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Prescribing for school nurses

Prescribing for school nurses. Bruce Arroll Dept of General Practice and Primary Health care School of Population Health. Rheumatic fever prevention. Mean ARF age is 9 years 5-14 yrs maori 79.3/100,000 5-14 yrs pacific is 19.2/100,000 5-14 yrs European is 0.7/100,000.

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Prescribing for school nurses

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  1. Prescribing for school nurses Bruce Arroll Dept of General Practice and Primary Health care School of Population Health

  2. Rheumatic fever prevention • Mean ARF age is 9 years • 5-14 yrs maori 79.3/100,000 • 5-14 yrs pacific is 19.2/100,000 • 5-14 yrs European is 0.7/100,000

  3. Rheumatic fever - issues • Cardiac damage • Penicillin prophylaxis until adult • Valve replacement (if diagnosed) • Premature death (heart failure, endocarditis)

  4. Rheumatic fever – primary prevention • Treating streptococcal tonsillitis with injectable penicllin reduces rheumatic fever (USA military 1950s) • Does oral work? • Whangaroa school project treating children with sore throats was accompanied by Rh fever reduction • nights per week) such that it interferes with your activities the following day (eg unrefreshed in the morning, fatigued, poor concentration or irritability- lasting for more than one month • 41% in Auckland GP Study • Poor sleep associated with poor mental health in 1 yr

  5. Rheumatic fever – primary prevention #2 • Rates of strep throat also dropped but in 2009 and 2010 rose to pre-programme levels but no more cases of rheumatic fever • Coincidence or cause and effect • Whangaroa school project –community driven lots of resources • nights per week) such that it interferes with your activities the following day (eg unrefreshed in the morning, fatigued, poor concentration or irritability- lasting for more than one month • 41% in Auckland GP Study • Poor sleep associated with poor mental health in 1 yr

  6. Rheumatic fever – primary prevention #3 • Kaikohe project so far less successful • ? Larger community less buy in from all players • GPs; schools, children,

  7. School based programmes • “Sore throats matter” • Health Promotion • Training –community health workers- 3 visits/week • Consent ? Prior to swabbing programme • Primary/Int not high school –wait for Ministry

  8. Sore throat • Most are viral 5-10% GAS in NZ samples • GAS = group A strep • Severity of sore throat no indication • Strep throat will get better on own usually occasionally quinsy peritonsillar abcess: v sick

  9. Sore throat • Criteria Point • Temp > 38oC 1 • No cough 1 • Tender glands 1 • Tonsillar swell/pus 1 • Age 3-14 1 • Age 15-44 0 • Age >44 -1

  10. Likelihood of strep tonsillitis based on scoring system

  11. If treating with amoxil • Advantages • Can take with food • Once daily: 1500mg > 30 kgs; or 750mg < 30 kgs • Vs penicillin twice daily on empty stomach • Disadvantages • Rash more common and glandular fever-avoid • ? More diarrhoea

  12. If treating with amoxil • Contraindications • Allergy to penicillin • Care with other antibiotics • Oestrogen oral contraceptives (birth control pill) • 7 day rule – from end of last dose

  13. Allergies to penicillin/amoxil • Erythromicinethinylsuccinate • Children: 40mg/kg/day in 2-4 divided doses Maximum 1g/day • Adults: 400mg twice daily

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