ACNE TREATMENT

Tips for antibiotic
therapy

• Do not use topical and
oral antibiotics at the
same time
• Use oral antibiotics for a
6-12-week course
• If a longer course of oral
antibiotics is required, use
benzoyl peroxide for a
week between courses
• Warn of side effects of
antibiotic therapy,
particularly
photosensitivity with
doxycycline

ACNE MANAGEMENT

IMPORTANT POINTS HISTORY AND EXAMINATION


History

• How long have you had
pimples for?
• Are there any triggers?
• Is there a family history?
• What treatments have you
had? How long did you
follow each treatment?
• What was the most
effective treatment? Why
did you stop it?
• How do you feel about
your skin? Does it stop
you from doing anything?

Examination

• Assess the severity and
whether there is any
scarring.
• Determine any
psychological impact.

Lethal In Low Doses

Box 1: Nine ingestants that can be
lethal in toddlers in low doses
• Calcium channel blockers
• Camphor
• Imidazolines (eg, clonidine)
• Cyclic antidepressants
• Lomotil
• Opiates
• Salicylates
• Sulphonylureas
• Toxic alcohols
Note: Not in order of lethality

Preventing Recurrent DVT

A patient with successfully treated
DVT remains at increased risk of
DVT or PE for life and will need prophylaxis
at times. Prophylaxis (with,
for example, enoxaparin 40mg daily)
should begin 12 hours before elective
surgery.
In orthopaedic surgery, it should
be continued at this dose for three
weeks after discharge from hospital2.
Early remobilisation and compression
stockings should be used routinely
for all surgery. Intra-operative
calf compression machines are often
used in prolonged elective surgery.
High-risk medical patients (eg,
those likely to be inpatients for more
than five days) should receive routine
prophylaxis whether or not they
have had a prior DVT.
Seek advice if the patient has renal
impairment because LMW heparins
accumulate quickly in patients with
moderate to severe renal failure.
All women with previous DVT or
artificial heart valves should receive
daily heparin prophylaxis during
pregnancy. Haematological review is
recommended in those with diagnosed
thrombophilia (deficiency of
anti-thrombin III, protein C or S,
mutations of factor V or prothrombin
genes), as more intense prophylaxis
may be needed in some.
Patients with a past history of
DVT who are planning air travel for
more than four hours should be
given recommendations in writing:
• Self-inject 40mg enoxaparin before
each separate flight (not including
refuelling stops)
• Ask for a seat with good leg room
• Accept every non-alcoholic
beverage offered
• Minimise alcohol consumption
• Perform in-seat exercises recommended
by the airline.
National guidelines do not recommend
frequent walking around the
cabin because of the risk of turbulence.
Aspirin does more harm than
good in air travellers.
References
Current Diagnosis of Venous Thromboembolism
in Primary Care: A Clinical Practice Guideline,
American Academy of Family Physicians and
the American College of Physicians.
Annals of Internal Medicine: p57- 62: Vol 5:
No 1: January/February 2007
1. Palareti G., Cosmi B., Legnani C., et al. DDimer
Testing to Determine the Duration of
Anticoagulation Therapy. N Engl J Med 2006;
355:1780-1789, Oct 26, 2006.

Preventing Recurrent DVT

A patient with successfully treated
DVT remains at increased risk of
DVT or PE for life and will need prophylaxis
at times. Prophylaxis (with,
for example, enoxaparin 40mg daily)
should begin 12 hours before elective
surgery.
In orthopaedic surgery, it should
be continued at this dose for three
weeks after discharge from hospital2.
Early remobilisation and compression
stockings should be used routinely
for all surgery. Intra-operative
calf compression machines are often
used in prolonged elective surgery.
High-risk medical patients (eg,
those likely to be inpatients for more
than five days) should receive routine
prophylaxis whether or not they
have had a prior DVT.
Seek advice if the patient has renal
impairment because LMW heparins
accumulate quickly in patients with
moderate to severe renal failure.
All women with previous DVT or
artificial heart valves should receive
daily heparin prophylaxis during
pregnancy. Haematological review is
recommended in those with diagnosed
thrombophilia (deficiency of
anti-thrombin III, protein C or S,
mutations of factor V or prothrombin
genes), as more intense prophylaxis
may be needed in some.
Patients with a past history of
DVT who are planning air travel for
more than four hours should be
given recommendations in writing:
• Self-inject 40mg enoxaparin before
each separate flight (not including
refuelling stops)
• Ask for a seat with good leg room
• Accept every non-alcoholic
beverage offered
• Minimise alcohol consumption
• Perform in-seat exercises recommended
by the airline.
National guidelines do not recommend
frequent walking around the
cabin because of the risk of turbulence.
Aspirin does more harm than
good in air travellers.
References
Current Diagnosis of Venous Thromboembolism
in Primary Care: A Clinical Practice Guideline,
American Academy of Family Physicians and
the American College of Physicians.
Annals of Internal Medicine: p57- 62: Vol 5:
No 1: January/February 2007
1. Palareti G., Cosmi B., Legnani C., et al. DDimer
Testing to Determine the Duration of
Anticoagulation Therapy. N Engl J Med 2006;
355:1780-1789, Oct 26, 2006.
2. TGA-approved product information for