Microsoft word - tees community infection guidance oct 2011 _final_.doc

Community Infection Guidance 2011
Aims
• To provide a simple, best guess approach to the treatment of common infections
• To promote the safe, effective and economic use of antibiotics • To minimise the emergence of bacterial resistance in the community

Principles of Treatment
1. This guidance is based on the best available evidence but its application must be modified by clinical judgement
and taking patient specific factors into consideration, e.g. renal / hepatic function, allergies, etc. 2. Prescribe by generic name; all treatments are oral unless otherwise stated.
3. A dose and duration of treatment is suggested. In severe or recurrent cases consider a larger dose or longer
course. Doses are for adults unless otherwise stated 4. Prescribe an antibiotic only when there is likely to be a clear clinical benefit. 5. Do not prescribe an antibiotic for viral sore throat or simple coughs and colds. 6. Limit prescribing over the telephone to exceptional cases. 7. Avoid broad spectrum antibiotics (e.g. co-amoxiclav, quinolones and cephalosporins) when first line antibiotics remain effective, as they increase the risk of Clostridium difficile, MRSA and resistant UTIs. 8. Avoid widespread use of topical antibiotics (especially those agents also available as systemic preparations). 9. In pregnancy, AVOID tetracyclines, aminoglycosides, quinolones and high dose metronidazole. Short-term use of trimethoprim (folate antagonist, theoretical risk in first trimester in patients with poor diet) or nitrofurantoin (at term, theoretical risk of neonatal haemolysis) is unlikely to cause problems to the foetus. 10. The effectiveness of oral and transdermal hormonal contraceptives, and vaginal rings, can be considerably reduced by antibiotics that induce hepatic enzyme activity, i.e. rifampicin and rifabutin – patients should always be advised
to use an additional method of barrier contraception (e.g. IUD) whilst taking the antibiotic and for 4 to 8 weeks
afterwards. Additional contraceptive precautions are not required during or after courses of antibiotics that do not
induce liver enzymes, unless diarrhoea or vomiting occurs (see BNF section 7.3.1 for more guidance).
11. Where a ‘best guess’ therapy has failed or special circumstances exist, specialist advice can be obtained from local consultant microbiologists at JCUH on 01642 282604 or via switchboard/bleep at UHNT/UHH on 01642 617617.
UPPER RESPIRATORY TRACT INFECTIONS
Refer to: NICE Clinical Guideline 69, Respiratory Tract Infections – antibiotic prescribing, July 2008
Sore Throat /
• Majority are viral and do not benefit
When antibiotics are needed:
Pharyngitis /
from antibiotics. Consider non- or
First line:
Tonsillitis
• Consider immediate prescription if 3 or more Centor criteria, systemically unwell If allergic to penicillin:
• Clarithromycin 250-500mg twice daily • Explain normal duration of symptoms – may take 8 days to resolve; antibiotics only shorten by 8 hours. Otitis media
• 80% resolve over 4 days without
When antibiotics are needed:
antibiotics. Consider non- or delayed
First line:
• Amoxicillin <2 yrs: 125mg three times daily • Unilateral pain in children >1 year should 2-10yrs: 250mg three times daily not routinely require antibiotic treatment. If allergic to penicillin:
• Erythromycin <2 yrs: 125mg four times daily • Antibiotics do not reduce pain in first 24 2nd line: co-amoxiclav
if penicillin-allergic: azithromycin for doses • Use regular paracetamol or ibuprofen for Note: Doses are oral and for adults unless otherwise stated. Please refer to BNF/BNF-C/SPC for further information.
Guidance updated October 2011. Next review due October 2012.
