Context

Pharmacy First

Inclusion/exclusion criteria

We included systemic community formulations of metronidazole relevant to Pharmacy First and primary care prescribing, including oral tablets, oral suspension, suppositories : Metronidazole 200mg suppositories, Metronidazole 200mg tablets Metronidazole 200mg/5ml oral solution, Metronidazole 400mg tablets Metronidazole 500mg suppositories , Metronidazole 500mg tablets

Borderline cases

We excluded: 1)Metronidazole + Nystatin because it combines antibacterial and antifungal agents and is primarily used for localised vaginal treatment rather than systemic antibacterial prescribing. 2)Infusion and other injectable formulations because these represent hospital-oriented parenteral treatments not routinely used within Pharmacy First or standard GP prescribing pathways. 3)Generic Pylera which is combination oral capsule containing: Bismuth subcitrate potassium 140 mg+Metronidazole 125 mg+ Tetracycline hydrochloride 125 mg. It is primarily indicated, together with a proton pump inhibitor such as omeprazole, for eradication of Helicobacter pylori infection and prevention of relapse of associated peptic ulcer disease. 4) Topical preparations (Vaginal gel, cutaneous cream, and cutaneous gel)

Sensitivity vs specificity

The codelist was designed to maximise sensitivity for community metronidazole prescribing by including commonly used oral primary care formulations while excluding hospital-oriented injectables,topical preparations and specialised combination therapies not routinely used within Pharmacy First.

Additional information

Oral solution and suppository formulations were included to ensure capture of prescribing among patients unable to tolerate or swallow tablets. Topical formulations (vaginal gel, cutaneous cream, and cutaneous gel) were excluded.