Patient Group Direction for Doxycycline (Tetracycline) Version: 01 Start Date: October 2015 Expiry Date: October 2018

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1 THIS PATIENT GROUP DIRECTION HAS BEEN AGREED BY THE FOLLOWING ORGANISATIONS: CLINICAL COMMISSIONING GROUP: Doncaster CCG Lancashire North CCG Fylde & Wyre CCG East Lancashire CCG Change history Version number Change details Date

2 CLINICAL CONTENT OF PATIENT GROUP DIRECTION FOR DOXYCYCLINE (TETRACYCLINE) Patient Group Direction Details Date comes into effect October 2015 Date of expiry and review October 2018 Staff characteristics: Qualifications Registered nurse, midwife, Paramedic practitioner, Physiotherapy Specialist competencies or qualifications Continuing training and education Clinical Details practitioner. Received training to undertake administration and supply of medicines under PGD Has undertaken appropriate training to carry out clinical assessment of patient, leading to diagnosis. Also that such diagnosis requires treatment according to the indications listed in this PGD. The practitioner should be aware of any change to the recommendations for the medicine listed. It is the responsibility of the individual to keep up to date with continued professional development and to work within the limitations of individual scope or practice. Indication Lower respiratory tract infections in patients with COPD/asthma Uncomplicated pneumonia (2 nd Line) Second line for those allergic to penicillin Asthma suffering: acute sinusitis, acute bronchitis (2 nd Line) Clinic failure of amoxicillin in acute exacerbation of COPD Inclusion criteria Patients over 12 years of age Exclusion criteria Pregnancy Breast feeding Age under 12 Hepatic impairment Prescribed cyclosporin Hypersensitivity to any component of product Absence of consent Acute porphyria Drug interactions, azathioprine, cyclosporin, coumarins, digoxin, meraptopurine, methotrexate, phenindione, phenytoin, pyrimethamine, strontium ranelate, retinoids

3 Precautions Alcohol dependency Avoid sun beds and sun exposure, can cause photosensitivity Patients with a history of oesophagitis or dysphagia The capsules should be swallowed with plenty of fluid in either a sitting or standing position and well before going to bed to reduce the likelihood of oesophageal irritation or ulceration If gastric irritation occurs, it is recommended that doxycycline capsules be given with food or milk Discontinue treatment at first signs or evidence of skin erythema, if the patient is exposed to direct sunlight or UV light Management of excluded patients Discuss alternative with GP or Clinical Lead If coumarins check INR within 7 days Action for patients not wishing / unable to receive care under this Make patient aware of alternative if available, risks and potential consequences of not being treated. Document refusal. PGD

4 CLINICAL CONTENT OF PATIENT GROUP DIRECTION FOR DOXYCYCLINE (TETRACYCLINE) Description of Treatment Name of medicine Formulation and route Strength Dosage Doxycycline Tablets, oral 100mg Age over 12, 200mg on first day then 100mg per day for 6 days Bronchiectasis 1BD (14 days) Repeated dose instructions Not applicable Duration of treatment Duration of treatment, acute sinusitis 7 days Acute bronchitis 5 days Acute exacerbation of COPD 5/7 days Bronchiectasis and TB 14 days Uncomplicated pneumonia 10 days Quantity to supply Pre-packed box of 8 capsules Legal status POM Special Precautions Explain indications, contraindications and cautions (refer to BNF) Adverse effects Nausea, vomiting, diarrhoea (antibiotic-associated colitis reported occasionally), dysphagia, and oesophageal irritation Other rare side-effects include hepatotoxicity, pancreatitis, blood disorders, photosensitivity (particularly with demeclocycline), and hypersensitivity reactions (including rash, exfoliative dermatitis, Stevens-Johnson syndrome, urticaria, angioedema, anaphylaxis, pericarditis) Headache and visual disturbances may indicate benign intracranial hypertension (discontinue treatment); bulging fontanelles have been reported in infants. Anorexia, dry mouth, flushing, anxiety, tinnitus Advice necessary Manufacturer s Patient Information Leaflet Any further instructions to aid compliance Storage or expiry details Practical advice on self-care if appropriate Advice on recognising side effects and what to do Advice on where to seek help if treatment fails or condition worsens Consider whether other health promotion material is appropriate e.g. Smoking Cessation clinics