Community Infection Guidance 2011
UPPER RESPIRATORY TRACT INFECTIONS (continued)
Otitis externa
• Use regular paracetamol or ibuprofen for If infection present:
Topical treatment (adults & child >2 years):
• Use thorough cleansing +/- topical acetic • Locorten-Vioform ear drops, 2-3 drops twice Systemic treatment:
• Prescribe oral antibiotics if there are signs of systemic infection, or if infection Flucloxacillin 250-500mg four times daily • Consider fungal infection in resistant • Clarithromycin 250-500mg twice daily Rhinosinusitis
• Many episodes are viral. Symptomatic When antibiotics are needed:
benefit of antibiotics is small
First line options:
• Amoxicillin 500mg three times daily, or • Doxycycline 200mg stat then 100mg daily • Reserve antibiotics for severe unilateral / Treatment failure / persistent symptoms:
• Co-amoxiclav 625mg three times daily, or • If failure to respond use another first line • Clarithromycin 500mg twice daily (if penicil in allergic) If allergic to penicillin and pregnant:
LOWER RESPIRATORY TRACT INFECTIONS
• Avoid tetracyclines in pregnancy and children under 12 years of age. • Low doses of penicillins are more likely to select out resistance - use amoxicillin 500mg. • Quinolones (e.g. ciprofloxacin) have poor activity vs. pneumococci; but do have a use in PROVEN pseudomonas infections • Antibiotics are not indicated for
When antibiotics are needed:
Bronchitis
First line options:
• Immediate prescription indicated for >65 years with 2 risk factors or >80 years • Doxycycline 200mg stat then 100mg daily congestive heart failure, oral steroids) General Advice:
irrespective of whether or not antibiotics are given. • Smokers should be encouraged to stop • Antibiotics only needed if:
When antibiotics are needed:
exacerbation
First line options:
• Amoxicillin 500mg three times daily, or Doxycycline 200mg stat then 100mg daily If antibiotics are needed and patient
allergic to penicillin and clinical
Second Line:
failure to doxycycline: use
• Doxycycline 200mg stat then 100mg daily • Co-amoxiclav 625mg three times daily Community
First Line:
Acquired
• Amoxicillin 500mg-1g three times daily Pneumonia
• Otherwise, start antibiotics
If allergic to penicillin:
immediately. If no response in 48 hours
clarithromycin (1st) or a tetracycline to Second line:
• Co-amoxiclav 625mg three times daily, or • Bronchiectasis – antibiotic choice should
• Doxycycline 200mg stat then 100mg daily Note: Doses are oral and for adults unless otherwise stated. Please refer to BNF/BNF-C/SPC for further information.
Guidance updated October 2011. Next review due October 2012.
Community Infection Guidance 2011
MENINGITIS
Suspected
• Transfer all patients to hospital
Meningococcal
immediately
admission unless definite history of penicillin anaphylaxis ( NOT allergy).
intramuscular (IM) if a vein cannot be found. Prevention of
Only prescribe following advice from the Contact telephone number, 9am – 5pm: 0844 2253550
secondary case
Out of hours – contact on-call HPU practitioner via NEAS on: of meningitis
0191 4144844
URINARY TRACT INFECTIONS
• Amoxicillin resistance is common, therefore only use if culture confirms sensitivity. • In the elderly (over 65 years) do not treat asymptomatic bacteriuria - it occurs in 25% of women and 10% of men and is not • In the presence of a catheter, antibiotics will not eradicate bacteriuria; only treat if systemical y unwel or pyelonephritis likely.
• Consider sexually transmitted infections as a cause of cystitis in appropriate patients.
• Community multi-resistant E. coli with ESBLs (extended-spectrum Beta-lactamase enzymes) are increasing so perform
culture in all treatment failures. ESBL-coliforms are multi-resistant but remain sensitive to nitrofurantoin or fosfomycin (unlicensed – seek further advice from microbiologist or Consultant in Infectious Disease). UHNT lab also test and report sensitivity to pivmecillinam Uncomplicated
First line options:
UTI in women
• Nitrofurantoin 50-100mg four times daily Treatment failure (second line): according to
Recurrent UTI
• Post coital prophylaxis is as effective First line options:
UTI in Men
First line options:
• Nitrofurantoin 50-100 mg four times daily Treatment failure (second line): according to
symptoms, especially if the dipstick test is negative for nitrite and positive for leukocyte. First line:
Pregnancy
• Nitrofurantoin 50mg four times daily • Avoid nitrofurantoin near-term, and in If nitrofurantoin not appropriate:
Cystitis /
Under 3 months old: Admit to hospital (as per Newcastle Guidelines 2008)
Lower UTI in
Children
Over 3 months old:
First line:
Alternative:
First line options:
Pyelonephritis/
Upper UTI
• Admit all children to hospital
• Co-amoxiclav 625mg three times daily Note: Doses are oral and for adults unless otherwise stated. Please refer to BNF/BNF-C/SPC for further information.
