Bedfordshire and Luton Community ANTIMICROBIAL PRESCRIBING GUIDELINES Important COVID-19 update NICE have issued a RAPID guidance relating to the management of suspected or confirmed pneumonia in adults in the community NICE guideline [NG165] . Please note the choice of antibiotics differs from the typical choices which are listed within these local guidelines. Clinicians should refer to the COVID-19 guidelines during this time. Click here to access the NICE Rapid guideline https://www.nice.org.uk/guidance/ng165/chapter/4-Managing-suspected-or-confirmed- pneumonia Virus? “Addressing known local sensitivities” Before you open this book…Do you need to prescribe an antibiotic or is it a virus? Symbol means that a virus is commonly involved. These guidelines are correct at time of issue (July 2021) Contents Acknowledgements ................................................................................................................................................................. 5 Introduction ............................................................................................................................................................................... 7 Aims............................................................................................................................................................................................. 8 Principles of treatment ........................................................................................................................................................... 8 Specific prescribing issues ................................................................................................................................................... 9 Penicillin allergy ................................................................................................................................................................... 9 Macrolides ............................................................................................................................................................................. 9 Trimethoprim and Co-trimoxazole interaction with Methotrexate ........................................................................ 10 Warfarin Interactions ........................................................................................................................................................ 10 Swallowing Difficulties ..................................................................................................................................................... 10 Prescribing in the frail elderly ........................................................................................................................................ 10 Antibiotic interactions with hormonal contraception .............................................................................................. 11 Culture sensitivity reporting ........................................................................................................................................... 11 IV antibiotics in the community ..................................................................................................................................... 11 Why should we be worried about Antimicrobial Resistance (AMR)? .................................................................. 11 How can we improve antimicrobial prescribing in primary care? ........................................................................ 11 Respiratory tract infections ................................................................................................................................................ 13 Acute Sore Throat .............................................................................................................................................................. 13 Scarlet Fever ....................................................................................................................................................................... 15 Acute Otitis Media (AOM) ................................................................................................................................................ 15 Otitis Externa ...................................................................................................................................................................... 16 Acute Bacterial Sinusitis.................................................................................................................................................. 16 Acute Cough .......................................................................................................................................................................... 17 Chronic Obstructive Pulmonary Disease (COPD) Exacerbation ........................................................................... 19 Community acquired pneumonia (CAP) ...................................................................................................................... 20 Bronchiectasis (non- cystic fibrosis) Exacerbation ................................................................................................. 22 Prevention of acute exacerbations of non-cystic fibrosis bronchiectasis ......................................................... 25 Treatment and prevention of pertussis in adults ..................................................................................................... 25 Dental infections ................................................................................................................................................................ 25 Mucosal Ulceration and Inflammation (simple gingivitis) ....................................................................................... 26 Dental Abscess ................................................................................................................................................................... 26 Urinary Tract Infections........................................................................................................................................................ 27 Collecting MSU Samples.................................................................................................................................................. 27 Urinary Tract Infection in Adults (No fever or flank pain) ....................................................................................... 27 Urinary Tract Infection in Pregnancy ............................................................................................................................ 28 Urinary Tract Infection in Men ........................................................................................................................................ 30 Urinary Tract Infection in Children ................................................................................................................................ 30 2 Acute Pyelonephritis ......................................................................................................................................................... 33 Prophylaxis of uncomplicated Urinary Tract Infections in adults ........................................................................ 35 Recurrent UTIs (2 in 6 months or > 3 infections/year) ............................................................................................ 35 Risks of long term prophylactic antibiotics ................................................................................................................ 38 Risks outweigh benefits in the elderly ......................................................................................................................... 38 Catheter associated Urinary Tract Infection ................................................................................................................... 39 Genital Infections ................................................................................................................................................................... 43 Prostatitis ............................................................................................................................................................................. 43 Epididymo-orchitis ............................................................................................................................................................ 44 Vaginal Discharge in an Adult ........................................................................................................................................ 45 Trichomonas vaginalis ..................................................................................................................................................... 45 Candidiasis .......................................................................................................................................................................... 46 Bacterial Vaginosis ........................................................................................................................................................... 46 Pelvic Inflammatory Disease (PID) ................................................................................................................................ 46 Chlamydia trachomatis (CT) ..........................................................................................................................................