*MEDICATION*: Pharmacy First - Acute Otitis Media treatment

[chrisjwood16]

User requirements

This codelist is used to identify supply of any medication included in the Pharmacy First Patient Group Directions for treatment of acute otitis media.

Sensitivity versus specificity

Specific to only the strength/formulations included in the PGDs for acute otitis media (including both brands and generics).

Relevant definitions or links to important reference sources

PGDs:
https://www.england.nhs.uk/wp-content/uploads/2023/11/PRN01010-7a.-Acute-otitis-media-phenazone-lidocaine-ear-drops-patient-group-direction-Pharmacy-First.pdf
https://www.england.nhs.uk/wp-content/uploads/2023/11/PRN01010-7b.-Acute-otitis-media-amoxicillin-patient-group-direction-Pharmacy-First.pdf
https://www.england.nhs.uk/wp-content/uploads/2023/11/PRN01010-7c.-Acute-otitis-media-clarithromycin-patient-group-direction-Pharmacy-First.pdf
https://www.england.nhs.uk/wp-content/uploads/2023/11/PRN01010-7d.-Acute-otitis-media-erythromycin-patient-group-direction-Pharmacy-First.pdf

Coding system

dm+d

Existing relevant codelists

N/A

Search terms / synonyms / search strategy

• Otigo
• Phenazone
• Amoxicillin
• Clarithromycin
• Erythromycin

Inclusion criteria for codes

• Otigo®(phenazone 40mg/lidocaine hydrochloride 10mg/g) ear drops, solution
• Amoxicillin 250mg capsules
• Amoxicillin 500mg capsules
• Amoxicillin 125mg/5mL oral suspension (or oral solution)
• Amoxicillin 125mg/5mL sugar free oral suspension (or oral solution)
• Amoxicillin 250mg/5mL oral suspension (or oral solution)
• Amoxicillin 250mg/5mL sugar free oral suspension (or oral solution)
• Amoxicillin 500mg/5mL sugar free oral suspension (or oral solution)
• Clarithromycin 250mg tablets
• Clarithromycin 500mg tablets
• Clarithromycin 125mg/5mL oral suspension (or oral solution)
• Clarithromycin 250mg/5mL oral suspension (or oral solution)
• Erythromycin 250mg tablets
• Erythromycin 250mg gastro-resistant tablets
• Erythromycin 500mg tablets
• Erythromycin 125mg/5mL oral suspension (or oral solution)
• Erythromycin 125mg/5mL sugar free oral suspension (or oral solution)
• Erythromycin 250mg/5mL oral suspension (or oral solution)
• Erythromycin 250mg/5mL sugar free oral suspension (or oral solution)
• Erythromycin 500mg/5mL oral suspension (or oral solution)
• Erythromycin 500mg/5mL sugar free oral suspension (or oral solution)

Exclusion criteria for codes

Strengths/formulations not listed above.

Borderline cases

Clarithromycin granules for oral solution, erythromycin capsules - excluded as form not included in PGD.

Final codelist

Published:
BNF code format: https://www.opencodelists.org/codelist/opensafely/pharmacy-first-acute-otitis-media-treatment/25601363/

dm+d format: https://www.opencodelists.org/codelist/opensafely/pharmacy-first-acute-otitis-media-treatment-dmd/4122468e/

[a-d-brown]

Consider adding:

• Amix 250 oral suspension (0501013B0BFAIAT)

Otherwise, all looks good. @chrisjwood16

Note, I debated whether amoxicillin syrups were technically distinct here, but it doesn't seem that dm+d has any distinct category for syrups. My understanding is that a syrup is just a sub-classification of an oral solution / suspension. So, I think fine to keep in the codelist.

[chrisjwood16]

Looks like I missed Amix 250. Added here now:
https://www.opencodelists.org/codelist/user/chriswood/pharmacy-first-acute-otitis-media-treatment/25601363/

Will keep syrups as I think basically the same. And the rest of the analysis code will ensure we identify the correct things.

[a-d-brown]

Checked - all correct.

[chrisjwood16]

Published:
BNF code format: https://www.opencodelists.org/codelist/opensafely/pharmacy-first-acute-otitis-media-treatment/25601363/

dm+d format: https://www.opencodelists.org/codelist/opensafely/pharmacy-first-acute-otitis-media-treatment-dmd/4122468e/

[chrisjwood16]

As explained here, due to complexities in the data we need to build this codelist directly in dmd to ensure we include products which don't have a BNF code.

