Antibiotic guide

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Highlights from 2017 BPAC antibiotic guide 

Shorter courses of antibiotics, more intensive dosing regimens and reserving broader spectrum antibiotics for specific scenarios.1

  • Sinusitis: Most cases are not bacterial - consider inhaled nasal steroid.2 Consider antibiotics when symptoms that persist for more than ten days, severe symptoms or fever (>39 °C) and purulent nasal discharge or facial pain lasting for at least three consecutive days, or onset of worsening symptoms after initial improvement. Amoxil first line. 
  • Impetigo: antiseptics first line (hydrogen peroxide 1% cream or povidone-iodine 10% ointment for 5 days. Topical antibiotics are strongly discouraged. Oral antibiotics second line or for widespread infection. 
  • A dispersible tablet of Roxithromycin for children is funded.
  • Cellulitis now shorter at 5 days with flucloxacillin 500 mg QID. 
  • Amoxicillin clavulanate first line for diabetic foot infections and human/animal bite if infected.
  • Diverticulitis: mild cases don’t need antibiotics; if needed then trimethoprim + sulfamethoxazole 960 mg, twice daily, with metronidazole, 400 mg, three times daily, for five days.

References:

  1. Antibiotics: choices for common infections. BPAC (2017) Click here
  2. EPOS Primary Care Guidelines: European Position Paper on the Primary Care Diagnosis and Management of Rhinosinusitis and Nasal Polyps 2007. p 87.  Click here

    Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.

       
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    As published in NZ Doctor 23/05/2018