PATIENT GROUP DIRECTION see notes
Direction for the administration or
supply of: (Identify as appropriate)
PGD Reference No.
Aim of care this direction will provide:
Azithromycin
PGD/
Prophylaxis treatmentof Mycobacterium
avium intracellulare (MAI) in HIV
antibody positive people with a CD4
count of less than 50 that present to the
HIV service within East Kent Hospitals
NHS Trust.
Date applicable:
Date of expiry or renewal:
Clinical Condition
1. Definition of clinical condition /
situation
2. Criteria for confirming clinical
condition
3. Specific patient criteria for inclusion
in direction.
4. Patients excluded from this direction
5. Criteria for referral to Clinician or
for further advice
6. Action for patients who do not wish
to receive, refuse or do not adhere to
care under this direction.
HIV antibody positive with a CD4 count
of less than 50. This count indicates how
immunosuppressed a client is. This is for
use with Adults only. A CD4 count of
less than 50 would put an HIV antibody
positive person at risk of contracting an
opportunistic infection. ie:
Mycobacterium avium intracellulare
(MAI)
HIV antibody positive patient with CD4
count of less than 50 as stated in the
British HIV Association Guidelines
(BHIVA)
HIV antibody positive patient with CD count
of less than 50. (Reference: Brian Gazzard,
Chelsea and Westminster Hospital AIDS
Care Handbook. Mediscript Ltd 1999)
Patients known to have hepatic or renal
impairment. Patients known to suffer with
Porphyria. Pregnant or breast feeding
women. Hypersentivity to Azithromycin or
other macrolide antibiotics. Patients taking
ergot derivatives eg: migraine medication..
Excluded clients


Explain reasons for this
medication.
Discuss alternatives
1

Refer to HIV Consultant
Staff Characteristics
7. Professional Qualifications to be
held by staff using this PGD.
8. Specialist qualification, training,
experience and competence required.
9. Continued training requirements
and frequency.
Level one Registered General Nurse
(RGN) HIV clinical nurse specialist
employed by East Kent Hospitals NHS
Trust.
 Clinical nurse specialist
 ENB 934 course
 Professionally accountable
 Trained and competent in relevant
pharmacology
Yearly updates in treatment and care of
HIV
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Treatment
10. Name of Medicine
Azithromycin
11. Legal status of medicine
Prescription only medicine. Out of
license indication.
12. Dose / Range
Adult: 1,250mg weekly
13. Route / Method
Oral capsules
14. Frequency and number of times
treatment can be administered over
what period of time.
Adult- Once a week
Until CD4 count above 100 on 2 separate
blood results 1 month apart. Give 2
months supply and refer to HIV
Physician
Azithromycin is best taken on an empty
stomach at least one hour before food or
2 hours after food to maximize
absorption. It should be taken at least
two hours apart from antacids
15. Special instructions
16. Maximum total dosage (where
appropriate)
Side effects include nausea, vomiting,
diarrhoea, abdominal discomfort and
allergy. See BNF for full list.
Drug interactions include antacids,
ciclsporin, digoxin, ergot derivatives,
terfenadine, theophylinne and warfin.
See BMF for full list
18. Written/ verbal advice for patient/
 Provide patient with written
carer before/after treatment.
information if available
 Give patient advice re-adherence
 Give patient advice re special
instructions and warnings
 Point out to patient drug
information from the medication
pack
19.Records to be completed.
 Enter date, details of patient and
(Specify method of recording supply/
time into nursing held notes and
administration sufficient to include audit
when able into medical notes or
trail)
clinic GUM notes
 Signature and designation must be
documented clearly.
20. Person responsible for maintaining Ann Broadhead
central list for Trust of trained
personnel under this Directive.
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17. Warnings including potential
adverse reactions.
4
Management and Monitoring
21. This Patient Group Direction has been prepared by:
Name:
Position:
Signature:
Date:
Name:
Position:
Signature:
Date:
22. This Patient Group Direction has been ratified by:
Name:
Position: Clinical Manager Authorising use
Title:
Signature:
Name:
Date:
Position: For Quality & Practice
Title:
Signature:
Name:
Date:
Position: For Drugs and Therapeutic Committee
Title:
Signature:
23. Approved on behalf of
EKHT by:
Date:
Signature
Date
Clinical Director
Director of Pharmacy
Clinical Governance Lead
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24. Each individual authorized to administer under this direction should receive
a copy and sign it. Individual competency sheets are kept by the individual and
their Manager.
Training received and required for use of this Patient Group Direction
EKHT PGD Reference No: PGD/
Type of training
Knowledge of HIV and opportunistic infections
1.
Understanding of the pharmacologisal issues in
2.
relation to the use of azithromycin eg side effects,
contraindications and interactions.
Knowledge of the priciples of health education
3.
Knowledge of the legislation around use of PGDs.
4.
5.
6.
Date
I have read the Patient Group Direction and agree to use it within the criteria
specified. I fully understand my professional accountability.
Name:
Title:
Signature:
Date:
6
Notes on preparing a PGD:
1) Use a Patient Group Direction when the health professional administrating or
supplying a drug is not doing so at the specific instruction of a registered
medical practitioner. Otherwise use a Patient Specific Direction (PSD).
2) You do not need to use either a PSD or PGD when a doctor can write
conveniently an individual prescription.
3) The only individuals allowed to supply and administer under a PGD are:
a. Those who hold a certificate of proficiency in ambulance paramedic
skills issued by, or with the approval of, the Secretary of State
b. State registered paramedics.
c. Pharmacists.
d. Registered health visitors.
e. Registered midwives.
f. Registered nurses.
g. Registered ophthalmic opticians.
h. State registered chiropodists.
i. State registered orthoptists.
j. State registered physiotherapists.
k. State registered radiographers.
4) Include in the Direction
a. the period during which the Direction shall have effect;
b. the description or class of prescription only medicine to which the
Direction relates;
c. whether there are any restrictions on the quantity of medicine which
may be supplied on any one occasion, and, if so, what restrictions;
d. the clinical situations which prescription only medicines of that
description or class may be used to treat;
e. the clinical criteria under which a person shall be eligible for
treatment;
f. whether any class of person is excluded from treatment under the
Direction and, if so, what class of person
g. whether there are circumstances in which further advice should be
sought from a doctor or dentist and, if so, what circumstances;
h. the pharmaceutical form or forms in which prescription only medicines
of that description or class are to be administered;
i. the strength, or maximum strength, at which prescription only
medicines of that description or class are to be administered;
j. the applicable dosage or maximum dosage;
k. the route of administration;
l. the frequency of administration;
m. any minimum or maximum period of administration applicable to
prescription only medicines of that description or class;
n. whether there are any relevant warnings to note, and, if so, what
warnings;
o. whether there is any follow up action to be taken in any circumstances,
and, if so, what action and in what circumstances;
p. arrangements for referral for medical advice;
q. details of the records to be kept of the supply, or the administration, of
medicines under the Direction.
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