Whats New on Antibiotic Prescribing

Recently updated content on the website

whatsnewNEW: Position statements for ‘The use of dipstick urinalysis to assess for evidence of urinary tract infection in adults’. September 2021:

  • Consensus best-practice statements for the use of dipstick urinalysis endorsed by the National Antimicrobial Advisory Group.
  • Inappropriate use of dipstick urinalysis can lead to unnecessary antibiotic prescribing which does not benefit the patient and may cause considerable harm.
  • Best-practice statements include the use of dipstick urinalysis to assess for evidence of UTI in several patient cohorts  such as:
    • Females (non-pregnant) <65yrs
    • Males <65yrs
    • Pregnant females
    • All persons >65yrs
    • All persons with a urinary catheter
    • Asymptomatic persons

Treatment of urinary tract infections in adults reviewed and updated, September 2021:

Guidelines on genital conditions updated July 2021, of particular note:

  • Chlamydia: Additional information on rectal infection with invasive chlamydia types (Lymphogranuloma (LGV) types), test of cure and window period
  • Anogenital warts: Updated HPV vaccine recommendations and drug treatment option
  • Genital Herpes: Patient resources updated
  • Candida: Update on use of high vaginal swab and treatment options
  • Gonorrhea: Referral criteria to GUM clinic; window period; treatment options and resistance information
  • Trichomoniasis: Updates on referral criteria; window period, test of cure information; drug counselling points
  • Bacterial Vaginosis: Update on use of high vaginal swab and drug counselling points
  • PID: Referral criteria to GUM clinic, including Mycoplasma genitalium guidance

Approach to an STI consultation in Primary Care, July 2021

  • Incudes quick reference guides for asymptomatic screening in primary care
  • Additional information on sexual history and STI testing
  • Window period explained, lookback periods/partner notification information listed for the different STIs
  • Also includes information on non-specific urethritis, HIV pre-exposure prophylaxis and genital care resources available for patients
  • Links to further resources for healthcare professionals and patients

