News

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In Practice: Children with suspected serious bacterial infection

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This week’s In Practice also features a renewed call for GPs to connect to the eRx Script Exchange gateway, details on a rheumatoid arthritis survey, obesity management education opportunities, and information regarding an upcoming review of voluntary assisted dying in Victoria.
 
Children with suspected serious bacterial infection
In the past year, the number of children (including adolescents) with serious bacterial infections, often associated with, or subsequent to, a viral infection, has increased.
 
The largest increase has been in severe Group A Streptococcus infections, but also Streptococcus pneumoniae and Staphylococcal infections. These bacterial infections include pneumonia, empyema, septicaemia, meningitis, and bone and soft tissue infections.
 
Children with these infections can deteriorate rapidly, and the Consultative Council on Obstetric and Paediatric Mortality and Morbidity has issued an alert reminding GPs that antibiotic treatment is time-critical and improves outcomes.
 
It is important that whenever serious bacterial infection is suspected in primary care, the first dose of effective antibiotics is given as soon as possible, and the child referred to a hospital urgently via ambulance or Paediatric Infant Perinatal Emergency Retrieval (PIPER) so complete assessment and investigation can occur.
 
GPs should take a blood culture if possible, but if not, diagnostic tests can still be done at a hospital. The recommendation is to give a first dose of ceftriaxone 100 mg/kg up to 2 g IM or IV, or benzylpenicillin 50 mg/kg up to 1.8g IM or IV, and then urgently refer by ambulance.
 
A child with suspected serious bacterial infection will likely present with a fever (temperature greater than 38°C), as well as other symptoms and signs, including: 

• erythematous, sunburn-like or purpuric skin rash
• lethargy, persistent drowsiness or high-pitched cry
• hypoxaemia, grunting or other signs of severe respiratory distress, pneumonia or pleural effusion
• cold or mottled limbs, >3 seconds capillary refill, tachycardia
• severe limb pain or refusal to walk
• inability to feed or persistent vomiting
• oliguria. 

No one sign is specific, but the more signs that are present or more severe, the more likely it is there is a serious bacterial infection.
 
Prolonged fever (more than five days) or very high fever (temperature greater than 40°C) are also more likely to indicate a serious bacterial infection. Parents of children with serious bacterial infections often correctly express concern about their failure to improve or their significant difference from normal.
 
PIPER can also be contacted from a primary care clinic or urgent care centre on 1300 137 650 for management and transfer advice and support.
 
Connect to eRx Script Exchange to continue prescribing PBS medications
In order to continue prescribing PBS medications, all providers must be connected to the eRx Script Exchange gateway by 30 September.
 
Beyond this time, prescribers will be unable to prescribe PBS scripts through MediSecure.
 
The Department of Health and Aged Care recommend ceasing entering prescriptions into MediSecure by 15 September to allow patients enough time to get their medications dispensed.
 
To continue prescribing PBS medications, GPs can register with eRx online, email eprescribing@erx.com.au, or call 1300 700 921. Those who are unsure if their practice is already registered with eRx can contact their software provider.
 
This advice applies to computer generated scripts that are printed and hand-signed, paper scripts that contain a barcode or QR code and all electronic prescriptions. The only exception to these requirements are scripts that are handwritten, hand-signed and do not contain a barcode or QR code.
 
GPs with questions or who require further information should email EPtransitions@health.gov.au
 
Rheumatoid arthritis survey
The Australian Rheumatology Association, in collaboration with Arthritis Australia, is developing a Quality Standard for rheumatoid arthritis (RA) in an effort to improve the quality of care for people living with the disease.
 
Over the past six months, a working group of rheumatologists and other health professionals, including GP, nurses, a range of allied healthcare professionals and several consumers, have prioritised specific areas of care for quality improvement. Based on these priority areas, the group formulated 13 quality statements and established seven guiding principles for RA care.
 
The final quality statements will be based on consensus agreement by healthcare professionals involved in the care of people with RA, as well as people living with RA.
 
RACGP members are invited to take part in an online survey to indicate their position on: 
 

• the selection of priority areas
• the content and wording of each quality statement. 

The survey will be open until Wednesday 6 September.
 
Obesity management education
RACGP Specific Interests has a number of upcoming online educational opportunities on the topic of obesity management.
 
Learn more and register by visiting the event webpages below:
Management of children living with obesity and overweight (webinar)
Date: Monday 21 August
Time: 7.00 – 8.00 pm (AEST)
CPD: 1 EA hour
 
Management of adolescents with obesity and overweight (webinar)
Date: Monday 28 August
Time: 7.00 – 8.00 pm (AEST)
CPD: 1 EA hour
 
Obesity management (two-part digital masterclass)
Date: Saturday 9 September
Time: 10.00 am – 3.30 pm (AEST) (Morning webinar only 10.00 am – 12.00 pm)
Price: $175 (Morning webinar only $50)
CPD: 2 EA hours, additional 3 RP hours for full masterclass
 
Voluntary Assisted Dying Review begins
The legally required review of the first four years of Australia’s first voluntary assisted dying law has now begun, with a final report due by the end of 2024.
 
The review will not consider any changes to the legislation.
 
It will instead evaluate the systems, processes and practices which underpin the operation of the Voluntary Assisted Dying Act including:
 

• safeguards and protections
• equity of access
• the Voluntary Assisted Dying Review Board’s role and functions
• the Department of Health-commissioned Statewide Pharmacy and Care Navigator services. 

Those engaged in voluntary assisted dying, including doctors and families, will take part in a consultation process to gauge how voluntary assisted dying has operated since its introduction.
 
Once the review concludes, the final report will be tabled in both Houses of Parliament.
 
Expressions of interest open for LGBTIQA+ advisory groups
The Victorian Government is encouraging members of the state’s lesbian, gay, bisexual, trans and gender diverse, intersex and queer communities interested in helping shape government policies to join the next term of the LGBTIQA+ Taskforce and its working groups.
 
LGBTIQA+ Victorians face higher levels of discrimination, stigma and exclusion, which can lead to poorer health, economic, social and mental health outcomes, and the two working groups will focus on justice and health and wellbeing, respectively.
 
More information about the LGBTIQA+ Taskforce and its working groups can be found on the Victorian Government website.
 
Telehealth policy
WorkSafe Victoria (WSV) introduced temporary telehealth codes in response to COVID-19 public health measures in April 2020, ensuring ongoing access to vital healthcare for injured workers.
 
With the Federal Department of Health having committed to the ongoing provision of telehealth through the MBS, WSV has developed a permanent policy position and committed to ongoing telehealth codes.
 
The policy provides the essential criteria for telehealth utilisation: 
 

• Clinically appropriate
• Injured workers preference
• Physical examination not required
• Appropriate technology platform
• Worker risk mitigation strategy in place

The policy also outlines the requirements for an established relationship between the treating health practitioner and worker, and utilisation of telehealth in a hybrid approach with face-to-face consultation. This aligns with MBS regulations.
 
Additional guidance included with the policy update: 
 

• WSV does not support providing certificates of capacity via telehealth
• Telehealth is not supported where either the worker or provider are overseas

WSV will continue to offer all telehealth codes which have been previously available as listed in the medical services reimbursement rates fee schedule on its website. 
 
Members with queries can contact Provider@worksafe.vic.gov.au.
 
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obesity management rheumatoid arthritis serious bacterial infection voluntary assisted dying

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