust evidence that ACE-inhibitors reduce a range of adverse outcomes in patients with CV
disease or high-risk diabetes. A proportion of patients cannot tolerate ACEIs, however, and in this group
ARBs are often used. While there is evidence of benefit for this group in some patient populations,
evidence on major clinical outcomes for a broad population is limited. The TRANSCEND study was
intended to clarify the place of these drugs in a broad population. Participants had CV disease or
diabetes with end-organ damage and were intolerant of ACEIs. Patients were randomised to telmisartan
or placebo, in addition to other proven therapies as required. Primary outcome was a composite of CV
death, MI, stroke, or hospitalisation for heart failure, and median duration of follow-up 56 months.
At the end of the study, there was no statistically significant difference between the groups for the
primary outcome, which occurred in 465 patients in the telmisartan group compared with 504 in the
placebo group (15.7% vs. 17.0%; hazard ratio 0.92, 95% CI 0.81 to 1.05, p=0.216).
The authors conclude that telmisartan did not improve the primary outcome in this patient population.
An accompanying editorial discusses the study and its implications. The authors comment that the role
of ARB in prevention of CV disease has been unclear: while there has been speculation that they might
be equivalent to or even better than ACEIs based on pharmacology, and there is evidence of similar
effectiveness in heart failure, clinical evidence in other situations has been limited. The results of this
study are unexpected, as other trials have suggested similar efficacy to ramipril. Overall, data on ARB in
prevention of adverse CV events are incomplete, except in heart failure. At present, they suggest,
although the data are too limited to reach definitive conclusions, the clinical effects of ARB seem to be
less robust than those of ACEIs, which therefore remain the preferred renin-active agents to prevent
vascular events in patients with or at high risk for cardiovascular disease.
This edition is also available on HNN (Health Network Northants)
http://nww.northants.nhs.uk/Display/Dynamic.jsp?topid=14070&lhsid=514&oid=2854¤tid=2854
Disclaimer
Information in this newsletter is believed to be accurate and true. Northamptonshire PCT and its employees accept no liability for loss of any
nature, to persons, organisations or institutions that may arise as a result of any errors or omissions.
Contact No 01536 480446