Guidance updated October 2011. Next review due October 2012.
Community Infection Guidance 2011
GENITAL TRACT INFECTIONS
• Refer patients with risk factors for STIs to Sexual Health Teesside for treatment and contact tracing. Clinics at: North Ormesby Health Village, Middlesbrough 01642 459583 Redcar Primary Care Hospital 01642 511728 • Group B Streptococcus is a common vaginal commensal and does not require treatment except during labour to prevent neonatal • Treat after collection of urine for C&S Prostatitis
• Refer for full GU screen if <35 years Epididymo-
Refer to Clinical Knowledge Summaries for guidance on assessment and management: orchitis
http://www.cks.nhs.uk/scrotal_swellings/background_information/causes/epididymo_orchitis#-404534 Balanitis
• Treat according to age of patient and Candidal balanitis (all ages):
• Clotrimazole 1% cream, apply twice daily, or • Fluconazole 150mg single dose (>16 years only) Gardnerella-associated balanitis (in adults):
Streptococcal balanitis (in adults):
• Amoxicillin 500mg four times daily Bacterial balanitis (in children - see BNF for
• Clarithromycin or erythromycin (if penicillin-allergic) • Clotrimazole 500mg pessary. Insert one pessary Candidiasis
• Topical and oral products are equally Avoid oral antifungal drugs if
pregnant or breastfeeding
If patient pregnant:
• Clotrimazole 100mg pessary insert one pessary Bacterial
• If patient pregnant – seek prompt
First line:
Vaginosis
advice from obstetrician if history
of preterm birth or 2nd trimester
If compliance likely to be a problem:
• If woman not pregnant, only treat if If patient pregnant:
• Clindamycin 2% cream insert one 5g applicator If breast feeding:
• Metronidazole 0.75% gel insert one 5g applicator Chlamydia
First line:
trachomatis
• Advise abstinence until all contacts • Azithromycin 1g single dose, 1 hour before or 2 hours after food. (Sexual abstinence for the Second line:
If patient pregnant:
• Azithromycin as above (unlicensed), or • Erythromycin 500mg four times daily (repeat swabs to check cure, 5 weeks after finishing the course) Note: Doses are oral and for adults unless otherwise stated. Please refer to BNF/BNF-C/SPC for further information.
Guidance updated October 2011. Next review due October 2012.
Community Infection Guidance 2011
GENITAL TRACT INFECTIONS (continued)
Trichomoniasis
First line:
If patient pregnant:
Uncomplicated
Gonorrhoea
• Essential to test for N. gonorrhoea First line:
Inflammatory
If high risk of gonococcal infection:
Genital Herpes
First line:
episode) send viral swab for herpes to laboratory Immunocompromised / HIV patients:
• Consider need for full STI screening • Aciclovir 400mg five (5) times daily of the start of the episode. Extend course if new lesions appear during treatment or healing incomplete • Advise abstinence until lesions have DENTAL INFECTIONS
Dental abscess
If an antibiotic is indicated (in adults):
• Amoxicillin 3g, repeated after 8 hours • Antbiotics are generally not indicated for otherwise healthy individuals or when there are no signs of spreading If penicillin-al ergic:
• Metronidazole 200mg three times daily or if there are signs of severe infection (e.g. fever, lymphadenopathy, cellulitis, diffuse swelling) risk of complications (e.g. people who are immunocompromised or diabetic or have valvular heart disease) prescriptions or switch antibiotics in people who fail to respond to first-line treatment – advise to see a dental practitioner urgently Note: Doses are oral and for adults unless otherwise stated. Please refer to BNF/BNF-C/SPC for further information.
Guidance updated October 2011. Next review due October 2012.
