Antibiotic Flash Cards11-12 Final

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Antibiotic Prescribing Treatment Tables for use in Primary Care

Please dispose of any previous editions of this document
http://www.suffolkextranet.nhs.uk / home /medicinesmanagement /formularies /tabid /1108 / Default.aspx
Safety issues Drug

Nitrofurantoin
Warning
Nitrofurantoin is contraindicated in people with renal impairment (glomerular filtration rate (eGFR) < 60); ineffective because of inadequate urine concentrations BNF 60, 2010. Avoid nitrofurantoin in people with glucose-6-phosphate dehydrogenase (G6PD) deficiency as there is a definite risk of haemolysis (BNF 60, 2010). G6PD deficiency is highly prevalent in people originating from most parts of Africa or Asia, Oceania, and Southern Europe, and it primarily affects men. Avoid in 3rd trimester of pregnancy. Not with methotrexate. Avoid in 1st trimester of pregnancy - folate antagonist (inhibitor of folic acid synthesis). Experience in anticoagulant clinics suggests that INR is possibly altered when given with the majority of antibiotics. Please check for interaction, consider options and advise the patient. See latest edition of BNF - guidance given in Table 2 of Chapter 5.1 is comprehensive and up to date. Metabolism inhibited by clarithromycin and erythromycin; reduce dose of theophylline by up to 50%. Increased risk of myopathy with clarithromycin, erythromycin and telithromycin.
Trimethoprim Warfarin Antibiotic prophylaxis Theophylline Statins

Urine sensitivity Result Result Result Result Result Amoxicillin Cefradine Ciprofloxacin Nitrofurantoin Trimethoprim S S S S S
The results from microbiology are generally in alphabetical order, please scroll through the whole screen and choose the appropriate antibiotic following the guidance in this formulary. N.B. MSU must be sent for culture in children, pregnancy, complicated UTIs and treatment failure.
Please note:DOSES: See BNF for doses to be given. Use upper end of dosage range to ensure adequate treatment and to prevent emergence of resistance.
Consultations for simple infections were once regarded as straightforward. Unfortunately, the management of these presentations is becoming more complex. Multiple drug regimens offer more opportunities for drug interactions. Patients may see several prescribers which necessitates a very careful history of medication use. More patients have reduced renal function; because of age or illness. There are new pressures on the choice and use of antibiotics. Resistant strains and the emergence of infections such as C.diff have put pressure on an already limited formulary of antimicrobials. The following acronym is a useful safety check when prescribing antimicrobials, to avoid being A PRIME example of the pitfalls of antimicrobial prescribing.
A P R I M E
Allergy
Be aware of combination drugs e.g. Septrin (contains trimethoprim), and which family the drug belongs to.
Pregnancy or paediatric
In pregnancy AVOID: tetracyclines, aminoglycosides, quinolones, high dose metronidazole In children AVOID: tetracyclines
Renal function Interactions Methotrexate Effective choice
Particularly OCP, warfarin, statins, theophylline and immunosuppressant medication. There have been several incidents locally, some resulting in hospital admissions, from trimethoprim interacting with methotrexate. (Remember this sometimes comes from the hospital and may not appear on a GP record unless correspondence is checked). Two factors to consider: 1) the patient - all of above 2) known or likely causative organism
Mean duration of illness and symptoms

It may be helpful to advise patients of the average total length of the illness (before and after seeing the doctor):
acute otitis media: acute sore throat/acute pharyngitis/acute tonsilitis: common cold: acute rhinosinusitis: acute cough/acute bronchitis: 4 days 1 week 11/2 weeks 21/2 weeks 3 weeks
Note: these are average durations: about one half of all patients will experience symptoms for longer. The graph below provides an estimate of the duration of common cold symptoms.
Cold Symptoms
70 60 50 40
Cough and nasal discharge may last 2 WEEKS or more
% of patients with symptoms
nasal discharge
cough
30 20 10 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
fever sore throat
Day of illness
DOSES: See BNF for doses to be given. Use upper end of dosage range to ensure adequate treatment and to prevent emergence of resistance.
Upper Respiratory Tract Infections