5 Records and Follow Up Referral arrangements Inform GP as soon as possible Advise if worsening or no improvement to seek further medical advice Records to be kept Patient s name, address, date of birth and consent given Contact details of GP (if registered) Diagnosis Dose and form administered Batch and expiry details Advice given to patient (including side effects) Signature / name of staff who administered or supplied the medication If relevant, signature / name of staff who removed / discontinued the treatment Details of any adverse drug reaction and actions taken, including documentation in the patient s medical record Referral arrangements (including self-care) Any side effects attributable to drug should be recorded and MHRA advised via yellow card system found in BNF Follow up Advise follow up with GP/ Practice nurse Advice on antibiotic prescribing Advice to Complete the prescribed course patient/carer If appropriate store liquid in the refrigerator and shake well before use See GP if symptoms do not improve within 48 hours Discard any unused medicines appropriately Prescribing Guidance To be prescribed in-line with the relevant antimicrobial formulary and licensed indications, local microbiologist advice and decisions based on local resistance patterns Otitis media Tonsillitis North Lancashire CCG Wyre and Fylde CCG East Lancashire CCG Antimicrobial Formulary [HYPERLINK] Doncaster CCG Refer to NICE guidelines Health protection agency primary care guidance for the management of infection Many cases of otitis media are viral and resolve in 4 days in 80% of cases. Use NSAID and paracetamol as appropriate. Antibiotics do not reduce pain in first 24 hours or subsequent attacks of deafness Use Centor Criteria to determine who is at high risk and may benefit from antibiotics: 1. Tonsillar exudate

6 Advice to patients Medications 2. Tender anterior cervical lymphadenopathy 3. Absence of cough 4. History of fever If 3 or 4 of these are present then the chance of infection with beta haemolytic streptococcus is 50%. These patients may benefit from antibiotic and suggest analgesia. Evidence suggests a 7 day course is most effective. Advise patients of the normal natural pathway of disease and average total illness length. Acute otitis media 4 days Acute sore throat /acute pharyngitis / acute tonsillitis 7 days Acute rhinosinusitis 10 days Acute cough / acute bronchitis 17 days Offer advice about managing symptoms including fever (analgesia and antipyretics) Warfarin If patient is taking warfarin, advise to attend anticoagulant in next week to advise staff of new antibiotic medication and have INR checked Patient Group Direction, organisation and individual authorisation signatures can be found on the managerial content sheet along with other non-clinical details relating to this patient group direction.

7 MANAGERIAL CONTENT OF PATIENT GROUP DIRECTION FOR DOXYCYCLINE (TETRACYCLINE) Patient Group Direction Owner Details of Patient Group Direction owner FCMS (NW) Ltd & PDS Medical Ltd Patient Group Direction Details Date comes into effect October 2015 Date of expiry and review October 2018 Staff characteristics Qualifications Registered nurse, midwife, Paramedic practitioner, Physiotherapy Specialist competencies or qualifications Continuing training and education Patient Group Direction Authorisation Lead Doctor Lead Pharmacist practitioner. Received training to undertake administration and supply of medicines under PGD Has undertaken appropriate training to carry out clinical assessment of patient, leading to diagnosis. Also that such diagnosis requires treatment according to the indications listed in this PGD. The practitioner should be aware of any change to the recommendations for the medicine listed. It is the responsibility of the individual to keep up to date with continued professional development and to work within the limitations of individual scope or practice. Dr Mark Spencer Lead Nurse Organisational Authorisation for CCG Organisational Authorisation by Gillian Gregory Jackie Hanson Patient Group Direction Peer Reviewed By Name Position Signature Date

8 MANAGERIAL CONTENT OF PATIENT GROUP DIRECTION FOR DOXYCYCLINE (TETRACYCLINE) Individual Authorisation BY SIGNING THIS PATIENT GROUP DIRECTION YOU ARE INDICATING THAT YOU AGREE TO ITS CONTENTS AND THAT YOU WILL WORK WITHIN IT. PGDs DO NOT REMOVE INHERENT PROFESSIONAL OBLIGATIONS OR ACCOUNTABILITY. IF THIS IS AN UPDATED OR REPLACEMENT PGD ENSURE THAT ALL OLDER VERSIONS ARE WITHDRAWN FROM USE WITH IMMEDIATE EFFECT. IT IS YOUR RESPONSIBILITY TO MAKE SURE YOU ARE USING THE CURRENT VERSION. NOTE TO AUTORISING MANAGERS: AUTHORISED STAFF SHOULD BE PROVIDED WITH AN INDIVIDUAL COPY OF THE CLINICAL CONTENT OF THIS PGD AND A PHOTOCOPY OF THE AUTHORISATION SHEET SHOWING THEIR AUTHORISATION. Name of Professional Signature Authorising Manager Date

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