We can use a view which contains required dmd fields and then query this to select products matching our inclusion criteria:

• Otigo®(phenazone 40mg/lidocaine hydrochloride 10mg/g) ear drops, solution
• Amoxicillin 250mg capsules
• Amoxicillin 500mg capsules
• Amoxicillin 125mg/5mL oral suspension (or oral solution)
• Amoxicillin 125mg/5mL sugar free oral suspension (or oral solution)
• Amoxicillin 250mg/5mL oral suspension (or oral solution)
• Amoxicillin 250mg/5mL sugar free oral suspension (or oral solution)
• Amoxicillin 500mg/5mL sugar free oral suspension (or oral solution)
• Clarithromycin 250mg tablets
• Clarithromycin 500mg tablets
• Clarithromycin 125mg/5mL oral suspension (or oral solution)
• Clarithromycin 250mg/5mL oral suspension (or oral solution)
• Erythromycin 250mg tablets
• Erythromycin 250mg gastro-resistant tablets
• Erythromycin 500mg tablets
• Erythromycin 125mg/5mL oral suspension (or oral solution)
• Erythromycin 125mg/5mL sugar free oral suspension (or oral solution)
• Erythromycin 250mg/5mL oral suspension (or oral solution)
• Erythromycin 250mg/5mL sugar free oral suspension (or oral solution)
• Erythromycin 500mg/5mL oral suspension (or oral solution)
• Erythromycin 500mg/5mL sugar free oral suspension (or oral solution)

SELECT DISTINCT
dmd_type, dmd_id, dmd_name, bnf_code
FROM
`chris.union_amp_vmp`
WHERE
(
  vtm = 'Phenazone + Lidocaine'
  AND
  formroute IN ('solutiondrops.auricular')
)
OR
(
  vtm = 'Amoxicillin'
  AND
  formroute IN ('capsule.oral')
  AND
  strength_num IN (250, 500)
)
OR
(
  vtm = 'Amoxicillin'
  AND
  formroute IN ('solution.oral', 'suspension.oral')
  AND
  (((5/strength_den)*strength_num) IN (125, 250, 500)) -- strength is often expressed as mg/ml - this calculation converts to dose per 5ml as expressed in inclusion criteria
)
OR
(
  vtm = 'Clarithromycin'
  AND formroute IN ('tablet.oral')
  AND strength_num IN (250, 500)
)
OR
(
  vtm = 'Clarithromycin' 
  AND formroute IN ('solution.oral', 'suspension.oral')
  AND (((5/strength_den)*strength_num) IN (125, 250)) -- strength is often expressed as mg/ml - this calculation converts to dose per 5ml as expressed in inclusion criteria
)
OR
(
  ingredient = 372694001 -- use ingredient code for erythromycin base substance here not vtm as a number of different erythromycin salts
  AND 
  ingredient_count = 1 -- as using ingredient code check it isn't a combo product
  AND
  formroute IN ('tablet.oral', 'tabletgastro-resistant.oral')
  AND
  strength_num IN (250, 500)
)
OR
(
  ingredient = 372694001 -- use ingredient code for erythromycin base substance here not vtm as a number of different erythromycin salts
  AND 
  ingredient_count = 1 -- as using ingredient code check it isn't a combo product
  AND
  formroute IN ('solution.oral', 'suspension.oral')
  AND 
  (((5/strength_den)*strength_num) IN (125, 250, 500)) -- strength is often expressed as mg/ml - this calculation converts to dose per 5ml as expressed in inclusion criteria
)

PF_treatment_acute_otitis_media.csv

[chrisjwood16]

