Alternative penicillin protocols for pharmacists
Following the announcement of serious shortage protocols (SSPs) on Thursday, December 15, five new SSPs have been issued.
This has increased the number of alternative antibiotics or formulations that pharmacists can provide if they do not have the medication on the prescription in stock.
Penicillin will continue to be prescribed by doctors for patients who require it.
Scarlet fever is on the rise, and as a result of the increased demand, some pharmacists are experiencing temporary and localised supply issues, and may not have the specific formulation listed on the prescription.
These SSPs provide pharmacists with the flexibility they need to provide an alternative antibiotic or penicillin formulation while ensuring patients continue to receive the medicine they require to treat the infection.
The SSPs apply to the following medicines:
- Phenoxymethylpenicillin 125 mg/5 ml oral solution
- Phenoxymethylpenicillin 125 mg/5 ml oral solution sugar free
- Phenoxymethylpenicillin 250 mg/5 ml oral solution
- Phenoxymethylpenicillin 250 mg/5 ml oral solution sugar free
- phenoxymethylpenicillin 250 mg tablets
SSPs are a standard procedure, used frequently to manage temporary and potential medicine supply issues.
They are a safe and efficient way to ensure that medicines are available for everyone who requires them, while also saving time for patients, pharmacists and prescribers.
Dupilumab (Dupixent▼): risk of ocular adverse reactions and need for prompt management
Dupilumab is a monoclonal antibody that inhibits interleukin-4 and interleukin-13 signalling and is used in adults and adolescents 12 years and older with moderate to severe atopic dermatitis.
Dupilumab is also used in children aged 6 and up who have severe atopic dermatitis or severe asthma, as well as in adults who have severe asthma (see background section for detailed indication).
Prescribers who use dupilumab should be aware of the risks of ocular reactions. New or worsening ocular symptoms necessitate prompt evaluation. As needed, an ophthalmological examination should be referred.
The potential for adverse reactions affecting the eye with dupilumab was established in the initial clinical trials. Further ocular adverse reactions have been identified during post-marketing clinical use. Although most ocular reactions are mild, some can become serious. We have received a small number of Yellow Card reports of ulcerative keratitis with serious corneal damage associated with dupilumab treatment.
The Medicines and Healthcare products Regulatory Agency (MHRA) recently reviewed the risk of dupilumab-related dry eye as well as serious ocular side effects. They sought independent advice from the Commission on Human Medicines' Gastroenterology, Rheumatology, Immunology, and Dermatology Expert Advisory Group, as well as ophthalmology expertise.
The review recommended that updates should be made to the product information for dupilumab to include the adverse drug reaction ‘dry eye’ and also to emphasise the need for prompt and appropriate management of any potential ocular reactions.
It is not currently possible to predict who may experience the rarer and most serious ocular adverse reactions, such as ulcerative keratitis. It is therefore important, with all ocular reactions, for patients to receive prompt care, with treatment provided as appropriate to prevent or minimise damage to the eye.
The MHRA has also issued a warning to healthcare professionals who use tralokinumab. Tralokinumab, an antibody that inhibits interleukin-13 signalling, was recently approved in the United Kingdom for the treatment of moderate-to-severe atopic dermatitis in adults. There has been very little clinical experience with it in the UK to date. Tralokinumab use has been linked to keratitis, conjunctivitis, and allergic conjunctivitis in clinical trials.
The MHRA are advising healthcare professionals prescribing dupilumab and tralokinumab to discuss with patients the potential for side effects affecting the eye and to ensure any reactions are managed promptly, especially in a patient experiencing eye pain or changes to their vision.