Community Infection Guidance 2011
SKIN & SOFT TISSUE INFECTIONS
Send swabs for culture in al cases if clinically appropriate. Impetigo
• Patients are infectious until lesions First line:
• Flucloxacillin 500mg four times daily If allergic to penicillin:
Adults & children able to take tablets: • Reserve topical antibiotics for very Children & adults requiring liquid formulation: Very localised lesions:
• Fusidic acid topically four times daily Using topical antibiotics or adding them to steroids in eczema management encourages resistance and
does not improve healing. In infected eczema, use antiseptic bath additives (e.g. Dermol-600, Oilatum Plus)
and treat with systemic antibiotics as for impetigo if clinically indicated.
First-line:
Second-line:
• Malathion 0.5% aqueous liquid x 200ml Cellulitis
• If patient afebrile and healthy
First line:
other than cellulitis, flucloxacillin
• Flucloxacillin 500 mg four times daily may be used as single drug
treatment.
• Phenoxymethylpenicllin 500mg four times daily If allergic to penicillin:
• In facial cellulitis use co-amoxiclav 2nd line (poor response to above after 48 hours):
If facial involvement:
• Co-amoxiclav 500/125mg three times daily If cellulitis has been caused by trauma or wound consider referral to specialist service. exposed to salt or fresh (not tap) water –seek
microbiology or ID advice re. appropriate antibiotic Leg Ulcers
Bacteria will always be present. Antibiotics do not improve healing. Culture swabs and antibiotics are only
indicated if there is evidence of clinical infection such as inflammation/redness/cellulitis, increased pain, purulent
exudate, rapid deterioration of ulcer or pyrexia.
Diabetic Leg or
First line:
Foot Ulcer /
immediately (less than 24 hrs) for
• Flucloxacillin 500mg four times daily Wound infection
specialist opinion if ANY signs of
• Metronidazole 400mg three times daily • Take swab for culture and sensitivity If allergic to penicillin:
• Clarithromycin 500mg twice daily (+metronidazole) Animal Bite
First line:
• Co-amoxiclav 375-625mg three times daily • Antibiotic prophylaxis advised for – If allergic to penicillin:
• Metronidazole 400mg three times daily • Doxycycline 200mg stat then 100mg twice daily
alcoholism, immunocompromised, diabetic, elderly, asplenic patients Human Bite
First line:
• Assess HIV / hepatitis B & C risk • Co-amoxiclav 375-625 mg three times daily If allergic to penicillin:
• Metronidazole 400mg three times daily • Clarithromycin 250–500mg twice daily Note: Doses are oral and for adults unless otherwise stated. Please refer to BNF/BNF-C/SPC for further information.
Guidance updated October 2011. Next review due October 2012.
Community Infection Guidance 2011
SKIN & SOFT TISSUE INFECTIONS – continued
Conjunctivitis
When antibiotic treatment is needed:
First line:
• Chloramphenicol 0.5% drops one drop every 2 hours (waking hours) for 2 days then reduce to • Essential eyelid hygiene is priority • Chloramphenicol 1% ointment; put a small amount into the affected eye(s) four times a day Second Line:
• Fusidic acid 1% eye drops one drop into the Blepharitis
• Essential eyelid hygiene is priority First line:
• Chloramphenicol 1% ointment apply once daily N.B. do not use chloramphenicol during third trimester of pregnancy – consult microbiologist for • Artificial tears can provide symptom • If persistent or severe, swab eyelid margin for culture & sensitivities before starting oral treatment Head Lice
• All regular household contacts should Treatment Options:
• Wet Combing:
Thoroughly comb wet, conditioner-covered hair with detection comb for 30 minutes, twice weekly • Insecticides:
Malathion 0.5% aqueous liquid x 50ml. Apply from root to tip, allow to dry naturally and rinse off after 12 hours. Repeat after 7 days (plus wet combing • Dimeticone (suitable for people with asthma)
Dimeticone 4% lotion x 50ml. Apply to dry hair from roots to tips. Leave to dry naturally. Wash off after 8 hours. Repeat after 7 days (plus wet combing as above) Dermatophyte
• For children seek advice
For superficial or early infection:
infection of
• Amorolfine 5% nail lacquer, apply twice a week x fingernail or
6 months for fingernails; 9-12 months for toenails For more severe infection:
• Terbinafine 250mg daily (prescribe generically) x 6 weeks for fingernails, 12 weeks for toenails improve in appearance despite adequate treatment Yeast and NON
• For children seek advice
For superficial or early infection:
dermatophyte
• Amorolfine 5% nail lacquer, apply twice a week infection of
x 6 months for fingernails; 9-12 months for fingernail or
For more severe nail disease:
• Itraconazole 200mg twice daily for 7 days, Note: Doses are oral and for adults unless otherwise stated. Please refer to BNF/BNF-C/SPC for further information.
