RECOMMENDATION FOR THE USE OF ANTIBIOTICS FOR THE ...

RECOMMENDATION FOR THE USE OF ANTIBIOTICS FOR THE TREATMENT OF INFECTION

Aims

to provide a simple, best guess approach to the treatment of common infections, based on known sensitivity and resistance patterns in Cumbria to promote the safe, effective and economic use of antibiotics to minimise the emergence of bacterial resistance in the community

Principles of Treatment

1.

This guidance is based on the best available evidence but its application must be modified by professional judgement in the light of

co-existing diseases and other drug therapy.

2.

Prescribe an antibiotic only when there is likely to be a clear clinical benefit.

3.

Limit prescribing over the telephone to exceptional cases.

4.

Use simple generic antibiotics first whenever possible.

5.

The use of new and more expensive antibiotics (e.g., quinolones and cephalosporins) is inappropriate when standard and less

expensive antibiotics remain effective. Antibiotics are listed in order of preference.

6.

Avoid widespread use of topical antibiotics (especially those agents also available as systemic preparations).

7.

In pregnancy AVOID tetracyclines, aminoglycosides, quinolones, high dose metronidazole. Short-term use of trimethoprim

(theoretical risk in first trimester in patients with poor diet, as folate antagonist) or nitrofurantoin (at term, theoretical risk of

neonatal haemolysis) is unlikely to cause problems to the foetus.

8.

Doses quoted are intended for otherwise fit adults. Doses may need to be changed in children and those with renal impairment. The

duration of therapy will vary by individual patient, disease severity and speed of resolution.

9.

Where a `best guess' therapy has failed or special circumstances exist, microbiological advice can be obtained from the Consultant

Microbiologists at:

West Cumberland Hospital

01946 693181

Cumberland Infirmary

01228 814641

Furness General Hospital

01229 491022

This guidance has been produced in consultation with the consultant microbiologists and the Cumbria Medicines Management team.

Published: December 2012, Review date: November 2014

Condition UPPER RESPIRATORY TRACT/ENT

Comments

Drug and dose (listed in order of preference)

Duration (days)

Delayed prescriptions are a useful strategy as most upper respiratory tract infections are viral, self-limiting and improve without antibiotics. Regular use of analgesics such as paracetamol and ibuprofen should be encouraged.

Influenza

Tonsillitis/pharyngitis/sore throat

Annual vaccination is essential for all those at risk of influenza. For otherwise healthy adults antivirals not recommended. Treat `at risk' patients, ONLY within 48 hours of onset and when influenza is circulating in the community or in a care home where influenza is likely. At risk:

pregnant 65 years or over chronic respiratory disease (including COPD and

asthma) significant cardiovascular disease (not

hypertension) immunocompromised diabetes mellitus chronic neurological renal or liver disease

AVOID ANTIBIOTICS as 90% resolve in 7 days without and pain only reduced by 16 hours. If Centor score 3 to 4:

lymphadenopathy history of fever tonsillar exudate no cough consider 2 or 3-day delayed antibiotics or immediate antibiotics.

OSELTAMIVIR 75mg BD or, if there 5 is resistance to oseltamivir ZANAMIVIR 10mg BD (2 inhalations by diskhaler)

For prophylaxis, see NICE. (NICE Influenza). Patients under 13 years see HPA Influenza link.

ANTIBIOTIC TREATMENT NOT ROUTINELY RECOMMENDED

If antibiotic is required, PHENOXYMETHYLPENICILLIN 500mg 10

QDS (severe), or

CLARITHROMYCIN 250-500mg BD

5

Acute rhinosinusitis

Antibiotics to prevent quinsy, NNT >4000

Antibiotics to prevent otitis media, NNT 200

AVOID ANTIBIOTICS as 80% resolve in 14 days without, and they only offer marginal benefit after 7 days (NNT 15)

ANTIBIOTIC TREATMENT NOT ROUTINELY RECOMMENDED

Use adequate analgesia

If antibiotic is required,

Consider 7-day delayed or immediate antibiotic when

AMOXICILLIN 500mg TDS, or

5

purulent nasal discharge (NNT 8)

DOXYCYCLINE 200mg stat, then

5

In persistent infection use an agent with anti-anaerobic 100mg daily, or

activity e.g., co-amoxiclav

CLARITHROMYCIN 250mg BD

5

2nd line ? CO-AMOXICLAV 625mg

5

TDS

Condition Otitis externa (acute)

Otitis media (acute) ? child doses

Comments

First use aural toilet and analgesia. Cure rates similar for topical acetic acid or antibiotic steroid

Antibiotics do not reduce pain in first 24 hours, subsequent attacks or deafness. Use paracetamol or NSAID.

Otitis media resolves in 60% of patients in 24 hours without antibiotics. Antibiotics reduce pain at 2 days (NNT 15)

Consider antibiotics (2 to 3 days) if: ................
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