www.nice.org.uk/nicemedia/pdf/CG69FullGuideline.pdf
Infection
Preference 1st Choice >
Formulary Choice No antibiotic
Duration of Treament
Tonsillitis
Only if S. pyogenes likely (sore throat)
Clinical Knowledge Summary
When no antibiotic is prescribed please consider using the Non Prescription form
2nd Choice >
Penicillin V (avoid amoxicillin)
10 days
3rd Choice >
Clarithromycin
10 days
Tonsillitis is commonly viral and rarely needs antibiotics. Sore throats should not be treated unless there is good evidence that they are caused by S.pyogenes.
Sinusitis acute
<12 weeks HPA
1st Choice >
No antibiotic, unless severe or symptoms for > 10 days

2nd Choice >
Amoxicillin
7 days
3rd Choice >
Clarithromycin or doxycycline
7 days
Many are viral. Symptomatic benefit of antibiotics is small - 69% resolve in 7-10 days without antibiotics.
Sinusitis chronic or recurrent

>12 weeks
Inform the person of the natural course of chronic sinusitis, and that it may last several months, but does not usually require referral unless the episodes are frequent. Consider whether a short-course of an antibiotic is appropriate. If required treat as acute.
Upper Respiratory Tract Infections (continued)

Infection Preference 1st Choice > Formulary Choice No antibiotic
Duration of Treament
Otitis media acute

2nd Choice >
Amoxicillin or clarithromycin
5 days
The benefits of antibiotics for acute otitis media are regularly questioned. Consider not prescribing antibiotics in acute diagnosis; recommend analgesia for the first three days and consider a delayed prescription.
Otitis media recurrent
1st Choice >
Co-amoxiclav
or clarithromycin
5 days
Thought to be associated with greater incidence of C.diff infections
Otitis externa
If recurrent or treatment fails, take swab for culture. Prescribe a topical ear preparation for 7 days. Options include: Intact tympanic membrane: Both a non-aminoglycoside antibiotic and a corticosteroid e.g. flumetasone-clioquinol (Locorten-Vioform ) ear drops OR Both an aminoglycoside antibiotic and a corticosteroid Both a non-aminoglycoside antibiotic and a corticosteroid e.g. flumetasone-clioquinol (Locorten-Vioform) ear drops
Perforated tympanic membrane:
Lower Respiratory Tract Infections

Infection Preference 1st Choice > Formulary Choice Duration of Treament
Acute bronchitis uncomplicated

No antibiotic Commonly viral - antibiotics not normally indicated

Acute bronchitis with bacterial infection

(Indicated by presence of purulent sputum, temperature, crackles and systemically unwell)
1st Choice >
Amoxicillin
5 days
2nd Choice >
Clarithromycin
5 days
Community acquired pneumonia

BTS
1st Choice >
Amoxicillin up to 1,000mg tds
up to 10 days with review
2nd Choice >
Clarithromycin
up to 10 days with review
Review at 48 hours. Unresponsive pneumonia including post-influenza (which could be S.aureus or other atypical organism), refer to hospital.
Chronic obstructive pulmonary disease with infective exacerbations

1st Choice >
Amoxicillin or doxycycline Clarithromycin (not MR)

Need to reduce theophylline by up to 50%
7 days 7 days
30% viral - use antibiotics if increased dyspnoea and increased purulence of sputum volume. There is insufficient evidence to recommend prophylactic antibiotic therapy in the managementof stable COPD.
Urinary Tract Infections Not as simple as you thought?