Guidance updated October 2011. Next review due October 2012.
Community Infection Guidance 2011
SKIN & SOFT TISSUE INFECTIONS – continued
Dermatophyte
Localised lesions:
infection of the
• Miconazole 2% cream applied twice daily 2nd line (adults only):
• Terbinafine 1% cream applied twice daily Multiple / intractable lesions / lesions on palms
or soles:
Pityriasis
• Ketoconazole 2% shampoo applied once daily; versicolor
(endorse prescriptions ‘SLS’) • For resistant or widespread infection, For resistant / widespread infection:
Varicella Zoster
• Seek specialist advice if:
• Aciclovir 800mg five times a day (Chicken Pox)
- pregnant
- immunocompromised
-
- severe infection
Valaciclovir may be considered for severe infection in immunocompromised patients (on specialist advice), but • Antivirals are only of clinical value if is unlicensed for this indication and 10x the cost of Famciclovir – unlicensed for this indication and 33x the cost of aciclovir. Prescribe only on specialist advice. Herpes Zoster
• If pregnant seek specialist advice
• Aciclovir 800mg five times a day (Shingles)
Valaciclovir may be considered for severe infection in immunocompromised patients (on specialist advice), but Famciclovir – 33x the cost of aciclovir. Prescribe only on • Antivirals are only of clinical value if started within 72 hours of onset of rash Mild disease (comedonal):
• Benzoyl peroxide 5-10% gel, applied 1-2 times daily after washing; start with lower strength • Treat with oral antibiotics for at least • Tretinoin 0.01-0.025% gel, applied 1-2 times Mild disease (inflammatory):
• Lymecycline – lower risk of
Moderate inflammatory disease):
pregnancy,
breastfeeding
and <12yrs
AVOID MINOCYCLINE – can cause liver damage
If tetracyclines contra-indicated:
Note: Doses are oral and for adults unless otherwise stated. Please refer to BNF/BNF-C/SPC for further information.
Guidance updated October 2011. Next review due October 2012.
Community Infection Guidance 2011
MRSA ERADICATION
• Use all antibiotics cautiously in patients with a history of MRSA infection or colonisation as they are at high risk of
recurrence. If systemic antibiotic therapy is required then use antibiotics which cover MRSA – seeks specialist advice.
• Not all isolates of MRSA indicate that there is an infection. Colonisation with MRSA is not an indication to use antibiotics.
• For further information please refer to the practice MRSA policy and seek specialist advice if necessary
Not all patients wil require eradication treatment. Refer When eradication is needed:
to MRSA Risk assessment tool for guidance • Mupirocin nasal ointment 2%, apply to both For patients undergoing eradication encourage daily change of flannel, towel and personal clothing and, if • Octenisan body wash once daily. (If excessive Rescreen 2 days after completion of eradication
skin drying occurs consider Oilatum Plus as an treatment. A patient cannot be regarded as MRSA-
negative until they have had three negative swabs taken at weekly intervals following eradication treatment. Such patients may still carry MRSA and • Hair wash with Octenisan twice in five-day MRSA should still be considered as the potential cause GASTRO-INTESTINAL TRACT INFECTIONS
Detection and
• Testing for H.pylori should not be First Line – Triple Therapy:
Eradication of H.
pylori
• One week triple treatment eradicates Treatment Failure – Triple Therapy
• No need to continue PPI beyond
If allergic to penicillin:
• Avoid clarithromycin or metronidazole increases risk of C.difficile infection – consider if severe or prolonged diarrhoea fol owing treatment. Gastroenteritis
Treatment should be considered on advice of microbiologist in severe or invasive infections (severe systemic upset and/or dysentery). Antibiotic therapy not usually
indicated.
