Primary Care Antimicrobial Guidelines
On 16 January 2019 the South West Yorkshire Area Prescribing Committee approved local use of the new NICE/PHE managing common infections guidance.
This supersedes our local primary care guideline. As NICE/PHE have not completed all sections yet, we will continue to use local guidelines for those sections.
These guidelines should be used in conjunction with professional judgement and involving patients in management decisions.
NICE/PHE – introduction to guidelines and further information on illnesses such as upper and lower respiratory conditions, UTIs, prostatitis, pyelonephritis. Within the summary tables some minor text has been added for clarifications in the Chlamydia, Conjunctivitis and Bites sections. NICE have included a summary for the Bronchiectasis guidance and have included an alternative dosing option for Nitrofurantoin.
NICE/PHE table – managing common infections (whole guideline)
NICE surgical site infections: prevention and treatment (NG125)
Urinary tract infection: diagnostic tools for primary care – This quick reference tool for primary care describes when to send for urine cultures and when to consider a UTI in adults >65 years, women < 65 years and in children. The flowchart for adults > 65 has been updated to reflect NICE guidance on managing catheter-associated UTIs.
Microbiological advice can be obtained from the duty Microbiologist via switchboard
Calderdale and Huddersfield NHS Foundation Trust
Calderdale Royal Hospital: 01422 357171 or Huddersfield Royal Infirmary: 01484 342000
Mid Yorkshire Hospitals NHS Trust: 0844 8118110
Bradford Teaching Hospitals NHS Foundation Trust: 01274 542200
Airedale NHS Foundation Trust: 01535 652511
Outpatient parenteral antimicrobial therapy (OPAT)
OPAT is a method for delivering intravenous antimicrobials in the community or outpatient setting as an alternative to inpatient care. It is useful for patients who require parenteral therapy for moderate to severe infections but are otherwise well enough to be at home. The benefits of OPAT include admission avoidance and reduced length of stay in hospital. This means there is an increase in inpatient capacity, significant cost savings compared with inpatient care, reduction in the risk of healthcare-associated infection and improved patient choice.
Contact your local acute Trust for further information.
Antimicrobial allergy e.g. penicillin
- Obtain an accurate allergy status from the patient. If they say they are allergic, ask them what happened to them when they took penicillin?
- Ensure that all patients’ allergies and adverse side effects are documented fully.
- Always check the allergy status of the patient before prescribing, dispensing or administering a medicine.
- Be alert to the fact that the name of a medicine itself may not indicate 100% of the time that the medicine is a penicillin or related to a penicillin.
Patients with a history of anaphylaxis, urticaria or rash immediately after penicillin administration are at risk of immediate hypersensitivity to penicillins. These individuals should not normally receive a penicillin, a cephalosporin, carbapenem (e.g. imipenem, meropenem, ertapenem), or another β-lactam antibiotic.
Signs and symptoms of immediate hypersensitivity include dyspnoea, swelling, rash and urticaria.
Individuals with a history of a minor rash (i.e. non-confluent restricted to a small area of the body), or a rash that occurs more than 72 hours after penicillin administration have a mild allergy and can be prescribed other β-lactam antibiotics like cephalosporins.
Drug intolerance (e.g. gastrointestinal symptoms, feeling faint) is not an indication to avoid β-lactam antibiotics.
Use of antibiotics in pregnancy
Refer to the BNF and UK Teratology Information Service http://www.uktis.org or phone 0344 8920909.
The Faculty of General Dental Practice (FGDP(UK)) and British Dental Association have published an updated version of their antimicrobial prescribing self-audit tool for dentists.
The move coincides with the launch of the government’s five-year action plan and 20-year vision for antimicrobial resistance. The tool is intended to help the dental profession play its part by further reducing inappropriate antibiotic prescribing.
Tools to support the system to consistently manage and remove urinary catheters.
The urinary catheter tools have been developed collaboratively with national experts to support providers in delivering consistent evidence based catheter care. The use of the tools needs to be supported by strong leadership and education.
Leaflets and forms
A range of leaflets for patients are 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.
The leaflet is available in different languages from the TARGET website.
FOR CARE HOME STAFF: Form (currently under review) to be completed and send to GP if an older resident has a suspected urinary tract infection:
For hospital patients and visitors
Public Health England has produced a patient information leaflet about an uncommon fungus called Candida auris.