Westmeath is among the worst counties for overuse of antibiotics

The HSE revealed earlier this year that Westmeath is among the worst three counties in Ireland for overuse of antibiotics. Pharmacist Eamonn Brady from Whelehans Pharmacy Mullingar explains that “antibiotics do not work for colds and flus and should be reserved for more serious infections”. Eamonn explains that “Antibiotic resistance still remains a major European and global public health problem and is, for a large part, caused by misuse of antibiotics. Antibiotic resistance is considered to be one of the biggest future threats to world health; already diseases which were considered curable such as tuberculosis and malaria are getting resistant to antibiotics and could become incurable in the future if we don’t tackle antibiotic overuse”.

One in four people still think an antibiotic cures a cold

Eamonn explains that a “2013 HSE survey revealed some worrying findings. It was revealed that one in four people in Ireland still wrongly believe that antibiotics prevent colds developing into more serious illness or that they speed up the recovery from colds. The HSE explain “Antibiotics have truly transformed modern medicine and are appropriately used to treat or prevent bacterial infections. However, we are all in danger of taking antibiotics for granted and we all have a role to play so that we don't return to the pre-antibiotic era. Before antibiotics were available, common injuries such as cuts and scratches that became infected sometimes resulted in death or serious illness because there was no treatment available. Thankfully, this does not happen anymore as we have antibiotics available to treat these infections. However a casual attitude to antibiotics is damaging their effectiveness”.

Under the weather?

European Antibiotic Awareness Day is an annual event to raise awareness on how to use antibiotics in a responsible way that will keep them effective now and in the future. To mark the occasion, Pharmacists are collaborating with GP’s and the HSE on a public campaign; this campaign is being launched today, Wednesday 18 November. The campaign is being supported by the HSE website www.undertheweather.ie and is being promoted as the place to go for sensible, practical advice on common complaints. Most young mothers, when discovering their child is ill, search online for advice. This website will give practical advice on what to do and when to seek help from the pharmacist or GP.

What to do if you have cold or flu

Pharmacist Eamonn Brady explains that “antibiotics are now becoming ineffective to many infections leading to the development of superbugs such as MRSA. Infections such as tuberculosis are now re-emerging because the bacteria are developing resistance because of our overuse of antibiotics. The best way to prevent this problem is for all of us to only use antibiotics when we really need them. Many infections are viral so an antibiotic should not be prescribed. Your GP or pharmacist can explain which infections need and which don’t need antibiotics” Pharmacists give the following advice if you have a cold or flu, “Stay at home and rest if necessary. Drink plenty of water or soft drinks. Take paracetamol to reduce your temperature if feverish or if you are in any discomfort. You may wish to take other remedies, but be aware that they may contain paracetamol - do not exceed the maximum daily dose of paracetamol by combining different products - ask your pharmacist. Ask your pharmacist about other remedies you can safely take to relieve your symptoms. If you are concerned that your symptoms are getting worse or you are not better in a few days, phone your GP surgery for further advice. Finally, personal hygiene precautions such as hand washing regularly prevent the risk of infections spreading and will protect you and others.”

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

Buccal Midazolam Directions- Quick-Guide (For Epileptic Seizures)

What is midazolam?
Midazolam belongs to a group of medicines called benzodiazepines. It is a relation of diazepam. It has traditionally used for sedation. Midazolam can be used to treat a number of different conditions, including seizures. It is prescribed for some but not all epileptics (eg) if a person has a history of longer seizures (also known as fits). If a seizure lasts for more than five minutes, it may be difficult to stop unless treatment is given. It is therefore important that rapid treatment is given to stop the seizures and therefore prevent status epilepticus. Status epilepticus is a condition where a person has a seizure (convulsion or fit) or a series of seizures that last for 30 minutes or more, without a complete recovery of consciousness.

How is buccal midazolam given?