• Do not use anti-motility drugs if stools Salmonella
Seek advice from microbiology / infectious diseases infection
(suspected)
prosthesis, bone metastases, haemoglobinopathy, chronic IBD Shigella
Seek advice from microbiology / infectious diseases infection
(confirmed)
Campylobacter
• Frequently self-limiting – treat if infection
(confirmed)
Traveller’s
• Consider private prescription (ciprofloxacin 500mg twice daily x 3 days) to be carried by people travelling to
diarrhoea
remote areas or in whom an episode of diarrhoea could be dangerous – to be taken if il ness develops • Empirical antibiotic treatment is unnecessary in most people. Seek advice from microbiology / infectious Note: Doses are oral and for adults unless otherwise stated. Please refer to BNF/BNF-C/SPC for further information.
Guidance updated October 2011. Next review due October 2012.
Community Infection Guidance 2011
GASTRO-INTESTINAL TRACT INFECTIONS - continued
Clostridium
First-line:
difficile
• Metronidazole 400mg three times daily • Do not prescribe anti-motility drugs Relapse:
• Repeat Metronidazole 400mg three times daily Seek Microbiology advice if patient Severe / Relapse (usually in hospital):
not responding to treatment
• Oral Vancomycin 125mg four times daily • Admit to hospital if severe: temp.
>38C, WCC >15, rising creatinine or signs/symptoms of severe colitis Threadworms
Adult and Child > 6 months:
(A second dose may be needed after 2 weeks) Child 3 months – 6 months:
• Piperazine + senna oral powder (Pripsen®), one level 2.5ml spoonful of dry powder mixed with milk or water to be given in the morning PROPHYLAXIS IN ASPLENIA / SPLENIC DYSFUNCTION
Refer to BCSH
• Ensure patient is fully vaccinated – Prevention of pneumococcal infection:
Guidelines for
full information
about the
Adult & child over 12 years: 500mg twice daily management of
Child 6 - 12 years: 250mg twice daily asplenia
Child 1 month – 6 years: 125mg twice daily patients
If allergic to penicillin:
Adult & child over 12 years: 250-500mg daily Child 2 – 12 years: 250mg daily Child 1 month – 2 years: 125mg daily unwel . Patients developing infection must be given systemic antibiotics and admitted urgently to hospital. potential risks of overseas travel, particularly with regards malaria and unusual infections, e.g. those resulting from animal bites. reliable – benefits are greatest in under-18s Note: Doses are oral and for adults unless otherwise stated. Please refer to BNF/BNF-C/SPC for further information.
Guidance updated October 2011. Next review due October 2012.
Community Infection Guidance 2011
QUICK REFERENCE GUIDE TO THE MOST COMMON INFECTIONS
Otitis media
• 80% resolve over 4 days without
When antibiotics are needed:
antibiotics. Consider non- or delayed
First line:
• Amoxicillin <2 yrs: 125mg three times daily • Unilateral pain in children >1 yr should If allergic to penicillin:
• Erythromycin <2 yrs: 125mg four times daily • Antibiotics do not reduce pain in first 24 2nd line options – co-amoxiclav, azithromycin (if
hours, subsequent attacks or deafness. penicillin-allergic) • Use regular paracetamol or ibuprofen • Antibiotics are not indicated for
When antibiotics are needed:
Bronchitis
First line options:
irrespective of whether or not antibiotics • Doxycycline 200mg stat then 100mg daily • Antibiotics only needed if:
When antibiotics are needed:
exacerbation
First line options:
• Amoxicillin 500mg three times daily, or • If antibiotics are needed and patient
• Doxycycline 200mg stat then 100mg daily allergic to penicillin and clinical
failure to doxycycline: use
Second Line:
• Doxycycline 200mg stat then 100mg daily • Co-amoxiclav 625mg three times daily First line options:
Uncomplicated
morning urine increase likelihood of UTI UTI in women
Avoid nitrofurantoin in CKD stage 3/4/5 • Nitrofurantoin 50-100mg four times daily (eGFR <60ml/min/1.73m2), as ineffective 2nd line treatments according to C&S Impetigo
• Patients are infectious until lesions have First line:
• Flucloxacillin 500mg four times daily If allergic to penicillin:
Reserve topical antibiotics (fusidic acid) Adults & children able to take tablets: only – have a low threshold for systemic treatment Children & adults requiring liquid formulation: • Reserve mupirocin for nasal eradication Cellulitis
• If patient afebrile and healthy other
First line:
than cellulitis, flucloxacillin may be
• Flucloxacillin 500mg four times daily used as single drug treatment.