Checked against existing codelist. These new codes are included:
dmd_type,dmd_id,dmd_name,bnf_code
VMP,35368511000001109,Amoxicillin 125mg/1.25ml oral suspension paediatric,0501013B0AAAIAI
VMP,323734001,VMP previous to 35368511000001109,0501013B0AAAIAI
AMP,14222611000001101,Erythrocin 500 tablets (Sigma Pharmaceuticals Plc),
AMP,14223111000001103,Erythroped A 500mg tablets (Sigma Pharmaceuticals Plc),
AMP,17899311000001109,Erythromycin ethyl succinate 500mg tablets (Sigma Pharmaceuticals Plc),
AMP,37369311000001108,Erythrocin 250 tablets (CST Pharma Ltd),
AMP,37369811000001104,Erythrocin 500 tablets (CST Pharma Ltd),
AMP,44154311000001102,Clarithromycin 500mg tablets (Quattro Pharma Ltd),
AMP,42816811000001105,Clarithromycin 250mg tablets (Drugsrus Ltd),0501050B0AAAAAA
AMP,42455811000001101,Clarithromycin 250mg tablets (Krka UK Ltd),0501050B0AAAAAA
AMP,42456611000001105,Clarithromycin 500mg tablets (Krka UK Ltd),0501050B0AAADAD
AMP,42830211000001104,Clarithromycin 500mg tablets (Drugsrus Ltd),0501050B0AAADAD
AMP,22878811000001100,Erythrocin 500 tablets (Waymade Healthcare Plc),
AMP,5286611000001101,Clarithromycin 125mg/5ml oral suspension (Dowelhurst Ltd),
AMP,5298511000001100,Klaricid Paediatric 125mg/5ml oral suspension (Dowelhurst Ltd),
AMP,5300211000001105,Klaricid Paediatric 250mg/5ml oral suspension (Dowelhurst Ltd),
AMP,5334311000001104,Amoxil 500mg capsules (Waymade Healthcare Plc),
AMP,5377011000001108,Klaricid 250mg tablets (Waymade Healthcare Plc),
AMP,5377411000001104,Klaricid 500 tablets (Waymade Healthcare Plc),
AMP,5459011000001106,Clarithromycin 500mg tablets (Dowelhurst Ltd),
AMP,5514211000001102,Clarithromycin 250mg tablets (Dowelhurst Ltd),
AMP,5541711000001100,Erythrocin 500 tablets (Dowelhurst Ltd),
AMP,5543211000001106,Erythroped A 500mg tablets (Dowelhurst Ltd),
AMP,5551011000001104,Klaricid 250mg tablets (Dowelhurst Ltd),
AMP,5551211000001109,Klaricid 500 tablets (Dowelhurst Ltd),
AMP,10460611000001105,Amoxil 500mg capsules (Dowelhurst Ltd),
AMP,10536411000001109,Erythroped A 500mg tablets (Waymade Healthcare Plc),
AMP,10833311000001107,Clarithromycin 125mg/5ml oral suspension (Waymade Healthcare Plc),
AMP,10833511000001101,Clarithromycin 250mg/5ml oral suspension (Waymade Healthcare Plc),
AMP,13110911000001100,Amoxicillin 250mg capsules (Dowelhurst Ltd),
AMP,13111311000001106,Amoxicillin 500mg capsules (Dowelhurst Ltd),
AMP,13112111000001104,Amoxicillin 125mg/5ml oral suspension (Dowelhurst Ltd),
AMP,13112511000001108,Amoxicillin 125mg/5ml oral suspension sugar free (Dowelhurst Ltd),
AMP,13112811000001106,Amoxicillin 250mg/5ml oral suspension (Dowelhurst Ltd),
AMP,13113311000001107,Amoxicillin 250mg/5ml oral suspension sugar free (Dowelhurst Ltd),
AMP,13225711000001103,Clarithromycin 250mg/5ml oral suspension (Dowelhurst Ltd),
AMP,13827911000001101,Amoxil 500mg capsules (DE Pharmaceuticals),
AMP,13875411000001102,Erythrocin 500 tablets (DE Pharmaceuticals),
AMP,14193111000001109,Amoxil 500mg capsules (Sigma Pharmaceuticals Plc),
AMP,14734611000001104,Klaricid 500 tablets (Sigma Pharmaceuticals Plc),
AMP,14735011000001105,Klaricid 250mg tablets (Sigma Pharmaceuticals Plc),
AMP,15122711000001104,Amoxicillin 250mg capsules (Mawdsley-Brooks & Company Ltd),
AMP,15122911000001102,Amoxicillin 500mg capsules (Mawdsley-Brooks & Company Ltd),
AMP,16138011000001103,Amoxil 500mg capsules (Lexon (UK) Ltd),
AMP,16172811000001109,Erythroped A 500mg tablets (Lexon (UK) Ltd),
AMP,16261411000001105,Amoxil 500mg capsules (Mawdsley-Brooks & Company Ltd),
AMP,16540411000001104,Amoxil 500mg capsules (Stephar (U.K.) Ltd),
AMP,16544311000001103,Erythrocin 500 tablets (Stephar (U.K.) Ltd),
AMP,16551711000001104,Klaricid 500 tablets (Stephar (U.K.) Ltd),
AMP,16572211000001101,Erythroped A 500mg tablets (Mawdsley-Brooks & Company Ltd),
AMP,17503311000001109,Erythrocin 500 tablets (Mawdsley-Brooks & Company Ltd),
AMP,17584311000001105,Amoxil 500mg capsules (Necessity Supplies Ltd),
AMP,18056411000001108,Erythrocin 500 tablets (Lexon (UK) Ltd),
AMP,18257211000001100,Erythrocin 500 tablets (Necessity Supplies Ltd),
AMP,18257511000001102,Erythroped A 500mg tablets (Necessity Supplies Ltd),
AMP,18271111000001101,Klaricid 250mg tablets (Necessity Supplies Ltd),
AMP,18271311000001104,Klaricid 500 tablets (Necessity Supplies Ltd),
AMP,24099111000001103,Erythromycin 250mg gastro-resistant tablets (Waymade Healthcare Plc),
AMP,389311000001106,Amoxil 125mg/1.25ml paediatric oral suspension (GlaxoSmithKline UK Ltd),0501013B0BCAGAI

This is in the existing codelist not in the new version. This appears to be a previous VMP ID which has since been updated more than once. Added in manuallly.
dmd_type,dmd_id,dmd_name,bnf_code
VMP,35902011000001106,VMP previous to 39021911000001105,0501013B0AAATAT

PF_treatment_acute_otitis_media.csv

[a-d-brown]

Checked, all looks correct.

[chrisjwood16]

Final version here - https://www.opencodelists.org/codelist/opensafely/pharmacy-first-acute-otitis-media-treatment-full-dmd-codelist/17ff19f3/