ringkasan antibiotik

M MA AN NA AG GE EM ME EN NT T O OF F I IN NF FE EC CT T I IO ON N G GU UI ID DA AN NC CE E F FO OR R P PR RI IM MA AR RY Y C CA AR RE E – – S SU UM MM MA AR RY Y Doses are oral and for adults unless otherwise stated. Refer to BNF for further informati on or links on full HPA guidance (☺=child doses):. Summarised on behalf of Prescribing Clinical Network (PCN) from Health protection Agency template October 2013 refer to PAD for related documents HPA template Last Reviewed Nov 2012 Page 1 of 2 Next Review: November 2014 ILLNESS/COMMENTS DRUG DOSE DURATION UPPER RESPIRATORY TRACT INFECTIONS INFLUENZA:Annual vaccination essential for all those at risk of influenza. For otherwise healthy adults antivirals not recommended. Treat ‘at risk’ patients, when influenza is circulating in the community and within 48 hours of onset or in a care home where influenza is likely. At risk: pregnant (including up to two weeks post partum), ≥65 yrs, chronic respiratory disease (including COPD and asthma), significan t CV disease (not hypertension), immunocompromised, diabete s mellitus, chronic neurological, renal or liver disease. Use 5 days treatment with oseltamivir 75 mg bd unless pregnant or if there is resistance to oseltamivir, use 5 days zanamivir 10 mg BD (2 inhalations by diskhaler) and seek advice. For prophylaxis, see NICE. (NICE Influenza). Patients under 13 years see HPA Influenza link. ACUTE SORE THROAT: Avoid ABx as 90% resolve in 7 days without, and pain only reduced by 16 hours. RCT in <18yr olds shows 10d had lower relapse. Antibiotics to prevent Quinsy NNT >4000 Antibiotics t o prevent Otitis media NNT 200. phenoxymethylpenicillin Penicillin Allergy: Clarithromycin 500 mg QDS/1G BD (QDS when severe) 250-500mg BD 10 days 5 days If Centor score 3 or 4: ( Lymphadenopathy; No Cough; Fever; Tonsillar Exudate) consider 2 or 3-day delayed or immediate antibiotics or rapid antigen test. ACUTE OTITIS MEDIA (child doses): Optimise analgesia and target ABx.OM resolves in 60% in 24 h without ABx, which only reduce pain at 2 days and does not prevent deafness .Consider 2 or 3- day delayed or immediate antibiotics for pain relief if: • <2 years AND bilateral AOM (NNT4) or bulging membrane & ≥ 4 marked symptoms • All ages with otorrhoea NNT3 Abx to prevent Mastoiditis NNT >4000 amoxicillin Penicillin Allergy: erythromycin Child doses: 40mg/kg/day in 3 doses (max. 1.5g daily) < 2yrs 125mg QDS 2-8yrs 250mg QDS 8-18yrs 250-500mg QDS 5 days 5 days ACUTE OTITIS EXTERNA:First use aural toilet (if available) & analgesia. Cure rates similar at 7 days for topical acetic acid or antibiotic +/- steroid. If cellulitis or disease extending outside ear canal, start oral antibiotics and refer First Line: acetic acid 2% Second Line: neomycin sulphate with corticosteroid 1 spray TDS 3 drops TDS 7 days 7 days min to 14 days max ACUTE RHINOSINUSITIS: Avoid ABx as 80% resolve in 14 days without, and they only offer marginal benefit after 7 days. Use adequate analgesia. Consider 7-day delayed or immediate antibiotic when purulent nasal discharge .In persistent infection use an agent with anti-anaerobic activity eg. co-amoxiclav amoxicillin or doxycycline or phenoxymethylpenicillin For persistent symptoms: co-amoxiclav 500mg TDS 1g if severe 200mg stat/100mg OD 500mg QDS 625mg TDS 7 days 7 days 7 days 7 days LOWER RESPIRATORY TRACT INFECTIONS: Note: Low doses of penicillins more likely to select out resistance, Do not use quinolone (ciprofloxacin, ofloxacin) first line due t o poor