Southwark & Lambeth antibiotic guideline for primary care 2019 guidelines: key points

URTI

• Acute Sore throat: phenoxymethylpenicillin (clarithromycin if penicillin allergy). Pregnant/BF: phenoxymethylpenicillin (erythromycin if allergic)

• Scarlet fever: as above

• Acute rhino-sinusitis: phenoxymethylpenicillin (doxy or clarithro if allergic). Pregnant/BF: phenoxymethylpenicillin (erythromycin if allergic). Co-amoxiclav if systemically unwell or high risk of complications. Mometasone nasal spray.

• Acute otitis media (AOM): Amoxicillin (clarithromycin if allergic). Pregnant/BF: Amoxicillin (erythromycin if allergic). Co-amoxiclav if symptoms worsen on first choice antibiotic

• Acute otitis externa (OE): Topical acetic acid 2% spray (available OTC as EarCalm®) OR neomycin sulphate with corticosteroid ear drops. If cellulitis: flucloxacillin (oral). symptoms >2 weeks, in particular DM, refer to exclude malignant OE caused by Pseudomonas aeruginosa & not responding to fluclox

LRTI

• Community-acquired pneumonia (CAP) - treatment in the community: CRB65=0: Amoxicillin (doxy or clarithro if allergic). CRB65=1 or 2: Amoxicillin AND clarithro OR doxy alone. Pregnant/BF: CRB65=0: Amoxicillin (erythro if allergic). CRB65≥1: admit

• Acute cough/bronchitis: Doxy, amoxicillin second-line (doxy OR clarithro if penicillin allergy). Pregnant/BF: CRB65=0: Amoxicillin (erythro in allergic)

• Exacerbation of COPD: Pred 30mg for 5/7 PLUS: Doxy or Co-amox if at risk of resistance (doxy or clarithro if penicillin allergic). Pregnant/BF: Amoxicillin (erythro if allergic)

UTI

• See: kidney disease/urology

Skin infections

• Impetigo OR eczema + visible signs of infection: see dermatology

• Cellulitis/erysipelas: see dermatology

• Mastitis: see SRH

• Acne: see dermatology

• Human or animal bites: see A&E

• Varicella zoster/chickenpox/shingles: see viral infections

• Tick bites (lyme disease): see dermatology

GI infections

• see Gastro

Meningitis

• Suspected meningococcal disease: benzylpenicillin IV (IM if cannot get access) ≥10Y 1.2g, 1-9Y: 600mg, <1Y 300mg unless history of true anaphylaxis

Eye conditions

• see ophthalmology

Dental infections

• send to dentist

Southwark & Lambeth STI guideline for primary care 2019 guidelines: key points

• See SRH

Antibiotic resources

• Primary Care Antibiotic Guideline 2019 (Lambeth & Southwark CCG, London), Antibiotics (NHS Choices)

• Antibiotic treatments in adults (MIMS)

• TARGET (Treat Antibiotics Responsibly, Guidance, Education, Tools) toolkit (RCGP)

• Managing common infections: guidance for primary care (gov.uk)​

Antivirals

• Antiviral drugs (BNF)

Antifungals

• Antifungal preparations (BNF)

• Antifungal medicines (NHS Choices)

Antiprotozoal drugs / Anthelmintics

• Antiprotozoal drugs (BNF)

• Antihelmintics (BNF)

Lice & Scabies treatments​

• Lice & Scabies treatments (MIMS)

Vaccines

• Tetanus