Antimicrobial Therapy General Notes
Principles of Treatment
- Prescribe an antibiotic only when there is likely to be a clear clinical benefit.
- It is important to use the correct dose and appropriate course length.
- Do not prescribe an antibiotic for viral infections.
- Use simple generic antibiotics if possible. Avoid broad spectrum antibiotics (e.g. co-amoxiclav, quinolones and cephalosporins) when narrow spectrum antibiotics remain effective, as they increase risk of Clostridium difficile, MRSA and resistant UTIs.
- Where a 'best guess' therapy has failed or special circumstances exist, microbiological advice can be obtained from the on call microbiologist via ARI switchboard (0845 456 6000).
For patients with a history of infection with meticillin-resistant staphylococcus aureus (MRSA) or extended spectrum beta-lactamases (ESBLs) specialist advice about choice of antibiotics should be sought from medical microbiology.
Dosing and Duration
Recommended adult doses and durations of treatment have been included but often this will depend upon clinical judgement in the individual case. Most infections will normally respond to a three to ten day course. Doses in the policy are for adults only unless otherwise stated, and assume normal renal and hepatic function.
Clostridium difficile and high risk antibiotic agents
The '4C' antibiotics (clindamycin, ciprofloxacin and other quinolones, co-amoxiclav and the cephalosporins, especially third generation) are associated with a higher risk of Clostridium difficile infection. The use of these agents has been restricted to try and reduce the rate of this infection by 50% in line with the Scottish Government HEAT target. These agents are therefore not recommended as first-line treatments for common primary care infections. There may be situations where these are the most appropriate antibiotics to give, and should only be prescribed after careful consideration of the risks and clinical benefit of prescribing. Specific consideration should be made to using these agents in patients over the age of 65 years who are particularly at risk of the development of this infection.
Further Reference Sources
Prescribers should refer to the BNF ( www.bnf.org.uk), BNF for children ( http://bnfc.org/bnfc/) or the manufacturers' summary of product characteristics ( www.medicines.org.uk) for further information.