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Above is a lettter written to the prescribers.

Together i have attached a copy of national formulary 2008, mims and bnf on the dosage of EES.

It’s noted that the national formulary 2004 quoted 400-800mg bd as recommended dosage.

So i called Pharmaceutical Services Division to clarify the discrepancy btw the new and old edition.

And the answer i got is dat they are following the latest  micromedex and mims.

Here’s an excerpt from Micromedex on EES:

* Bacterial lower respiratory infection (Mild to Moderate), Caused by S. pyogenes or S. pneumonia: 400 mg ORALLY every 6 hr; MAX 4 g/day, depending on type and severity of infection
* Bacterial upper respiratory infection (Mild to Moderate), Caused by S. pyogenes, S. pneumoniae, or H. influenzae: 400 mg ORALLY every 6 hr; MAX 4 g/day, depending on type and severity of infection
* Chlamydial infection: 800 mg ORALLY 4 times daily for 7 days
* Chlamydia trachomatis infection – Genitourinary chlamydia infection – Pregnancy: ORAL; 800 mg three times daily for 7 days
* Diphtheria, To antitoxin; Adjunct: 400 mg ORALLY every 6 hr; MAX 4 g/day, depending on type and severity of infection
* Erythrasma: 400 mg ORALLY every 6 hr; MAX 4 g/day, depending on type and severity of infection
* Female gonococcal pelvic inflammatory disease: 400 mg ORALLY every 6 hr; MAX 4 g/day, depending on type and severity of infection
* Infection due to Entamoeba histolytica – Intestinal infectious disease: 400 mg ORALLY four times daily for 10 to 14 days
* Infection due to Mycoplasma pneumoniae – Respiratory tract infection: 400 mg ORALLY every 6 hr; MAX 4 g/day, depending on type and severity of infection
* Infection of skin AND/OR subcutaneous tissue (Mild to Moderate), Caused by S. pyogenes or S. aureus: 400 mg ORALLY every 6 hr; MAX 4 g/day, depending on type and severity of infection
* Legionnaire’s disease: 1.6 to 4 g ORALLY daily in divided doses
* Listeriosis: 400 mg ORALLY every 6 h; MAX 4 g/day, depending on type and severity of infection
* Lyme disease: (alternative to first-line) 500 mg ORALLY four times daily for 14 to 21 days for early localized or early disseminated Lyme disease associated with erythema migrans, or borrelial lymphocytoma
* Lymphogranuloma venereum: 500 mg ORALLY 4 times daily for 21 days
* Nongonococcal urethritis: 800 mg ORALLY 3 times daily or 4 times daily for 7 days
* Pertussis: (estolate preferred) 40 to 50 mg/kg/day ORALLY in divided doses for 5 to 14 days
* Primary syphilis, In penicillin allergic patients: 48 to 64 g ORALLY in divided doses over a period of 10 to 15 days
* Rheumatic fever, In penicillin allergic patients; Prophylaxis: 400 mg ORALLY every 6 h; MAX 4 g/day, depending on type and severity of infection for 10 days

Interestingly, it’s also noted in the national antiobiotic guideline dat 400mg bd can be used for acute urti like tonsilitis for a period of 10 days.

So far the EES given for urti is mostly 400mg bd for 5 days in my clinic (recommendation by manufacturer is at least 10 days)

Is there any strong evidence indicating 400mg bd for 5 days is good enough or is it just a practise?

My doc said dat 800mg bd is for severe infection but as micromedex pointed out it’s for acute to moderate infection and the dose can go to a max of 4g/day…

I think i have done my part in informing them on the latest recommendation.

Whether it;s accepted not, that’s another story aye?

PS: So wat’s the practise at ur workplace?