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back. However, this resolved when
the infusion was given over two hours
instead of one.
The ID team recommended
consolidation therapy be initiated
before ceasing the induction
treatments (amphotericin and
flucytosine). Fluconazole po 800 mg
daily was initiated and there was a
five-day overlap before the induction
therapies were ceased.1 At this point,
Paul was discharged from hospital.
If consolidation therapy is successful
after eight weeks the dose of
fluconazole can be reduced to 400 mg
daily (for the eradication/suppression
phase). Paul received four months of
consolidation therapy and continued
to be reviewed by the ID physician.
The eradication/suppression treatment
may be continued for 6--18 months
in immunocompetent patients with
cerebral involvement.1 Paul received
18 months of therapy and the team was
able to reduce the dose of fluconazole to
200mg daily. He was stable on this dose
for eight months; however, at the end of
2013 a new lesion was noted on the MRI.
Even though he was asymptomatic the
dose of fluconazole has been increased
to 400 mg daily and the plan is for this to
continue for another 12 months.
In conclusion, this cryptic case
demonstrates how rural and
metropolitan practitioners can work
together to ensure patients receive the
best possible care.
Furthermore, it is one of many interesting
cases pharmacists in rural areas are
exposed to within their clinical practice.
1. Therapeutic Guidelines Antibiotic Expert Group, 2010.
Therapeutic Guidelines: Antibiotic, version 14, Therapeutic
Guidelines Pty., accessed via CIAP at: www.ciap.health.nsw.
gov.au/ (accessed: 10/03/2014).
2. Dixit, A. et al., Cryptococcus gattii: An Emerging Cause
of Fungal Disease in North America, Interdisciplinary
Perspectives on Infectious Diseases, Review Article 2009;1-
13 At: www.ncbi.nlm.nih.gov/pmc/articles/PMC2686104/
pdf/IPID2009-840452.pdf (accessed: 10/03/2014).
3. The University of Adelaide, 2014, Mycology Online:
Cryptococcus gattii At: www.mycology.adelaide.edu.au/
4. Rossi, S. (ed), Australian Medicines Handbook, 2014. AMH.
Last modified by AMH: Jan 2014, accessed via CIAP at:
www.ciap.health.nsw.gov.au/ (accessed: 10/03/2014).
coats in Qld
The University of Queensland's
Pharmacy Australia Centre of
Excellence (PACE) was flooded with
white coats last month.
The School of Pharmacy hosted the
annual Student Engagement Ceremony
to welcome new students and present
them with their white dispensing coat
which is symbolic of the pharmacy
Head of School Professor Nick Shaw
said the purpose of the ceremony was
to welcome first-year students not only
to the school but to the profession as
'We see the ceremony as our
opportunity to provide new students
with a sense of the history, pride,
public service and professionalism
that is pharmacy and highlight the
responsibility and crucial role that
pharmacists play in the healthcare of
the community,' he said.
'We hope and trust the ceremony
gives students a sense of community,
a sense of 'being' a professional, both
as students and as health professionals
in training. Professionalism can be
pictured or imagined as something that,
when it commences, requires a firm
foundation but requires room to grow,
to be nurtured and to develop.
'Professionalism can, unfortunately, be
easily damaged but should form part of
every health professional's daily life and
be firmly established through individual
Professor Shaw said the white
dispensing coat was a symbol of
professionalism and a commitment to
the provision of healthcare.
First-year student Chloe Minns said the
event helped the students feel engaged
in their learning and development as
'The ceremony helped us hit the ground
running, right from the beginning of this
four year course we aren't just reading
books, we are learning how to behave
and feel like pharmacists,' Chloe said.
'Having the coat, I think, gives us a sense
of pride, that we are somewhere we are
welcome and somewhere we belong.
'My favourite part was hearing from the
guest speakers, and seeing so many
esteemed guests actually there; having
them in front of us, telling us about
all the opportunities and the future
ahead of us in the pharmacy profession,
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