Updates

New content updates

Our available guidelines are always growing with the below coming soon:
  • Antibiotic guidelines
  • New Kidney and Urinary guidelines

Update: February 2025

Updated guidelines

Other practice-changing updates

Cardiovascular guidelines
  • Drug therapy for lipid modification has been updated to include information on inclisiran; a small interfering RNA therapy that is now listed on the Pharmaceutical Benefits Scheme (PBS).
Dermatology guidelines
  • Ranitidine is available in Australia; recommendations for its use in patients with urticaria have been updated to reflect this.
  • Following a Therapeutic Goods Administration (TGA) safety alert, promethazine is no longer recommended in children younger than 6 years. The promethazine dose for patients with sleep disturbance associated with urticaria has been updated to reflect this.
Gastrointestinal guidelines
Respiratory guidelines
Rheumatology guidelines
  • Drug recommendations for axial spondyloarthritis and psoriatic arthritis have been updated to include bimekizumab; an interleukin-17 (IL-17) inhibitor that is now available on the Pharmaceutical Benefits Scheme (PBS).
Toxicology and Toxinology guidelines
  • Revised recommendations for the treatment of scombroid poisoning are included to reflect changes in drug availability and practice. Separate recommendations are given for adults and children 12 years and older, and children younger than 12 years.
  • Glucose correction should be prioritised over thiamine supplementation for patients with hypoglycaemia who are also at high risk of thiamine deficiency. The ethanol intoxication and isopropyl alcohol poisoning topics have been amended to clarify this.
We welcome feedback from our community; please contact feedback@tg.org.au.

Update: December 2024

Updated guidelines

Other practice-changing updates

Antibiotic guidelines
  • A new topic on mpox (monkeypox) summarises key clinical considerations and serves as a directory to the most up-to-date Australian and international resources.
  • The Antibiotic prescribing in primary care summary table and Otitis media topic have been amended to clarify that Aboriginal and Torres Strait Islander children at high risk of complications require antibiotic therapy for acute otitis media.
  • Procaine benzylpenicillin was discontinued in Australia in December 2022; drug recommendations have either been removed, or have had a footnote about the change in availability added.
  • An oral azole (including fluconazole) may be prescribed by a gynaecologist or dermatologist to treat chronic candidal vulvovaginitis in adult females. The chronic candidal vulvovaginitis topic has been updated to reflect this.
  • Test of cure recommendations for several infections and syndromes, including Chlamydia trachomatis, Mycoplasma genitalium , Lymphogranuloma venereum, pelvic inflammatory disease and infective proctitis, have been revised to align with key national guidelines.
Bone and Metabolism guidelines
Cardiovascular guidelines
Dermatology guidelines
  • Potency classifications of topical corticosteroids (eg methylprednisolone aceponate) may differ depending on the guideline or resource consulted. An explanatory footnote in our topical corticosteroid preparations table outlines the factors affecting these classifications.
  • The weekly fluconazole dose recommended for tinea capitis (including kerion) has been restricted to use in children, to better reflect the patient population in which this regimen has been used. A dose cap has also been added.
Fatigue guidelines

Neurology guidelines

  • The intramuscular formulation of interferon beta 1a (Avonex) for the management of multiple sclerosis was discontinued in Australia in April 2023; subcutaneous formulations are still available. The table of available immunotherapies for multiple sclerosis has been updated to reflect this.

Pain and Analgesia guidelines

  • Opioid toxicity is usually reversed by 2 mg of naloxone or less, and the need for higher doses should prompt consideration of other diagnoses. The naloxone recommendations have been updated to reflect this. More detail has also been included on managing recurrent toxicity.

Psychotropic guidelines

Respiratory guidelines

  • Inhaled cromones (sodium cromoglycate and nedocromil), which are rarely used preventer therapies for asthma, have been discontinued globally; recommendations for asthma maintenance management have been updated to reflect this.
  • Ipratropium nasal spray products were discontinued in Australia in December 2021. Recommendations for allergic and nonallergic rhinitis, acute rhinosinusitis, and management of adverse effects associated with noninvasive ventilation have been updated to reflect this.

