I

IMMUNISATION

Immunisation is the cornerstone of preventive medicine. Basic diseases (diphtheria, tetanus, polio, whooping cough, measles, mumps, rubella) should be covered. Children should be immunised according to the NHMRC recommendation.

All adults should receive an adult diphtheria and tetanus (ADT) booster each 10 years.

All women of child-bearing years should have their rubella antibody status reviewed.

Other recommendations

• Influenza: annually for those with chronic debilitating diseases, persons >65, children aged 6 mths to 5 yrs, health care personnel and the immunosuppressed

• Hepatitis B: for those at risk through work or lifestyle

• Q fever: those at risk, esp. abattoir workers

• Tuberculosis (BCG vaccine): infants at risk (e.g. Indochinese babies exposed to TB, health workers who are Mantoux negative)

• Pneumococcal vaccine: splenectomised persons >2 yrs, Hodgkin’s lymphoma, all people from 65 years

• Meningococcal b vaccine: children (especially pre-school aged) and adolescents

IMPETIGO

• If mild and limited: antiseptic cleansing and removal of crusts bd with an antibacterial soap or chlorhexidine or povidone-iodine. Apply mupirocin (Bactroban) tds for 7–10 d

• Daily bath with Oilatum Plus bath oil for 2 wks is helpful

• If extensive: oral di(flu)cloxacillin or cephalaxin or erythromycin for 10 d (if penicillin sensitive), likely to be S.pyogenes in remote settings + use penicillin

• Exclude from childcare/school settings until fully healed

INCONTINENCE OF URINE

• Search for a cause:

  • D—delirium, drugs (e.g. antihypertensives)

  • I—infection of urinary tract

  • A—atrophic urethritis

  • P—psychological

  • E—endocrine (e.g. hypercalcaemia); environmental: unfamiliar surrounds

  • R—restricted mobility

  • S—stool impaction, sphincter damage or weakness

• Avoid various drugs (e.g. diuretics, psychotropics, alcohol)

• Weight reduction if obese

In women:

• perform urodynamics to assess stress incontinence

• bladder retraining (instruct patient to delay micturition for 10–15 mins on impulse to void) and pelvic floor exercises (mainstay of treatment)

• physiotherapist referral

• consider a trial of anticholinergic drugs if bladder atony instability or voiding dysfunction (e.g. solifenacin 5–10 mg daily, propantheline 15 mg (o) bd or...