• If febrile, il or rapidly worsening infection • Phenoxymethylpenicllin 500mg four times daily If allergic to penicillin:
• In facial cellulitis use co-amoxiclav completely resolved after the initial 7 day 2nd line (poor response to above after 48 hours):
If facial involvement:
• Co-amoxiclav 500/125mg three times daily consider referral to specialist service. • Stop clindamycin if diarrhoea occurs If caused by trauma or wound exposed to water –seek specialist advice Bacterial
• Treat pregnant women with
First line:
Vaginosis
asymptomatic bacterial vaginosis.
If compliance likely to be a problem:
for women with history of preterm birth or • Metronidazole 2g single dose (not if pregnant) If patient pregnant:
• Advise cautious insertion of applicator in • Clindamycin 2% cream insert one 5g applicator • If woman not pregnant, only treat if If breast feeding:
• Metronidazole 0.75% gel insert one 5g • Oral metronidazole gives breast milk a applicator full into the vagina at night bitter taste & may stop the baby feeding. Note: Doses are oral and for adults unless otherwise stated. Please refer to BNF/BNF-C/SPC for further information.
Guidance updated October 2011. Next review due October 2012.
Community Infection Guidance 2011

Information Collated from:
• Health Protection Agency Management of Infection Guidance for Primary Care, July 2010 (amended
• Clinical Knowledge Summaries, accessed October 2011, http://www.cks.nhs.uk • South Tees Hospitals Foundation Trust. Antimicrobial drugs: a guide to the treatment of common • NICE Guidance – Management of dyspepsia in adults in primary care; August 2004 • NICE Clinical Guidelines, UTI in Children, August 2007 • NICE Clinical Guidelines, Respiratory Tract Infections, August 2008 • The National Teratology Information Service – Metronidazole in Pregnancy • British Committee on Standards in Haematology, Guidance for the prevention and treatment of infection in patients with an absent or dysfunctional spleen, 2002 • DECENT Guidelines – Antibiotic treatment of foot complications in people with diabetes, 2010 • Newcastle Childhood UTI Guidelines, 2008 • British Association for Sexual Health & HIV (BASHH). UK National Guideline for the Management of • Royal College of Obstetrics & Gynaecology, Faculty of Sexual & Reproductive Healthcare. Clinical Guidance: Drug Interactions with Hormonal Contraceptives. January 2011

With thanks to the following contributors:

Dr. Joy Baruah, Consultant Microbiologist, North Tees & Hartlepool Foundation Trust
Dr. Deborah Beere, Lead Consultant in Contraception & Sexual Health, Sexual Health Teesside
Dr. Richard Bellamy, Consultant in Infectious Disease, South Tees Hospitals Foundation Trust
Dr. Jonathan Berry, GP, Stockton-on-Tees
Dr. John Hovenden, Consultant Microbiologist, South Tees Hospitals Foundation Trust
Dr. Janice Kibirige, Medical Director, Sexual Health Teesside
Debbie Lockwood, Antibiotic Pharmacist, South Tees Hospitals Foundation Trust
Dr. Sarup Tayal, Consultant in Genito-Urinary Medicine, Sexual Health Teesside
Guidance developed by:
Richard Morris, Prescribing Adviser, NHS Tees
Approved by:
Tees Medicines Management Committee, November 2011
Note: Doses are oral and for adults unless otherwise stated. Please refer to BNF/BNF-C/SPC for further information.
Guidance updated October 2011. Next review due October 2012.

Source: http://www.hartlepool.nhs.uk/includes/documents/Tees%20Community%20Infection%20Guidance%20Oct%202011%20_final.pdf