In treatment failure or if unsure consider ESBL and consult microbiology Infection Preference 1st Choice > Formulary Choice Trimethoprim
Not with methotrexate
Duration of Treament 3 days
UTI (simple - female)

No fever or flank pain Clinical Knowledge Summary
2nd Choice >
Nitrofurantoin
3 days
It is generally self-limiting; on average antibiotics shorten the duration of symptoms by about a day. If symptoms are mild, dipstick test the urine to guide treatment decisions. Discuss not using an antibiotic, especially if the urine dipstick test is negative for nitrites and leucocyte esterase and blood. If symptoms are moderate to severe offer an antibiotic. Do not dipstick test the urine as the decision to offer an antibiotic is not influenced by urine dipstick test results. Asymptomatic bacteriuria in over 65s should not be treated. Avoid nitrofurantoin in people with glucose-6-phosphate dehydrogenase (G6PD) deficiency, see first page. Nitrofurantoin is contraindicated in people with renal impairment , see first page.
UTI (simple - male)

No fever or flank pain
1st Choice >
Trimethoprim
7 days
2nd Choice >
Nitrofurantoin
7 days
MSU must be sent for culture in children, pregnancy, complicated UTIs and treatment failure.
Urinary Tract Infections (continued)

Infection Preference 1st Choice > Formulary Choice Trimethoprim
Duration of Treament 3 days
UTI (child - lower UTI)
2nd Choice >
Nitrofurantoin
3 days
UTI (child - upper UTI)
1st Choice
Co-amoxiclav
7 to 10 days
UTI (pregnancy)
1st Choice >
Trimethoprim avoid in 1st trimester or nitrofurantoin avoid in 3rd trimester Cefalexin or amoxicillin
7 days 7 days
2nd Choice >
Repeat MSU for culture 1 to 2 weeks after end of treatment. Avoid co-amoxiclav in pregnancy, risk to neonate of necrotising enterocolitis unless recommended by microbiologist.
UTI (complicated)
Fever or flank pain, structural abnormality, diabetic, recent instrumentation.
1st Choice >
Co-amoxiclav
7-10 days
2nd Choice >
Nitrofurantoin or trimethoprim
7-10 days
Urinary Tract Infections (continued)

Infection Preference Formulary Choice Duration of Treament
UTI
(long term suppressive treatment)
Antibiotics only to be used on recommendation of a consultant
Pyelonephritis
1st Choice >
Co-amoxiclav
14 days
2nd Choice >
Ciprofloxacin
7 days
Thought to be associated with greater incidence of C.diff infections Refer if fail to improve significantly within 24 hours of starting antibiotics or pyrexial with other risk factors e.g. pregnancy. Risk of under treatment or under estimation of severity of condition.
Pyelonephritis
(pregnancy)
1st Choice >
Cefalexin
10 to 14 days
Indwelling catheter
Bacterial colonisation is inevitable in long term catheterised patients and urethral catheters should be changed only when clinically necessary or according to the manufacturer's current recommendations. With regard to the formation of struvite (encrustation), some patients develop this problem routinely and good practice would be to record the lifespan of 3 consecutive catheters and base the optimum time to change the catheter on this. Bladder instillations or washouts must not be used to prevent catheter-associated infection. Avoid dehydration. Only if patient is systemically unwell take a CSU for antibiotic sensitivity and treat according to results. Please ensure urine specimens are labelled correctly i.e. CSU or MSU. Using a dipstick is not appropriate. Antibiotic use for suppression of recurrent infection in this group is not supported as it is likely to encourage multi-resistant organisms.
Genital Tract Infections

Infection Preference 1st Choice > Formulary Choice Ofloxacin or ciprofloxacin Duration of Treament 28 days then review
Acute prostatitis
Clinical Knowledge Summary and local guidance
Thought to be associated with even greater incidence of C.diff infections
2nd Choice > t
Trimethoprim
28 days then review
Generally antibiotic penetration of prostate is very poor. Quinolones are most effective as they have greater penetration into prostate with ofloxacin giving highest concentrations.
Epididymo-orchitis
1st Choice >
Ciprofloxacin or ofloxacin
28 days then review
2nd Choice >
Trimethoprim
28 days then review
If sexually active and STD suspected refer to GUM for treatment. In older patients normally coli forms, 98% of which are resistant to tetracyclines.
Pelvic inflammatory disease