Sexual and Reproductive Health guidelines

  • Regulations regarding prescribing medical abortion have changed. Mandatory training and registration are no longer required to prescribe or dispense medical abortion, although prescribers can access free online training at the MS-2Step website. In addition to medical practitioners, and depending on state and territory legislation, nurse practitioners and authorised midwives can now prescribe medical abortion.
  • A new combination preparation of oral estradiol and oral micronised progesterone has been added to the table of continuous combined menopausal hormone therapy (MHT) preparations.
  • Revised advice suggests that micronised progesterone 200 mg orally daily might provide better endometrial protection than a dose of 100 mg daily for patients taking 17-beta estradiol 2 mg orally daily (medium-dose estrogen) in continuous combined MHT.
  • Long-term use of cyclic combined MHT for over 5 years may be associated with more endometrial risk than continuous combined MHT; advice outlines options for patients at the 5-year mark.
  • Updated advice acknowledges that evidence is limited for effective doses of progestogens for endometrial protection in patients taking high-dose estrogens for cyclical combined MHT; specialist advice is recommended.

Toxicology and Toxinology guidelines

  • In addition to the changes described in What's New, a new dose recommendation for the 0.5% solution of methylene blue has been added for the treatment of methaemoglobinaemia.

We welcome feedback from our community; please contact feedback@tg.org.au.


Update: May 2023

Updated guidelines

Other practice-changing updates

Antibiotic prescribing in primary care: summary table
  • The freely available Antibiotic prescribing in primary care summary table has been updated to include temporary advice on alternative recommendations to first-line antibiotics for use in shortage situations. The listed alternatives should only be considered if first-line treatment is unavailable as the alternatives may be less efficacious, have a suboptimal spectrum of activity and have a less favourable harm–benefit profile.
  • Shortage of oral liquid formulations of some antibiotics is particularly an issue. To enable the preferred antibiotic to be used in children when an oral liquid formulation is not available, the summary table also includes temporary advice developed by The Society of Hospital Pharmacists of Australia, from Don’t Rush To Crush, on the suitability of crushing or dispersing oral solid-dose formulations.
  • For more information about the development of the table, see the news article.
Antibiotic guidelines
  • The pneumonia topics have been updated to indicate that pneumonia can be a feature of coronavirus disease (COVID-19), and to provide links to the COVID-19 topic for resources on diagnosis and management.
Diabetes guidelines
  • Following the discontinuation of the modified-release formulation of exenatide in Australia in 2021, the immediate-release formulation was discontinued in December 2022; there are now no formulations of exenatide available in Australia, so use of alternative glucagon-like peptide-1 (GLP-1) receptor agonists (dulaglutide, liraglutide, semaglutide) should be considered for type 2 diabetes in adults.
Fatigue guidelines
  • New links to updated National Institute for Health and Care Excellence (NICE) guidance and advice on energy management have been added to help clinicians support patients with myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS).
Pain and Analgesia guidelines
  • The Role of analgesics in chronic noncancer pain topic has new links to the revised Addiction Guidelines to support management of patients who may have a disorder of opioid use.
  • Advice on take-home naloxone has been updated to include information about eligibility and availability.
Sexual and Reproductive Health guidelines
  • Advice has been added on new contraceptive pill formulations—the drospirenone-only progestogen only pill (Slinda) and the estetrol-drospirenone combined oral contraceptive pill (NextStellis).
  • A revised printable table on switching between contraceptives includes new pill formulations and expands on advice for switching from combined hormonal contraceptives to other formulations.
  • Rufinamide has been added to the list of antiepileptic drugs that interact with contraceptives and advice on lamotrigine’s interactions with hormonal contraception is expanded.
  • Vaping is included the section on tobacco smoking and eligibility to use hormonal contraception.
  • New advice for patients aged 50 years and older explains which contraceptives can be combined with cyclical combined menopausal hormone therapy.
Toxicology and Toxinology guidelines
  • Ranitidine injection and tablets are currently suspended for use in Australia; alternative histamine H2-receptor antagonists (famotidine or nizatidine) are now recommended in combination with promethazine for the treatment of mild to moderate scombroid poisoning.

