Can rabies vaccine be given intradermally?

Yes. The rabies vaccine can be administered via the intradermal route. This would, however, be an ‘off-label’ use as it is only licensed for intramuscular administration. The Joint Committee on Vaccination and Immunisation recommends that rabies vaccine be administered intramuscularly for both pre- and post-exposure prophylaxis. Administration via the deep subcutaneous route is recommended for patients with bleeding disorders. Healthcare professionals should only administer the vaccine via the intradermal route if they are experienced in using this technique.

Can a patient take penicillin if they are allergic to cephalosporins?

Cephalosporin (and other beta-lactam) antibiotics should be avoided in patients who are allergic, or have a history of being allergic, to penicillins, as there is a risk of cross-sensitivity. The main side-effect of cephalosporins is hypersensitivity and some patients who are sensitive to penicillins also allergic to cephalosporins. Cephalosporins should only be prescribed if considered essential by the prescriber. If the patient has a history of a minor rash or a rash that occurs 72 hours following penicillin administration, this might not be considered a penicillin allergy. The use of penicillins and cephalosporins should not be restricted in these patients and the choice of antibiotic is up to the prescriber. They should check the latest prescribing advice and local guidelines when considering the use of cephalosporin antibiotics in penicillin-allergic patients.

Can I sell urine test strips over-the-counter for detecting infections?

Urine test strips are not classed as a prescription-only medicine and, as such, can be sold over-the-counter. Urine test strips that indicate an infection are not allowed on NHS prescription because they are not listed in the Reagents section of the Drug Tariff. They are intended as a diagnostic tool for healthcare professionals, who understand how to interpret the reading. Indicators of infection include levels of pH, protein, leucocytes and nitrites, but this should be determined by a healthcare professional. Sometimes a urine sample given to a healthcare professional may be sent for analysis to determine the most appropriate antibiotic. If selling OTC, care should be taken to ensure that the recipient knows what indicators and parameters they are looking for, how to accurately read the results, and what action to take. The patient should also be asked how long they have had the infection, as referral may be more appropriate, depending on duration and symptoms.