1st Choice >
Metronidazole and ofloxacin
14 days
Thought to be associated with even greater incidence of C.diff infections. Not for use in children and not for use in pregnancy unless essential. See summary of product characteristics.
2nd Choice >
Ceftriaxone 250 mg as a single intramuscular dose and metronidazole and doxycycline
14 days
If STD suspected refer to GUM clinic for treatment, contact tracing and follow-up. In pregnancy seek advice from obstetrics or GUM. For children seek guidance from paediatrics or GUM.
Genital Tract Infections

Infection
(continued) Formulary Choice Oral metronidazole (preferred route) or vaginal metronidazole gel Clindamycin 2% cream Duration of Treament 7 days orally 5 days for topical 7 nights
Preference 1st Choice >
Bacterial vaginosis
2nd Choice >
If STD suspected refer to GUM for treatment, contact tracing and follow-up. In pregnancy seek advice from obstetrics or GUM.
Chlamydia trachomatis
1st Choice >
Azithromycin 1g
single dose
2nd Choice >
Doxycycline 100mg twice a day
7 days
Treat contacts and refer to GUM clinic. In pregnancy or breastfeeding azithromycin can be used but it is unlicensed. It is recommended by WHO and is more effective than erythromycin and amoxicillin.
Vaginal candidiasis
1st Choice >
Clotrimazole vaginal 10% cream or clotrimazole 500mg pessary Fluconazole 150mg capsule
Stat dose
2nd Choice >
Stat dose
The partner may also be the source of re-infection and, if symptomatic, should be treated with cream at the same time.
Gastro-intestinal Tract
Infection Formulary Choice Usually no antibiotics in mild disease. In severe disease or patients with co-morbidity seek advice from microbiology.
Campylobacter
Salmonella
Usually no antibiotics in mild disease. In severe disease or patients with co-morbidity seek advice from microbiology.
Shigella
Usually no antibiotics in mild disease. In severe disease or patients with co-morbidity seek advice from microbiology. Antibiotics can increase the risk of complications.
Be aware that the Shiga and Shiga-like toxins, produced by some strains of S.dysenteriae and E. coli O157:H7, have been associated with approximately 70% of cases of haemolytic uraemic syndrome (HUS) in children.
E coli 0157 colitis
As advised by microbiologist. Not normally recommended as antibiotics may increase the risk of haemolytic uraemic syndrome.
Travellers diarrhoea
Mostly self limiting and will need supportive management only. Send a stool specimen if diarrhoea occurs after foreign travel to anywhere other than Western Europe, North America, Australia or New Zealand, or other pathologies are a possibility e.g. parasites.
Gastro-intestinal Tract (continued)

Antibiotic associated diarrhoea

(C.difficile toxin positive)
Stop offending antibiotic and review patients on PPIs. Seek advice from microbiology.
Giardiasis
1st Choice >
Metronidazole 2g or 400mg TDS or 500mg BD
daily for 3 days 5 days 7 to 10 days
Cryptosporidium
Treatment not readily available and not normally indicated
Acute diverticulitis
1st Choice >
Co-amoxiclav
7 days
2nd Choice >
Ciprofloxacin and metronidazole (if allergic to penicillin)
7 days
Helicobacter pylori
1st Choice >
Lansoprazole and clarithromycin and either amoxicillin or metronidazole
7 days, 14 days in relapse
Miscellaneous
Cellulitis
(routine swabs not required for leg ulcers) Clinical Knowledge Summary
People with mild or moderate cellulitis with no systemic illness or uncontrolled co morbidities can usually be managed in primary care. If serious, admit. If MRSA suspected i.e. previous infection, colonisation or failure to respond, take swab. 1st Choice > Flucloxacillin 7-14 days
2nd Choice >
Clarithromycin
7-14 days
Water contact
If cellulitis has arisen from wound contaminated with fresh or salt water please discuss with microbiology.
Complicated cellulitis and facial cellulitis
1st Choice >
Co-amoxiclav - Consider admitting
7-14 days
Miscellaneous (continued)
Infection Preference 1st Choice > Formulary Choice Admit to hospital immediately Duration of Treament
Severe, necrotising infections Infected Leg Ulcers