Update: November 2022

Updated Guidelines
Cardiovascular guidelines
  • The alteplase recommendation for haemodynamically unstable pulmonary embolism has been amended to clarify that the total daily dose (including initial intravenous bolus dose) for patients less than 65 kg is 1.5 mg/kg.

Update: August 2022

Updated Guidelines

Other practice-changing updates:

Antibiotic guidelines
  • The Australasian consensus guidelines for the management of invasive fungal disease and use of antifungal agents in the haematology/oncology setting were updated in 2021; all links to these guidelines have been updated.
  • All mentions of the bacterium, Clostridium difficile, have been updated to its new name, Clostridioides difficile.
  • In response to user feedback, printable summary tables of the indications and regimens for surgical antibiotic prophylaxis have been developed for most groups of procedures. A link to the summary table is included in each relevant section of the Surgical antibiotic prophylaxis for specific procedures topic, and a collation of all the summary tables is available via the ‘Quick links’ drop-down menu at the top of each page in Therapeutic Guidelines.
  • Advice on diagnosing and managing COVID-19 changes frequently. To improve access to the most up-to-date advice, a list of the most relevant Australian resources has been collated.
  • Primary prophylaxis for Mycobacterium avium complex (MAC) is no longer recommended for adults with HIV infection who immediately start antiretroviral therapy. See here for further information.
  • The section on Management of neonates born to mothers with tuberculosis (TB) has been extensively revised following updates to a number of key state and international guidelines.
    • The section on Management of neonates born to mothers with tuberculosis (TB) has been extensively revised following updates to a number of key state and international guidelines. Presumptive therapy for latent TB is now only recommended for neonates born to mothers with pulmonary TB if the mother is still considered infectious at the time of birth. Presumptive therapy for latent TB now includes the option of a 4-month rifampicin regimen.
    • Flucytosine injection is no longer available for induction therapy of cryptococcal meningitis and pulmonary cryptococcosis. Recommendations for these conditions have been updated—use oral flucytosine (or consider administration via a nasogastric tube), or seek expert advice for other treatment options.
    Pain and Analgesia guidelines
    • The modified-release morphine recommendation for chronic noncancer pain has been updated to clarify dosing for the 12-hour and 24-hour formulations.
    • Following updates to international guidelines, duloxetine is now the preferred drug for the management of painful chemotherapy-induced peripheral neuropathy.
    • Paracetamol is a first-line analgesic in children. Information on paediatric-specific formulations has been added to support paracetamol use in this group.
    Respiratory guidelines
    • The new combination inhaler, fluticasone furoate+umeclidinium+vilanterol, has been added to the stepwise maintenance management of asthma for adults and adolescents for patients who continue to have uncontrolled asthma despite optimised dual therapy with an inhaled corticosteroid plus long-acting beta2 agonist. In these patients, therapy consists of either increasing the inhaled corticosteroid dose or adding a long-acting muscarinic antagonist. The role of type 2 airway inflammation in selecting appropriate therapy has been updated.
    Rheumatology guidelines
    • Advice on NSAID use during the perinatal period has been updated to reflect current evidence. In general, NSAIDs should be avoided in pregnancy and must be avoided after 30 weeks’ gestation.
    Toxicology and Toxinology guidelines
    • Updated intravenous calcium drug recommendations throughout Therapeutic Guidelines to address change in labelling of calcium gluconate and to emphasise mmol dosing.