pneumococcal activity. Reserve all quinolones (including levofloxacin) for proven resistant organisms. ACUTE COUGH, BRONCHITIS: AB little benefit if no co-morbidity. Consider 7d delayed AB with advice. Symptom resolution can take 3 weeks. Consider immediate ABx if > 80yr and ONE of: hospitalisation in past year, oral steroids, diabetic, congestive HF OR> 65yrs with 2 of above amoxicillin or doxycycline 500 mg TDS 200 mg stat/100 mg OD 5 days 5 days A AC CU UT T E EX XA ACE ER RB BA AT T I ION N O OF F C CO OP PD D: T Tr re ea at t e ex xac ce er rb bat ti i o on ns p pr ro omp pt tl ly y w wi it th h A AB Bx x i if f p pu ur ru ul le ent t sp pu ut tu um a an nd d i in nc cr re ea ase ed d sh ho or rt tn ne ess s o of f b br re ea at th h a an nd d/ /o or r i i n ncr re ea as se ed d s sp pu ut tum m v vo ol l u ume e . . R Ri i s sk k f f a ac ct t o or r s s f f o or r A AB B r r e es si i s st t a an nt t o or r g ga an ni i s sm ms s i i n nc cl l u ud d e e c co o- -mo or r b bi i d d d d i i s se ea as se e , , se ev v e er r e e C C O OP PD D , , f f r r e eq qu ue ent t e e x x a ac ce er r b ba at t i i o on ns , , an nt t i i b bi i o ot t i i c cs s i i n n l l a as st t 3 3m m amoxicillin or doxycycline or clarithromycin If resistance: co-amoxiclav 500 mg TDS 200 mg stat/100 mg OD 500 mg BD 625 mg TDS 5 days 5 days 5 days 5 days COMMUNITY ACQUIRED PNEUMONIA - Tx in the community Use CRB65 score to help guide and review: Each scores 1: Confusion (AMT<8); Respiratory rate >30/min; Age > 65; BP systolic <90 or diastolic ≤ 60; Score 0: suitable for home treatment; Score 1-2: hospital assessment or admission Score 3-4: urgent hospital admission Mycoplasma infecti on is rare in over 65s IF CRB65=0: amoxicillin or clarithromycin or doxycycline 500 mg TDS 500 mg BD 200 mg stat/100mg OD 7 days 7 days 7 days If CRB65=1 & AT HOME amoxicillin AND clarithromycin or doxycycline alone 500 mg TDS 500 mg BD 200 mg stat/100mg OD 7-10 days 7-10 days ILLNESS/COMMENTS DRUG DOSE DURATION MENINGITIS (NICE fever guidelines) *Transfer all patients to hospital immediately* SUSPECTED MENINGOCOCCAL DISEASE : *Transfer all patients to hospital immediately* If time before admission, and non-blanchi ng rash, give IV benzylpenicillin or cefotaxime,unless definite history of hypersensitivity IV or IM benzylpenicillin or IV or IM cefotaxime Age 10+ years: 1200 mg Children 1 - 9 yr: 600 mg Children <1 yr: 300 mg Age 12+ years: 1gram Child < 12 yrs: 50mg/kg (give IM if vein cannot be found) Prevention of 2 0 case of meningitis: Only prescribe following advice from Public Health D octor: refer to signposting document URINARY TRACT INFECTIONS (refer to HPA UTI guidance for diagnosis information): People > 65 years: do not treat asymptomatic bacteriuria; it is common but is not associated with increased morbidity. Catheter in situ: ABx will not eradicate asymptomatic bacteriuria; only treat if systemically unwell or pyelonephritis likely . Do not use prophylactic ABx for catheter changes unless history of catheter-change-associated UTI or trauma (NICE & SIGN guidance). UTI IN ADULTS (no fever or flank pain): Women severe/or ≥ 3 symptoms: treat. Women mild/or ≤ 2 symptoms: use dipstick and presence of cloudy urine to guide Tx. Nitrite & blood/leucocytes has 92% PPV; -ve nitrite, leucocytes, and blood has a 76% NPV. Men: Consider prostatitis & send pre- treatment MSU OR if symptoms mild/non-specific, use –ve dipstick to exclude UTI. trimethoprim or nitrofurantoin 200mg BD 100mg m/r BD Women all ages 3 days