(not normal colonization)
1st Choice >
Flucloxacillin
7 days while awaiting swab results
2nd Choice >
Erythromycin or clarithromycin
7 days while awaiting swab results
Bacteria will always be present. Antibiotics do not improve healing. Culture swabs and antibiotics are only indicated if there is evidence of clinical cellulitis, increased pain, enlarging ulcer or pyrexia. Do not use topical antibiotics.
Infection Preference 1st Choice > Formulary Choice Flucloxacillin oral or clarithromycin oral If MRSA suspected consult microbiology. Duration of Treament 7 days
Impetigo
Systematic review indicates topical and oral treatment produces similar results. As resistance is increasing reserve topical antibiotics for very localised lesions. N.B. some strains of S.aureus are particularly resistant to sodium fusidate, do not repeat topical treatment if treatment failure. National guidance states that mupirocin should be reserved for MRSA.
Moderate to severe acne

1st Choice >
Topical antibiotic combined with benzoyl peroxide. (In addition to increased therapeutic effect, the combination reduces chance of resistance developing) Lymecycline Oral for 6 months
2nd Choice >
3rd Choice >
Doxycycline (Caution photosensitivity) or erythromycin if tetracyclines not tolerated.
Oral for 6 months
Human/animal bites
1st Choice >
Co-amoxiclav
7 days
2nd Choice >
Metronidazole and doxycycline (animal) or clarithromycin (human)
7 days
Animal bite: surgical toilet most important. Assess tetanus and rabies risk. Antibiotic prophylaxis advised for bites >24 hours old, crush or puncture wounds, dog and cat bites, hand wound and at risk patients e.g. diabetics, elderly. Human bite: antibiotic prophylaxis advised. Assess HIV/hepatitis B & C risk.
Infection Preference 1st Choice > Formulary Choice Co-amoxiclav Duration of Treament 5 days
Wounds, badly soiled i.e. dirty,

traumatic wounds
2nd Choice >
Metronidazole and clarithromycin
5 days
Conjunctival infections
1st Choice >
No antibiotic or consider a delayed prescription
2nd Choice >
Chloramphenicol 1% ointment or 0.5% drops.
5 days
Check patient has not purchased drops from a community pharmacy. Refer if no improvement, particularly if patient wears contact lenses.
3rd Choice >
Prescribe fucidic acid only in patients in whom chloramphenicol not suitable.
Meningococcal disease suspected
Transfer patient to hospital immediately. Unless patient has a history of anaphylaxis (not allergy) give Benzylpenicillin as below: Age Under 1 year 1 - 9 years 10 years and over, including adults Ideally IV but IM if a vein cannot be found. If history of anaphylaxis just transfer to hospital. Dose 300mg 600mg 1200mg
PVL S.aureus
HPA
The Health Protection Agency website says: Panton-Valentine Leukocidin (PVL) is a toxin produced by 2% of Staphylococcus aureus and is associated with persistent recurrent pustules and carbuncles or cellulitis. Send swabs for culture in these clinical scenarios with appropriate clinical information. On rare occasions it causes more severe invasive infections, even in otherwise fit people. Risk factors include: nursing homes, contact sports, sharing equipment, poor hygiene and eczema. Discuss treatment of suspected cases with Consultant Microbiologist www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/PantonValentineLeukocidinPVL/
Dental abscess
1st Choice >
Metronidazole or amoxicillin
5 days
Infectious mastitis
1st Choice >
Flucloxacillin
14 days
2nd Choice >
Erythromycin
14 days
If symptoms fail to settle after 48 hours of antibiotic treatment: Check that the patient has taken the antibiotic correctly. Send a sample of the milk for culture.
Simple urinary tract infection (UTI) patient decision aid

