Antimicrobial guidelines and resources

Use of antibiotics in pregnancy

A Canadian case-control study has found new evidence of increased risk of spontaneous abortion associated with use of antibiotics in pregnancy (Flory TM et al. Use of antibiotics during pregnancy and risk of spontaneous abortion. CMAJ. 2017; 1(189):625-33: http://www.cmaj.ca/content/189/17/E625).

Public Health England (PHE) now states:

in pregnancy, take specimens to inform treatment, use this guidance or seek specialist advice. Penicillins, cephalosporins and erythromycin are not associated with increased risks. If possible, avoid tetracyclines, quinolones, aminoglycosides, azithromycin, clarithromycin and high dose metronidazole 2g stat unless the benefit outweighs the risk. Short term use of nitrofurantoin is not expected to cause foetal problems (theoretical risk of neonatal haemolysis). Trimethoprim is also unlikely to cause problems unless poor dietary folate intake, or taking another folate antagonist.

 

Further analysis from this Canadian study suggests increased risk of major congenital malformations associated with certain antibiotics. The antibiotics in this study which increased the risk included erythromycin, doxycycline, phenoxymethylpenicillin, ofloxacin, clindamycin, moxifloxacin. The authors highlight that the results should be interpreted with caution as only a small number of cases were exposed to antibiotics. The absolute increased risk remains small, but the authors suggest clinicians use other antibiotics for pregnant women.

 

Leaflets and forms

A range of leaflets for patients is available from the Royal College of General Practitioners TARGET Antibiotics Toolkit page.

One can be used during consultations with women who are experiencing non-complicated urinary tract infections, when the clinician feels that the patient does not require an antibiotic prescription:

TARGET urinary tract infection information leaflet Nov 2016

The leaflet is available in different languages from the TARGET website.

 

FOR CARE HOME STAFF: Form to complete and fax to GP if an older resident has a suspected urinary tract infection:

Management of UTIs in nursing homes form dec16 FINAL

 

Primary Care Antimicrobial Guidelines

 

Public Health England (PHE) has updated sections of the PHE management of infection for primary care guidance, which is for consultation and local adaptation. This is currently being used to update our local guidelines (the summary diagram and full guideline will be put back on the website once these changes have been made).

PHE has issued updated guidance on fungal skin/nail infections and guidance on treating Helicobacter pylori in patients with dyspepsia. These will also be used to update the local guidelines.

 

National guidance

Diagnosis of UTI – Quick Reference Guide for Primary Care

 

In the process of being reviewed:

Principles of Treatment

Antimicrobial Allergy

Healthcare Associated Infections

Outpatient parenteral antimicrobial therapy

 

 

These guidelines should be used in conjunction with professional judgement and involving patients in management decisions.

 

 

 

For hospital patients and visitors

Public Health England has produced a patient information leaflet  about an uncommon fungus called Candida auris.

 

Quality premium

CCGs are continuing to work with healthcare professionals, patients and the public to reduce inappropriate prescribing of antibiotics. In addition, from 1 April 2017 we will be working to reduce gram negative blood stream infections (BSI) across the whole health economy and reduce inappropriate antibiotic prescribing for urinary tract infections (UTI) in primary care.

Further details and resources are available from the NHS England website and the NHS Improvement website.

 

CQUIN

Hospitals are working on reducing the impact of serious infections. This includes timely identification and treatment of sepsis and a reduction of clinically inappropriate antibiotic prescription and consumption. Further details are here.