Conjunctivitis: May 2021

  • The use of Chloromycetin® Eye Drops contraindicated in children under 2 years (due to presence of excipient Boron).
  • Printable content added regarding self-care advise for the patient presenting with sticky eye/conjunctivitis.
  • Content added regarding when to swab, refer or seek specialist input.
  • Oral Infections (previously Dental infections) March 2021
    • Treatment of oral and dental infections revised and updated.
    • Acute Dento-Alveolar Abscess:
      • If antibiotics are indicated, phenoxymethylpenicillin now preferred option instead of amoxicillin (unless adherence likely to be challenging)
    • Angular Cheilitis:
      • Additional guidance provided regarding eradication of bacterial or fungal reservoir.
      • Terbinafine 1% provided as option for patients on warfarin where use of miconazole should be avoided.
    • Fungal Infections:
      • Additional guidance provided regarding management of breast-feeding mother for an infant with oral candida infection.
      • Use of oral fluconazole should be reserved for severe cases or those who are non-responsive to first-line therapies.
      • All patients who require fluconazole should be seen by their GP for investigation into possible underlying causes.
    • Gastro Conditions March 2021
      • Clostridium difficile
        • Name change: Clostridium difficile → Clostridioides difficile. Criteria for assessing non-severe versus severe C. Diff added.
      • Threadworms
        • Removal of piperazine as a  treatment option – no longer available in Ireland
        • Additional information re. 2nd dose of mebendazole administered after 2-4 weeks
        • Mebendazole is unlicensed in < 2year olds but some evidence to support use at >6months age.
      • Travelers' Diarrhoea
        • Change from Ciprofloxacin to Azithromycin as recommended antibiotic if treatment is required.
        • Additional clinical information and links have been added.
    • Respiratory tract infections February 2021
      • For pregnancy, if macrolide considered necessary, azithromycin added as an option for all trimesters.
    • Pregnancy and Postpartum infections February 2021
      • Additional Patient information resources added to all sections
      • Additional Healthcare Professional information resources added to Prescribing Antimicrobials in Pregnancy and Lactation page
    • Asymptomatic Bacteriuria in Pregnancy new content! February 2021
      • Advice on when and how to test for and treat asymptomatic bacteriuria in pregnancy
      • Urine culture remains the gold standard for detection of asymptomatic bacteriuria
      • Dipstick testing is not sufficient to screen for bacterial UTIs in pregnancy.
      • Drug treatment based on the bacteria isolated in urine culture and trimester of pregnancy
    • Nipple and breast thrush: February 2021
      • The use of all-purpose nipple ointment is not recommended as treatment option.
      • Additional information points on use of miconazole for mother and baby.
    • Helicobacter pylori: December 2020
      • H. Pylori duration of treatment for all treatment regimens has been increased from 7 days to 14 days in line with published national guidelines.
      • A Bismuth quadruple regimen, if available, has been added as a 1st line treatment option. A levofloxacin regimen has also been added but should be reserved as a 2nd line option for failed treatment eradication.
    • Pharyngitis/ sore throat / tonsillitis: December 2020
      •  Cefalexin is an option for non-severe penicillin allergy, if antibiotic deemed necessary.
      •  Majority are viral however if antibiotics deemed necessary, recommended duration now 5 days (instead of 10 days)
    • Lyme Disease, Nov 2020
      • Criteria for post-exposure prophylaxis updated
    • Seasonal Influenza, Nov 2020
      • Seasonal Influenza page updated for 2020/2021 season. 
      • Duration of treatment for oseltamivir in immunocompromised patients changed to 10 days. 
      • Links to Coronavirus COVID-19 information added.  
    • COVID-19 acute respiratory infection, Nov 2020
      • Link to HSE COVID-19 repository added
      • Updated re advice on penicillin allergy in pregnancy.
    • Upper Respiratory Tract Infections, Nov 2020
      • Pharyngitis: Majority are viral however if antibiotics deemed necessary, recommended duration now 5 days (instead of 10 days)
      • Sinusitis (adults): Majority are viral however if antibiotics deemed necessary, doxycycline (first line if penicillin allergy) can be dosed at 200mg daily.
    • Lower Respiratory Tract Infections Nov 2020
      • Doxycycline (often first line if penicillin allergy) can be dosed at 200mg daily across the range of lower respiratory tract infections.
      • Duration of recommended therapy for community-acquired pneumonia reduced; 5 days for CRB-65 score 0 (instead of 5-7days), 7 days for CRB-65 score 1-2 (instead of 7-10 days)
      • Recommend higher dose amoxicillin (1g tds as opposed to 500mg tds) for community-acquired pneumonia CRB-65 score 1-2
    • New content to support deprescribing UTI prophylaxis, Nov 2020
      • All UTI prophylaxis should be reviewed at 3-6mths with a view to stopping as many patients can stop without a return of symptoms.
      • There is no evidence of additional benefit beyond 3-6 months but there is significant evidence of harm.
    • About Us, Nov 2020
      • Contact details for community antimicrobial pharmacists added.
      • List of contributors updated
    • Renal Impairment Summary Sept 2020
      • Medicines list expanded to include anti-fungals and anti-helmintics
      • Advice on Fosfomycin updated (avoid if CrCl <10ml/min)
      • Advice on Nitrofurantoin updated (contraindicated if CrCl <30ml/min, caution in use if CrCl 30-45ml/min)
    • Animal and Human Bites Sept 2020 
      • Content of both pages merged
      • Expanded advice on general management and antibiotic prophylaxis
      • Duration of prophylaxis 5 days, duration of treatment 7 days
    • COVID-19 acute respiratory infection May 2020
      • COVID-19 is a viral infection.
        Antivirals or agents with antiviral properties for COVID-19 should not be prescribed for treatment or prophylaxis in the community, unless as part of a clinical trial.
        Secondary bacterial infection appears uncommon in COVID-19 patients.
    • Key messages from AMRIC to community prescribers March 2020
      • Tips on safe us of clarithromycin, and important safety concerns for fluoroquinolones especially moxifloxacin are just some of the items covered
    • Recurrent UTI in Adult, Non-Pregnant Females March 2020
      • This guideline refers to symptomatic culture-proven recurrent urinary tract infection (UTI)
        It covers non-antimicrobial measures, antibiotic prophylaxis. It is important to remember that recurrent or persistent lower urinary tract symptoms are not always due to recurrent UTI. Other conditions such as STI, postmenopausal atrophic vaginitis and dermatological conditions often cause similar symptoms.
        Antimicrobial prophylaxis should be reviewed after 3-6 months with a view to stopping