    Updates: May 2022

    Updated Guidelines

    Practice-changing updates to other guidelines

    The following practice-changing updates were included in Therapeutic Guidelines in May 2022.
    Several functional improvements have been included in this release. The Therapeutic Goods Administration (TGA) pregnancy category and advice on drug compatibility with breastfeeding is now presented in a pop-up box when clicking on the pregnancy and breastfeeding buttons next to a drug recommendation, so users can access this information more directly. Links to the Pharmaceutical Benefits Scheme (PBS) schedule have also been updated, with the PBS button next to a drug recommendation now linking directly to the relevant section of the PBS website, so the latest information is always provided.
    Antibiotic guidelines
    General
    • The ventrogluteal site is preferred for administration of intramuscular benzathine benzylpenicillin because of reduced pain and risk of nerve injury.
    • Instructions on intramuscular injection of benzathine benzylpenicillin at the ventrogluteal site have been included.
    • Benzathine benzylpenicillin dosing has been streamlined for sore throat, impetigo, and prophylaxis for invasive group A streptococcal (iGAS) infection, with three weight-based bands recommended for dosing instead of five.
    • Advice on compatibility with breastfeeding for trimethoprim+sulfamethoxazole has been updated.
    • The primary care summary table has been updated to include the changes to management of sore throat.
    Liver abscess
    • Based on new evidence, an early switch to oral therapy can be considered for Klebsiella pneumoniae liver abscess in patients who are not critically ill and do not have metastatic infection.
    Antibiotic management of chronic obstructive pulmonary disease (COPD)
    • Fever has been removed from the criteria for suspecting a bacterial cause of COPD exacerbation because it is not a sensitive marker for infection. The limited benefits of antibiotic therapy for bacterial exacerbations of COPD outside of the intensive care setting have been emphasised.
    Prevention of infective endocarditis
    • Studies have demonstrated that rheumatic heart disease is an independent risk factor for infective endocarditis and adverse outcomes from this disease. Therefore, infective endocarditis prophylaxis is now recommended for all patients with rheumatic heart disease undergoing certain procedures.
    • A footnote has been added to clarify that obstetric procedures (eg caesarean section) are not considered to be genitourinary procedures when discussing procedures for which endocarditis prophylaxis is recommended for patients with a specified cardiac condition.
    Impetigo
    • Advice has been added on the management of impetigo in patients receiving benzathine benzylpenicillin for prevention of recurrent acute rheumatic fever.
    Malaria
    • A quantitative test for assessing glucose-6-phosphate dehydrogenase activity to enable the safe use of tafenoquine is now available in Australia; the footnote about use of tafenoquine for radical cure of P. vivax malaria has been updated.
    Shingles
    • A footnote has been added to explain that the quantity of famciclovir listed on the Pharmaceutical Benefits Scheme to treat shingles in patients who are not immunocompromised is not sufficient for the recommended course of treatment.
    Lyme disease
    • The Lyme disease topic now includes more detail on clinical manifestations; links to international publications on the prevention, diagnosis and treatment of Lyme disease; and a link to the recently published clinical pathway on debilitating symptom complexes attributed to ticks (DSCATT).
    Salmonella typhi and paratyphi A, B and C bacteraemia (typhoid and paratyphoid fever)
    • Due to increasing resistance rates, we now emphasise that ciprofloxacin should not be used to treat typhoid or paratyphoid fever unless susceptibility is confirmed, regardless of the country of acquisition.
    Bone and Metabolism guidelines
    • The place of romosozumab (a new monoclonal antibody that increases bone formation and bone mineral density) in the management of osteoporosis has been addressed—it is usually reserved for patients who experience a fracture while on antiresorptive therapy.
    Diabetes guidelines
    • Empagliflozin has now been approved by the Australian Therapeutic Goods Administration for use in patients with an estimated glomerular filtration rate (eGFR) or creatinine clearance (CrCl) of 30 mL/min or more (previously 45 mL/min or more). The drug recommendation for empagliflozin for patients with type 2 diabetes has been updated.
    Neurology guidelines
    • Several clinical studies have demonstrated that levetiracetam has similar efficacy to sodium valproate and phenytoin for treatment of status epilepticus. Levetiracetam is now recommended as an alternative first-line drug to treat status epilepticus in adults and children who continue to experience seizures after the administration of a benzodiazepine.
    Oral and Dental guidelines
    • The rationale for antibiotic choice for surgical prophylaxis for dental procedures has been clarified.
    • Romosozumab (a new monoclonal antibody for the treatment of osteoporosis) has been reported to be associated with medication-related osteonecrosis of the jaw, but the magnitude of the risk is unclear. Most patients receiving romosozumab would have had at least 12 months of therapy with an antiresorptive drug, so this should be considered when assessing the risk of medication-related osteonecrosis of the jaw in a patient taking romosozumab. If a bone-invasive dental procedure is required in a patient taking romosozumab, the benefits of continued therapy outweigh the low risk of medication-related osteonecrosis of the jaw in most patients.
    • The rankings for topical antifungals for oral candidiasis and angular cheilitis have been updated to reflect their similar efficacy; practical considerations on drug choice for oral candidiasis have also been included (e.g., amphotericin B lozenges may not be suitable for patients with a dry mouth).
    Pain and Analgesia guidelines
    • The Australian Therapeutic Goods Administration has added enhanced warnings to the product information and consumer medicines information for the gabapentinoids, gabapentin and pregabalin, to highlight the potential for misuse (pregabalin only), abuse and dependence. Advice on when to consider deprescribing gabapentinoids for chronic pain has been updated accordingly.
    Respiratory guidelines
    • New combination inhalers, mometasone+indacaterol and mometasone+indacaterol+glycopyrronium, have been added to the stepwise maintenance management of asthma for adults and adolescents.
    • New triple therapy combination inhalers, beclometasone+glycopyrronium+formoterol and budesonide+glycopyrronium+formoterol, have been added as options for patients who continue to have symptoms and exacerbations of COPD despite dual therapy with a long-acting bronchodilator and inhaled corticosteroid.
    • Dupilumab and omalizumab have now been approved by the Australian Therapeutic Goods Administration for use in adults with inadequately controlled chronic rhinosinusitis with nasal polyps. The role of biologics for patients with chronic rhinosinusitis with nasal polyps has been updated.

