Supply of azithromycin for chlamydia trachomatis - community pharmacists

1. Supply of azithromycin for chlamydia trachomatis - community pharmacists Pauline Walton Lead Pharmacist Contractor Development NHS Hertfordshire November 2011

2. What are the requirements for a Patient Group Direction (PGD) • There is specified lawful criteria for information that must be included in a PGD • Follow SPC and good practice guidance – e.g. BASHH • Each PGD must be signed by a pharmacist, doctor or dentist, as appropriate

3. Things to be careful of • Use most current version • Can’t be delegated • Stick to the PGD

4. Indication • Treatment of uncomplicated genital infections due to Chlamydia trachomatis • Treatment of identified contact of an index client who has had a positive Chlamydia test

5. Inclusion • Informed client consent is obtained – needs to be clearly documented • All clients whether they are index clients or partners need to be a subject of a faxed message to the pharmacy from the Hertfordshire Chlamydia Screening Programme (HCSP) confirming positive Chlamydia infection in that individual • Clients aged 16 years to 24 years inclusive • Identified partners of index clients who are over the age of 16

6. Exclusion • Client consent refused • Patients with a known hypersensitivity to Azithromycin or any of the macrolide or ketolide antibiotics, erythromycin or to any excipients thereof of tablet or capsule contents • Patients with a known hypersensitivity to soya or peanut • Pregnant or suspected pregnancy • Breast-feeding • Porphyria • Hepatic impairment • Renal impairment • Patients at increased risk for prolonged cardiac repolarisation (predisposition to QT interval prolongation (including electrolyte disturbances, concomitant use of drugs that prolong QT interval).

7. Exclusion • Client under 16 years of age • Clients over 24 years of age unless they are an identified sexual partner of an index client. • Male patient presenting with symptoms associated with complicated Chlamydia infection (acute testicular pain and / or swelling - suspected epididymitis) • Female patient presenting with symptoms associated with complicated Chlamydia infection (acute pelvic pain - suspected pelvic inflammatory disease) • Patients with suspected re-infection • Clients who are severely systemically unwell or with any serious illness • Immunocompromised clients • Patients with known Human Immunodeficiency Virus (HIV) infection

8. Patients taking any of the following medication: Ergot derivatives (including ergotamine and methysergide) Ciclosporin Digoxin Nelfinavir Terfenadine Theophylline Coumarin-Type Oral Anticoagulants Rifabutin Reboxetine Mizolastine Artemether/ Lumefantrine Quetiapine Sertindole Ritonavir Bromocriptine and Cabergoline Droperidol Exclusion

9. Action if excluded • In the first instance refer client to Herts Chlamydia Screening Programme (HCSP) who can be contacted on 01707 369519. If not contactable then refer client to Genito Urinary Medicine,(GUM) Contraceptive and Sexual Health Service (CaSH) or their own GP or GP out of hours services (Herts Urgent Care (HUC) Tel 03000 333333 . Out of hours only) • Document reason(s) for exclusion and advice given.

10. Dose / Dose range • 1 g (2 x 500mg tablets) as a single dose • 1 g (4 x 250mg tablets) as a single dose • 1 g (4 x 250mg capsules) as a single dose (Capsules should be swallowed whole at least 1 hour before or 2 hours after food (or on an empty stomach))

11. Action if patient declines treatment • Refer client to Genito Urinary Medicine (GUM), Contraceptive and Sexual Health Service (CaSH) or their own GP or GP out of hours services (www.Hertfordshire.nhs.uk for local details) • Document reason(s) for decline and advice given on the Community Pharmacy Azithromycin PGD audit form Az1 (inform HCSP)

12. Other sections • Patient advice / Follow up treatment – e.g. abstain from sexual intercourse • Adverse Reactions and their Management - S/E to inform the patient of

13. Thank you for listening