Guidance for managing common infections, including upper respiratory, lower respiratory and urinary tract infections, for consultation and local adaptation.
This guidance is to help GPs and heathcare staff treat infections, and use antibiotics responsibly.
Updated guidance following minor review in early 2016.
- 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.