Men 7 days Second line: perform culture in all treatment failures Amoxicillin resistan ce is common; only use if susceptible Community multi-resist ant Extended-spectrum Beta-lactamase E. coli are increasing: consider nitrofurantoin (or fosfomycin 3g stat in women plus 2nd 3g dose in men 3 days later), on advice of microbiologist ACUTE PROSTATITIS: Send MSU for culture & start ABx.4-wk course may prevent chronic prostatitis. Quinolones achieve higher prostate levels. ciprofloxacin or ofloxacin 2nd line: trimethoprim 500mg BD 200mg BD 200mg BD 28 days 28 days 28 days UTI IN PREGNANCY : Send MSU for culture and start ABx. Short-term use of nitrofurantoin in pregnancy unlikely to cause problems to foetus. Avoid trimethoprim if low folate status or on folate antagonist (eg antiepileptic or proguanil). First line: nitrofurantoin if susceptible: amoxicillin Second line: trimethoprim Give folate if 1st trimester Third line: cefalexin 100 mg m/r BD 500 mg TDS 200 mg BD (off-label) 500 mg BD All for 7 days UTI IN CHILDREN: Child <3 mths: refer urgently for assessment. Child ≥ 3 months: use positive nitrite to start ABx. Send pre-treatment MSU for all. Refer to BNF for dosage. Imaging: only refer if child <6 months, recurrent or atypical UTI. Lower UTI: trimethoprim or nitrofuranto in if susceptible: amoxicillin Second line: cefalexin Lower UTI 3 days Upper UTI: co-amoxiclav Second line: cefixime Upper UTI 7-10 days ACUTE PYELONEPHRITIS: If admission not needed, send MSU for culture & sensitivities and start ABx. If no response within 24 hrs, admit ciprofloxacin or co-amoxiclav 500 mg BD 500/125 mg TDS 7 days 14 days RECURRENT UTI IN NON-PREGNANT WOMEN ≥ 3 UTIs/year: Cranberry products OR Post-coit al OR standby ABx may reduce recurrence . Nightly: reduces UTIs but adverse effects. Antibiotics: nitrofurantoin or trimethoprim 50 –100 mg 100 mg Post coital stat (off-label) Prophylaxis OD at night GASTRO-INTESTINAL TRACT INFECTIONS ORAL CANDIDIASIS: Antifungal agents absorbed from the gastrointestinal tract prevent oral candidiasis in patients receiving treatment for cancer. Drugs fully absorbed (fluconazole, ketoconazole and itraconazole) and partially absorbed (miconazole and clotrimazole) are effective compared with placebo or no treatment. See BNF for licensed dosage. ERADICATION OF HELICOBACTER PYLORI: Eradication is beneficial in known DU, GU or low grade MALToma. Conside r test and treat in persistent uninvesti gated dyspepsia. Do not offer eradication for GORD. Do not use clarithromycin or metronidazol e if used in the past year for any infection. DU/GU relapse: retest for H. pylori using breath or stool test OR consider endoscopy for culture & susceptibility . NUD: Do not retest, offer PPI or H 2RA. First line: PPI (use cheapest) PLUS clarithromycin (C) AND metronidazole (MTZ) or amoxicillin (AM) 2 nd line: PPI PLUS bismuthate (De-nol tab®) PLUS 2 unused antibiotics: amoxicillin metronidazole tetracycline TWICE DAILY 250 mg BD with MTZ 500mg BD with AM 400 mg BD 1g BD TWICE DAILY 120 mg QDS 1 g BD 400 mg TDS 500 mg QDS All for 7 days Relapse or MALToma 14 days INFECTIOUS DIARRHOEA: Refer previously healthy children with acute painful or bloody diarrhoea to exclude E. coli 0157 infection. AB therapy not indicated unless systemically unwell. If systemically unwell and campylobacter suspected (e.g. undercooked meat and abdominal pain), consider clarithromycin 250 –500 mg BD for 5 –7 days if treated early.

ringkasan antibiotik

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