Benefits from taking antibiotics for simple UTI
Imagine 100 women who present with signs and symptoms suggestive of simple UTI. If none of them takes an antibiotic, after 3 - 10 days, 26 of them will have few or no UTI symptoms, but 74 of them will still have significant symptoms. However, if all 100 take an antibiotic for up to three days, at 3 - 10 days: 1. About 36 women will have few or no symptoms, because they took the antibiotic (the yellow faces). 2. About 26 women will have few or no symptoms, just as they would have done if they had not taken the antibiotic (the green faces). 3. About 38 women will still have symptoms , even though they took the antibiotic (the red faces). But remember: It is impossible to know for sure what will happen to each individual person. All 100 women have to take an antibiotic.
As seen at the National Prescribing Centre: http://www.npci.org.uk
These 38 women still have These 38 women still have significant symptoms, even signif ic ant symptoms, though they took an antibiotic even though they took an antibiotic These 36 women have few or These 36 women have few or no symptoms, because they no symptoms, because they took an antibiotic took an antibiotic
These 26 women have few or These 26 women have few or no symptoms, just as if they no symptoms,an antibiotic had not taken just as if they had not taken an antibiotic
Simple urinary tract infection (UTI) patient decision aid

Harms from taking antibiotics for simple UTI
Imagine 100 women who present with signs and symptoms suggestive of simple UTI. If none of them takes an antibiotic, 13 of them will experience adverse events and 87 of them will not. However, if all 100 take an antibiotic for up to three days: 1. About 6 will experience adverse events because they have taken an antibiotic (the green faces with the red cross). 2. About 81 will not experience adverse events, whether or not they take an antibiotic (the green faces). 3. About 13 will experience adverse events, whether or not they take an antibiotic (the red faces). But remember: It is impossible to know for sure what will happen to each individual person.
These 6 women experience These 6 women experience adverse events, because they adverse antibioticbecause they took an events, took an antibiotic
These 81 women experience These 81 women experience no adverse events, just as no adverse events, just as if they had not taken an if they had not taken antibiotic
an antibiotic
These 13 women experience These 13 women experience adverse events, just as if adverse events, just as if they had had not an antibiotic they not taken taken an antibiotic
Otitis media risks and benefits of antibiotics patient decision aid

Benefits of antibiotics: pain, fever or both at 3 - 7 days
Children aged 6 months to 2 years with bilateral AOM Imagine a group of 100 children like this. If they all take an antibiotic, at 3 - 7 days: About 25 will not have pain, fever or both because they have taken an antibiotic (the yellow faces). About 45 will not have pain, fever or both, but would not have done even if they had not taken the antibiotic (the green faces). About 30 will still have pain, fever or both, even though they have taken an antibiotic (the red faces). But remember: It is impossible to know for sure what will happen to each individual person. All 100 children will have to take the course of antibiotic treatment.
These 45 children do These 45 children do not have fever, pain or not have fever, pain or both whether or not bothwhether or not they take antibiotics they take antibiotics
These 25 children do These 25 children do not have fever, pain or not have fever, pain or both because they take both because they antibiotics take antibiotics
These 30 children have These 30 children have pain, fever or both even pain, fever or both even thoughtake though they they antibiotics take antibiotics
Otitis media risks and benefits of antibiotics patient decision aid