    Update: February 2022

    The following practice-changing updates were included in Therapeutic Guidelines in February 2022.
    Antibiotic guidelines:
    • Antibiotics with activity against Pseudomonas aeruginosa are included in empirical regimens for severe diabetic foot infection. When intravenous ciprofloxacin is used to treat P. aeruginosa, it must be dosed 8-hourly (not 12-hourly).

    Update: September 2021

    The following practice-changing updates were included in eTG complete in September 2021.
    Antibiotic guidelines:
    • Based on new evidence, residence in a correctional facility has been included as a risk factor for methicillin-resistant Staphylococcus aureus (MRSA) infection.

    Update: July 2021

    The following practice-changing updates were included in eTG complete in July 2021.
    Antibiotic guidelines:
    • The empirical antibiotic regimens for children 2 months or older with community-acquired sepsis or septic shock have been updated in line with current Australian practice. The addition of gentamicin is recommended for children with septic shock to ensure adequate treatment of bacteria not susceptible to cefotaxime and ceftriaxone, but is not required for children with sepsis. Vancomycin has been added to ciprofloxacin for children with severe penicillin hypersensitivity to ensure adequate treatment of Gram-positive bacteria.
    • The nitazoxanide drug recommendation for children with recurrence of or ongoing refractory Clostridium difficile infection has been updated to include specific dosing for children 12 years or older.
    • Separate advice is given for dilution of benzylpenicillin for intramuscular and intravenous administration for management of suspected meningococcaemia in the community setting.
    • The graphic to support shared decision making discussions for patients with acute rhinosinusitis has been updated to clarify that decongestants should not be used for children younger than 6 years.
    Sexual and Reproductive Health guidelines
    • Rhesus antibody testing and anti-D immunoglobulin use is no longer recommended for medical abortion before 10 weeks’ gestation based on updated advice from the National Blood Authority and RANZCOG.

    For guidelines updates from 2019 - 2020 view this page.