Principles of Treatment

  1. This guidance is based on the best available evidence but use professional judgement and involve patients in management decisions.
  2. It is important to initiate antibiotics as soon as possible in severe infection.
  3. Where an empirical therapy has failed or special circumstances exist, microbiological advice can be obtained from tel 01324 566000
  4. Prescribe an antibiotic only when there is likely to be a clear clinical benefit.
  5. Consider a ‘No’ or ‘Back-up/Delayed’, antibiotic strategy for acute self-limiting upper respiratory tract infections,1A+ and mild UTI symptoms.
  6. Limit prescribing over the telephone to exceptional cases.
  7. Use simple generic antibiotics if possible. Avoid broad spectrum antibiotics (eg. co-amoxiclav, quinolones and cephalosporins) when narrow spectrum antibiotics remain effective, as they increase risk of Clostridium difficile, MRSA and resistant UTIs.
  8. A dose and duration of treatment for adults is usually suggested, but may need modification for age, weight and renal function. In severe or recurrent cases consider a larger dose or longer course.                                       
  9. Child doses are provided when appropriate and can be accessed through the childrens BNF.                                                                               
  10. Please refer to BNF for further dosing and interaction information (e.g. interaction between macrolides and statins) if needed and please check for hypersensitivity.
  11. Lower threshold for antibiotics in immunocompromised or those with multiple morbidities; consider culture and seek advice.
  12. Avoid widespread use of topical antibiotics (especially those agents also available as systemic preparations, e.g. fusidic acid).
  13. In pregnancy take specimens to inform treatment; where possible avoid tetracyclines, aminoglycosides, quinolones, high dose metronidazole (2 g) unless benefit outweighs risks. Short-term use of nitrofurantoin (at term, theoretical risk of neonatal haemolysis) is not expected to cause foetal problems. Trimethoprim is also unlikely to cause problems unless poor dietary folate intake or taking another folate antagonist eg antiepileptic.
  14. This guidance should not be used in isolation; it should be supported with patient information about back-up/delayed antibiotics, infection severity and usual duration, clinical staff education, and audits. Materials are available on the RCGP TARGET website.