Harms of antibiotics: vomiting, diarrhoea or rash
Children aged 6 months to 15 years with AOM Imagine a group of 100 children like this. If they all take an antibiotic, at 3 - 7 days: About 6 will have vomiting, diarrhoea or rash, fever or both because they have taken an antibiotic (the green faces with the red cross). About 83 will not have vomiting, diarrhoea or rash, whether or not they take an antibiotic (the green faces). About 11 will have vomiting, diarrhoea or rash, whether or not they take an antibiotic (the red faces). But remember: It is impossible to know for sure what will happen to each individual person.
These 6 children have These 6 children have diarrhoea, vomiting oror diarrhoea, vomiting rash because they take rash because they antibiotics take antibiotics
These 83 children do not These 83 children do not have diarrhoea, vomiting have diarrhoea, vomiting or rash, whether or not or rash, whether or not they take antibiotics they take antibiotics
These 11 children have These 11 children have diarrhoea, vomiting or or diarrhoea, vomiting rash, whether or not they rash, whether or not take antibiotics they take antibiotics
Supporting Materials
There is a wide range of support materials available on the DoH website which can be ordered free of charge:
These are all available as posters and the first design is also available as a leaflet and non-prescription pad. They can be ordered using the following form: www.dh.gov.uk/prod_consum_dh/groups/ dh_digitalassets/documents/digitalasset/dh_095163.rtf
The best way to treat most colds, coughs or sore throats is plenty of uids and rest. For more advice talk to your pharmacist or doctor.
Crown copyright 2008. 290980/Hand 1p 40k Oct08 (MRP)
Crown copyright 2008. 290981/Goal 1p 40k Oct08 (MRP)
Crown copyright 2008. 290982/Cloud 1p 40k Oct08 (MRP)
Main References:- Clinical Knowledge Summaries www.cks.nhs.uk/home A site giving evidence-based information, about the common conditions managed in primary care Health Protection Agency Guidance http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1279888711402 Management of Infection Guidance for primary care for local consultation and adaptation document
Prepared by GPs in Suffolk, local microbiologists and NHS Suffolk Medicines Management Team
Graphic design by The Support Service, SMHPT. NHSS 2010 Ref: Comms/SPCT/194

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Antibiotic Prescribing Treatment Tables for use in Primary Care

Safety issues Drug

Trimethoprim Warfarin Antibiotic prophylaxis Theophylline Statins

Renal function Interactions Methotrexate Effective choice

Mean duration of illness and symptoms

Cough and nasal discharge may last 2 WEEKS or more

% of patients with symptoms

fever sore throat

Upper Respiratory Tract Infections

Preference 1st Choice >

Formulary Choice No antibiotic

2nd Choice >

Penicillin V (avoid amoxicillin)

3rd Choice >

1st Choice >

No antibiotic, unless severe or symptoms for > 10 days

2nd Choice >

3rd Choice >

Sinusitis chronic or recurrent

Upper Respiratory Tract Infections (continued)

Otitis media acute

2nd Choice >

Otitis media recurrent

1st Choice >

Thought to be associated with greater incidence of C.diff infections

Perforated tympanic membrane:

Lower Respiratory Tract Infections

Acute bronchitis uncomplicated

No antibiotic Commonly viral - antibiotics not normally indicated

Acute bronchitis with bacterial infection

1st Choice >

2nd Choice >

Community acquired pneumonia

1st Choice >

Amoxicillin up to 1,000mg tds

up to 10 days with review

2nd Choice >

up to 10 days with review

Chronic obstructive pulmonary disease with infective exacerbations

1st Choice >

Amoxicillin or doxycycline Clarithromycin (not MR)

Urinary Tract Infections Not as simple as you thought?

Duration of Treament 3 days

UTI (simple - female)

2nd Choice >

UTI (simple - male)

1st Choice >

2nd Choice >

Urinary Tract Infections (continued)

Duration of Treament 3 days

UTI (child - lower UTI)

2nd Choice >

UTI (child - upper UTI)

Thought to be associated with greater incidence of C.diff infections

1st Choice >

2nd Choice >

1st Choice >

Thought to be associated with greater incidence of C.diff infections

2nd Choice >

Urinary Tract Infections (continued)

Antibiotics only to be used on recommendation of a consultant

1st Choice >