Vitamin D
The Lab Reports Team will only allocate children <50mcg/L, and adults <25mcg/L without CKD Stage 4, history of malabsorption, Cirrhosis, Osteoporosis, or those with recent fractures
General Advice
- The government recommends that everyone should consider taking a daily Vitamin D supplement during autumn & winter - this can be purchased over the counter (10mcg)
- People at high risk of not getting enough Vitamin D, all children aged 1-4 babies (unless having >500ml/day of infant formula) should take a daily supplement throughout the year - see ICB guidance
ICB Guidance
The ICB Guidance isn’t suitable for patients with CKD Stage 4, history of renal stones or sarcoidosis, or patients with hypercalcaemia/hyperparathyroidism
H. Pylori
Main Page: H. Pylori Eradication for testing information
- We should discuss treatment adherence with the patient, and emphasis the importance of this.
- PHE advises that patients should be referred for an endoscopy, culture and susceptibility testing if the choice of antibacterial treatment is reduced due to: Hypersensitivity, there are known high local resistance rates or patients have previously received treatment with clarithromycin, metronidazole, and a quinolone.
1️⃣ First-line treatment
Most patients:
A 7-day, twice-daily course of:
- a PPI and
- Amoxicillin and
- Clarithromycin or Metronidazole
⚠️ Consider previous exposure to clarithromycin and metronidazole
Patients with penicillin allergy:
A 7-day, twice-daily course of:
- a PPI and
- Clarithromycin and
- Metronidazole
Patients with penicillin allergy & previous exposure to clarithromycin:
A 7-day, twice-daily course of:
- a PPI and
- bismuth [unlicensed use] and
- metronidazole and
- tetracycline [unlicensed use]
⚠️ Seek specialist advice before prescribing
2️⃣ Second-line treatment
Used if symptoms are ongoing after first line treatment.
Most patients:
A 7-day, twice-daily course of:
- a PPI and
- amoxicillin and
- either clarithromycin or metronidazole (whichever was not used first-line, and no previous exposure)
If patient had previous exposure to clarithromycin and metronidazole:
a 7‑day course of:
- a PPI and
- amoxicillin and
- tetracycline [unlicensed use] (or, if a tetracycline cannot be used, levofloxacin [unlicensed use])
⚠️ Seek specialist advice before prescribing
Patients with penicillin allergy:
A 7-day, twice-daily course of:
- a PPI and
- metronidazole and
- levofloxacin [unlicensed use]
⚠️ Seek specialist advice before prescribing
Patients with penicillin allergy & previous exposure to a fluoroquinolone antibiotic:
a 7‑day course of:
- a PPI and
- bismuth [unlicensed use] and
- metronidazole and
- tetracycline [unlicensed use]
⚠️ Seek specialist advice before prescribing
Choosing a PPI
Proton pump inhibitor | Dose | Notes |
Omeprazole | 20–40 mg | First-line (EXCEPT Clopidogrel Patients) |
Lansoprazole | 30 mg | First-line for Clopidogrel patients |
Esomeprazole | 20 mg | Non-formulary |
Pantoprazole | 40 mg | Restricted in SEL |
Rabeprazole | 20 mg | Non-formulary |
Folic Acid
The Lab Reports Team will allocate patients who have a low folic acid result, but otherwise normal Vitamin B12.
Folic acid is used to:
- Treat folate deficient anaemia
- Help baby’s brain, skull and spinal cord development during pregnancy
- Help reduce side effects from methotrexate
Treatment of folate deficient anaemia
Pregnancy
- It is recommended to take folic acid when trying for a baby, and during the first 12 weeks of pregnancy: 400mcg OD, purchased OTC (See also Over-The-Counter Medication Prescribing)
- If there is a higher chance of having a baby with a neural tube defect, prescribe 5mg OD
Bacterial Vaginosis (BV)
Prescribing recommendations from SEL ICB Antimicrobial guidelines
First Line: Metronidazole, PO, 400mg BD for 5-7 days
Second Line: Metronidazole 0.75% vaginal gel, PV, 5g ON for 5 nights (Where oral metronidazole has failed, or is not well tolerated - avoid during menstruation and use with caution in pregnacny)
Other Alternatives:
Clindamycin 2% vaginal cream, PV, 5g ON for 7 nights OR
Dequalinium Chloride Tablets, PV, 10mg OD for 6 days (Not for over 55. Only use in pregnancy under guidance of GUM or Obstetric consultant)
Note:
- For recurrent BV, refer to local sexual health services
- If pregnant, and asymptomatic, discuss with woman’s obstetrician
- Advise alcohol avoidance during course and for 48 hours after
Other Resources
Thrush (Acute)
- Lab Reports will allocate <12, >69 or diabetic patients
- All other patients will have received a message informing them to purchase OTC treatments
First Line: Fluconazole 150mg PO (single dose)
OR Clotrimazole 500mg PV (Single dose) [If oral therapy is contraindicated]