The midazolam solution should be placed against the sides of the gums and cheek so that the medicine is absorbed directly into the bloodstream. This is known as the buccal or oromucosal route. Administer slowly. If the medicine is swallowed accidentally, it might not work as quickly. Nowadays, Buccal Midazolam is prescribed mainly in an easy to use pre-filled syringe eg. Epistatus Pre-filled syringe or Buccolam pre-filled syringe.

Using Buccolam^® pre-filled oral syringes or Epistatus^® pre-filled oral syringes

·         Check the dose and expiry date of the pre-filled syringe provided.

·         Remove the oral syringe from the packaging.

·         Place the syringe into the side of the person’s mouth, between the gums and teeth.

·         If possible, divide the dose so you give half into one cheek and the remaining half into the other cheek.

·         Slowly push the plunger of the syringe down until the syringe is empty.

·         Watch for any breathing difficulties.

·         Confirm that the seizure has stopped.

 

·         Dispose of syringe safely

If the patient is going to a hospital or a medical professional after administering, it is good practice to send the used syringe with the patient so the medical professional can see exactly what has been administered. Also, t aim to record the time the buccal midazolam was administered (this is important in cases where further doses need to be administered).

Never use another person’s Buccal Midazolam for a person it is not prescribed for

Only administer Buccal Midazolam that is specifically prescribed for that patient. NEVER use another person’s buccal midazolam for a patient it is not prescribed for.

How long does it take to work?            

Buccal Midazolam takes a few minutes to work so the seizure is likely to continue for a few minutes after administering. Some of the midazolam may flow out of the side of the mouth (especially as the patient is undergoing seizures); however once the majority stays in the mouth then the patient will get sufficient amount into the bloodstream to work.

When to administer?                               

1^st Dose: Administer if a seizure lasts for five minutes (as the majority (75%) of seizures will expire within five minutes and buccal midazolam may cause severe drowsiness)

The amount of midazolam buccal liquid used depends on weight and age. The dose for children over 10 years and adults is 10mg (1ml)

·         For younger children, doses come in 2.5mg, 5mg and 7.5mg; administer the dose the doctor prescribes

·         The doctor will prescribe the correct dose based on the child’s age and weight so you do not have to worry about picking correct dose. Simply use the buccal midazolam labelled for that patient

2^nd Dose: ONLY GIVE A 2^ND DOSE IF ADVISED BY PRESCRIBING DOCTOR AND AFTER THE ADVISED TIME PERIOD. For adults (and some children), a second dose may be given 10 minutes later if no response is apparent and the patient is breathing normally. If the patients’ breathing becomes shallow, call an ambulance and do not administer a second dose. If a response is not seen after a further 5 minutes, call for assistance. Ambulance staff may repeat the dose if deemed appropriate.

 What to do if a seizure starts again: Generally a 3^rd dose is not advised without medical supervision. An ambulance should be called if seizures continue. The maximum recommended dose in 24 hours is 20mg for adults (or less for children). Please follow the advice given by the initiating specialist.

What are the side effects of buccal midazolam?

• Drowsiness and sedation – recovery is usually fast.
• Amnesia or short-term memory loss – the person may not remember having had a seizure.
• Breathing difficulties – the person is unlikely to have breathing difficulties if midazolam is given at the correct dosage. If breathing difficulties do develop, seek medical assistance.
• Restlessness, agitation and disorientation – these can occur but are usually rare.

Storage
Keep midazolam at room temperature (not in a fridge). Store away from bright light or direct sunlight and away from heat. Always double check expiry date (written on side of pack) and get a replacement prescribed by your GP if nearing expiry.

 It is good practice to have a trained first aider on hand if a person is undergoing a seizure

Disclaimer: This is a general guide; individual patients will have more specific guidance depending on their type of epilepsy and seizure history. Always follow the prescribing doctor’s advice. If a person is prescribed Buccal Midazolam, it is good practice to have written administration instructions or protocol specific for that patient (eg) When to administer? Can a 2^nd dose be administered? After how long?

For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591. Email queries to info@whelehans.ie. Find us on Facebook.

Thank you: Thank you Great Ormond Street Hospital (London) for some of the Buccal Midazolam guidance in this health blog