Guidance

Managing common infections: guidance for primary care

Guidance for managing common infections, including upper respiratory, lower respiratory and urinary tract infections, for consultation and local adaptation.

Documents

Managing common infections: guidance for consultation and adaptation

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Summary tables: infections in primary care

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Managing common infections: guidance for consultation and adaptation

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Detail

This guidance is to help GPs and heathcare staff treat infections, and use antibiotics responsibly.

Updated guidance following minor review in early 2016.

Updates include:

  • Acute sore throat: removal of Centor criteria and replacement with FeverPAIN score.
  • Acute otitis externa: minor word change (refer to exclude malignant OE).
  • Acute cough/bronchitis: minor word change (consider CRP test if antibiotic being considered).
  • UTI in adults: change of pivmecillinam dose for acute uncomplicated UTI to 200mg TDS, or 400mg TDS if resistance risk.
  • Oral candidiasis: wording clarified, and dose of oral fluconazole corrected to 50mg OD, or 100mg OD if HIV or immunosuppression.
  • Eradication of Helicobacter pylori: as De-Noltab may no longer be available in the UK, Bismuth Subsalicylate (Pepto-Bismol) at a dose of 525mg QDS in penicillin allergic patients with previous clarithromycin has been added.
  • Epididymitis: epididymitis has been separate from Chlamydia trachomatis or urethritis in both summary table and references.
  • Gonorrhoea: section on gonorrhoea has been added, with associated references and rationale, due to increasing risk of antimicrobial resistance and recommendations from experts in the field.
  • Pelvic inflammatory disease: wording clarified (resistance to quinolones is high), and drug or dosing changes (metronidazole PLUS ofloxacin or doxycycline. If high risk of gonorrhoea ADD ceftriaxone).
  • MRSA: section removed in both summary table and references. Rationale for this is that MRSA is now decreasing, and GPs usually contact a microbiologist for advice and should not be prescribing empirically. Sentence added next to ‘Skin Infections@ title with a link to the PHE MRSA Quick Reference Guide.
  • Cellulitis: wording modified to be in line with national guidance. Cellulitis treatment now based on severity: Class I, Class II, Class III illness, and if on statins: doxycycline 200mg stat then 100mg OD.
  • Dental abscess: wording changed (if severe: refer to hospital; spreading infection or allergy: metronidazole; all up to 5 days, review at 3 days). Information added under rationale regarding reason for using higher dose of metronidazole. References added under metronidazole rationale for using higher dose (Lewis et al, 2000; Cudmore et al, 2004; eMC Medicine, 2014; Pahkla et al, 2005; Lamp et al, 1999; Wexler. 2015; Poulet et al, 2005). Changes were made due to differences between PHE 400mg TDS dosage and BNF 200mg TDS dosage of metronidazole. Dental abscess rationale has been modified to clarify 3 days treatment and review.

All changes are accompanied by appropriate changes to references and rationale.