Octenisan md Nasengel, 6 ml

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In Hospital A, universal daily whole-body chlorhexidine bathing (chlorhexidine gluconate 4%; Microshield∗4, Johnson & Johnson, Australia) has been ongoing since 2014 and continued throughout 2015 and 2016. A 5-day regimen of intranasal octenidine gel (octenidine hydrochloride, Octenisan ® md nasal gel, Schülke & Mayr GmbH, Germany) applied to MRSA-colonisers from the day of admission was instituted from March to July 2016. In Hospital B, universal daily octenidine bathing (octenidine hydrochloride, Octenisan ® wash lotion, Schülke & Mayr GmbH, Germany) with a 5-day regimen of intranasal octenidine (octenidine hydrochloride, Octenisan ® md nasal gel, Schülke & Mayr GmbH, Germany) from the day of admission for MRSA-colonisers was implemented from March to July 2016. Prior to March 2016, Hospital B had not used any antiseptic products for MRSA decolonisation. Neither antiseptic bathing nor intranasal octenidine was administered in Hospital C throughout the study period. Bessa GR, Machado DC, Weber MB, D’Azevedo PA, Quinto VP, Lipnharski C, et al. Staphylococcus aureus resistance to topical antimicrobials in atopic dermatitis. An Bras Dermatol. 2016;91:604–9. Springer BD, Cahue S, Etkin CD, Lewallen DG, McGrory BJ. Infection burden in total hip and knee arthroplasties: an international registry-based perspective. Arthroplast Today. 2017;3:137–40.

van Belkum A, Verkaik NJ, de Vogel CP, Boelens HA, Verveer J, Nouwen JL, et al. Reclassification of Staphylococcus aureus nasal carriage types. J Infect Dis. 2009;199:1820–6. Primary outcome was decolonisation efficacy, measured by MSSA positive culture on the day of surgery. The secondary outcome was MSSA PJI.

Octenisan MD Nasal Gel 6ml

Specialist initiated - These are medicines that require little or no monitoring by the GP, but should only be prescribed in general practice after they have been initiated following specialist referral. Nouwen JL, Ott A, Kluytmans-Vandenbergh MFQ, Boelens HAM, Hofman A, van Belkum A, et al. Predicting the Staphylococcus aureus nasal carrier state: derivation and validation of a “culture rule.” Clin Infect Dis. 2004;39:806–11. Sakr A, Brégeon F, Rolain JM, Blin O. Staphylococcus aureus nasal decolonization strategies: a review. Expert Rev Anti Infect Ther. 2019;17:327–40. Koburger T, Hübner NO, Braun M, Siebert J, Kramer A. Standardized comparison of antiseptic efficacy of triclosan, PVP-iodine, octenidine dihydrochloride, polyhexanide and chlorhexidine digluconate. J Antimicrob Chemother. 2010;65:1712–9.

This is a holding category for drugs that have not been formally assessed by NPAG and awarded a traffic light designation. Grey medicines, or those not included elsewhere, are those that NPAG has not assessed for therapeutic use and prescribers should refrain from prescribing where possible. Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing Joint effects* (simultaneous influences) of Hospitals A, B and C, and years 2015 and 2016, respectively, on the prevalence of MRSA colonisation *adjusted for age, gender, Charlson's comorbidity index >5, prior MRSA carriage in preceding 12 months, prior antibiotics exposure in preceding 12 months, length of hospital stay prior to MRSA screening. **Prevalence of MRSA colonization in Hospital C in 2015 served as the reference. For moistening and decontamination of nasal vestibules and supportive wound treatment of lesions in the nasal epithelium Neomycin is an aminoglycoside antibiotic active against both gram-positive and gram-negative bacteria. There is limited research into the efficacy of neomycin ointment for nasal MSSA decolonisation. Leigh et al. showed neomycin achieved nasal decolonisation in 61% of cases compared to 95% with mupirocin at 8days after treatment [ 18]. Resistance to neomycin has been reported as high as 42% in a study from Brazil, the authors note this is likely due to its popular use without prescription in the country [ 19].

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Tsang STJ, McHugh MP, Guerendiain D, Gwynne PJ, Boyd J, Simpson AHRW, et al. Underestimation of Staphylococcus aureus (MRSA and MSSA) carriage associated with standard culturing techniques: One third of carriers missed. Bone Jt Res. 2018;7:79–84. There is strong evidence that nasal S. aureus decolonisation is effective at reducing PJIs [ 13, 14]. However, mupirocin nasal ointment is the only treatment with good quality evidence. In a recent meta-analysis all nine studies included used the same eradication treatment [ 13]. There is very little literature comparing decolonisation agents. With the risks of drug resistance research is needed into alternative therapies to mupirocin [ 15]. Sousa RJG, Barreira PMB, Leite PTS, Santos ACM, Ramos MHSS, Oliveira AF. Preoperative Staphylococcus aureus screening/decolonization protocol before total joint arthroplasty-results of a small prospective randomized trial. J Arthroplasty. 2016;31:234–9. If a Shared Care Protocol exists then this must be followed. Amber 1 medicines require more monitoring by the GP than Amber 2 medicines.