WELCOME to the Doncaster and Bassetlaw antimicrobial guidelines for primary care.

Principles of Treatment

  • To provide a simple, empiric approach to the treatment of common infections in primary care
  • To promote the safe, effective and economic use of antibiotics
  •  To minimise the emergence of bacterial resistance and reduce the risk of antibiotic associated  infections  in the community

  Please note - unless stated all guideline doses are for adults. Please refer to BNFC for children's doses.

Principles of Treatment

1. This guidance is based on the best available evidence but its application must be modified by professional judgement

2. Always consult the latest BNF or Summary of Product Characteristics for full prescribing details

3. Prescribe an antibiotic only when there is likely to be a clear clinical benefit – see link to top ten tips below

4. All antibiotics can cause Clostridium difficile infection. Those associated with the highest risk (especially in elderly patients) are cephalosporins, quinolones, clindamycin and possibly co-amoxiclav. Use of these antibiotics should be restricted to the specific indications within the guidelines.

5. Limit prescribing over the telephone to exceptional cases based on individual clinical judgement

6. The use of deferred scripts for indications of doubtful value (e.g. otitis media) is one method of managing patient expectation. Retaining the prescription in the surgery for future collection is the recommended method.

7. Educating patients about the benefits and disadvantages of antimicrobial agents is advocated. Practices can provide leaflets and/or display notices advising patients not to expect a prescription for an antibiotic, together with the reasons why. This educational material can be obtained from various sources, such as the British Medical Association (BMA), Department of Health, Infection Control Team and Medicines Management Team.

8. For uncomplicated cystitis in otherwise fit non-pregnant women limit course to 3 days

9. Topical antibiotics should be used very rarely, if at all (eye infections are an exception). For wounds, topical antiseptics are generally more effective. Topical antibiotics encourage resistance and may lead to hypersensitivity. If antibiotic use is essential, try and select an antibiotic that is not used systemically.

10. In children under 12 years avoid the use of tetracyclines.

11. In children under 18 years avoid the use of quinolones if possible. Treatment should be initiated only after a careful benefit/risk evaluation, due to possible adverse events related to joints and/or surrounding tissue. See BNF for Children for further details

12. Co-amoxiclav should be reserved for bacterial infections likely, or known, to be caused by amoxicillin-resistant beta lactamase-producing strains, in view of the increased side effects (jaundice). (The Committee on Safety of Medicines: Current Problems, May 1997).

13. Where a ‘best guess’ therapy has failed or special circumstances exist, seek advice from a relevant specialist/medical microbiologist.

Top ten tips on effective antibiotic prescribing: click link or refer to the Royal College of Physicians website www.rcplondon.ac.uk

Use the QR code to bookmark the antimicrobial site onto your smartphone. To do this you will require a free to download QR/barcode reader and then simply point your phone over the QR and this will identify the URL (www site) and simply bookmark for future reference. 

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