抗生素处方的忠告Advice-to-COCP-users-when-prescribing-anti.ppt

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Advice to COCP users when prescribing antibioticsJan 2011,New advice,When prescribing antibiotics there is no need to give“extra precaution”advice(condoms or abstain for length of course and 7 days afterwards)to COCP users.,Something you always thought or does this feel uncomfortable?,Exceptions!,Enzyme inducing drugs rifampicin,rifambutin(consistently shown to decrease ethinyl estradiol levels),If antibiotics cause vomiting and diarrhoea,Old theory,Antibiotics temporarily reduce colonic bacteria,Decrease in colonic bacteria decreases enterohepatic recycling of ethinyl estradiol,Estradiol part of COCP that is the anovulant,Ovulation.pregnancy,There is no evidence for any of this!,Studies investigating contraceptive failures on COCP,Lack of controls,Recall bias,Potential confounders,Vomiting and diarrhoea(secondary to antibiotics or illness),Forgetting pill because of illness,Are you going to change your advice?,9 replies,2 will change advice,3 wont,4 are just a bit cross,“,Who made a mistake?How did they do that?What advice are they currently offering?Why should I pay more attention to that?If the FRSH thingummy follows advice they have no reason to think is correct,why should I follow them?As they apparently demand.”,