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22. Diarrhoea - antibiotic associated: Metronidazole

Diarrhoea - antibiotic associated: Metronidazole Metronidazole | Prescribing information | Diarrhoea - antibiotic associated | CKS | NICE Search CKS… Menu Metronidazole Diarrhoea - antibiotic associated: Metronidazole Last revised in March 2019 Metronidazole What are the cautions and contraindications with metronidazole? Do not prescribe metronidazole in people with: Known metronidazole or nitroimidazole hypersensitivity. Prescribe metronidazole with caution in people with: Cockayne syndrome

2019 NICE Clinical Knowledge Summaries

23. Acne vulgaris: Topical antibiotics

Acne vulgaris: Topical antibiotics Topical antibiotics | Prescribing information | Acne vulgaris | CKS | NICE Search CKS… Menu Topical antibiotics Acne vulgaris: Topical antibiotics Last revised in December 2019 Topical antibiotics Topical antibiotics Prescribing issues Topical antibiotics licenced in the UK for treatment of acne vulgaris include clindamycin and erythromycin. Application is usually once or twice a day and varies between agents — for information on specific products see (...) the (BNF) and the . Topical monotherapy with antibiotics is not recommended because of the risk of antibiotic resistance. Topical antibiotics should be prescribed in combination with benzoyl peroxide. Cautions and contraindications Hypersensitivity to the active ingredient or any of the excipients. History of inflammatory bowel disease or a history of antibiotic-associated colitis. If diarrhoea occurs, the product should be discontinued immediately. Caution is advised when prescribing to people

2019 NICE Clinical Knowledge Summaries

24. Acne vulgaris: Oral antibiotics

Acne vulgaris: Oral antibiotics Oral antibiotics | Prescribing information | Acne vulgaris | CKS | NICE Search CKS… Menu Oral antibiotics Acne vulgaris: Oral antibiotics Last revised in December 2019 Oral antibiotics Oral antibiotics Prescribing issues If acne fails to respond adequately to topical preparations alone an oral antibiotic such as lymecycline or doxycycline (for a maximum of 3 months) can be added. Minocycline is not recommended for use in acne as it is associated (...) with an increased risk of adverse effects such as drug-induced lupus, skin pigmentation and hepatitis. Macrolide antibiotics (such as erythromycin) should generally be avoided due to high levels of P. acnes resistance but can be used if tetracyclines are contraindicated (for example in pregnancy). A topical retinoid (if not contraindicated) or benzoyl peroxide should always be co-prescribed with oral antibiotics to reduce the risk of antibiotic resistance developing. Do not use topical and oral antibiotics

2019 NICE Clinical Knowledge Summaries

25. Is the use of chlorhexidine contributing to increased resistance to chlorhexidine and/or antibiotics?

’ defined by using the clinical breakpoints for resistance as specified by the European Committee on Antimicrobial Susceptibility testing (EUCAST) or the Clinical and Laboratory Standards Institute (CSLI). 2. Increase in the incidence (rate) of antibiotic-resistant strains of bacteria established through the use of chlorhexidine identifying dosage form, exposure and specific population and / or setting. Antibiotic-resistant strain of bacteria through the use of chlorhexidine to be recorded. 3. Increases (...) to chlorhexidine in a specific population and / or setting. To address the question ‘Does exposure (different dosages, duration of use, and stratification of exposure) to any form of chlorhexidine increases the incidence and/or prevalence of antibiotic- resistant strains of bacteria in any person within different healthcare settings? ’ the outcomes included: ? ‘Resistance against antibiotics’ defined by using the clinical breakpoints for resistance as specified by the European Committee on Antimicrobial

2018 National Health and Medical Research Council

26. Adult and Pediatric Antibiotic Prophylaxis during Vascular and IR Procedures: A Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radological Society of Europe and the Canadian Association for

procedures, including the increasing prevalence of pediatric IR procedures, and the increasing repertoire of antibacterial agents. As was the case for the original guidelines (1), the availability of randomized controlled data regarding antibiotic prophylaxis is lacking in the IR literature. Much data are derived from retrospective reviews From the Department of Diagnostic Radiology (M.A.C.), Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Department of Radiology (A.S.T (...) to oropharyngeal ?ora, which can potentially seed the skin entry site. This procedure carries a peristomal infection rate of approximately 30% (156). Prophylactic antibiotic therapy is therefore recommended for all patients undergoing this procedure with antimicrobial agents targeting skin and oropharyngeal bacteria, eg, cefazolin followed by oral/enteric cephalexin (156). (New data reviewed, recommendations updated.) Liver Tumor Ablation In 2015, Bhatia et al (157) described a very low incidence of hepatic ab

2019 Society of Interventional Radiology

27. Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics: Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) in collaboration with the German Society of Allergology (AeDA), German Society fo Full Text available with Trip Pro

Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics: Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) in collaboration with the German Society of Allergology (AeDA), German Society fo Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics: Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) in collaboration with the German Society of Allergology (AeDA (...) Cancel RSS Link Copy Actions Cite Display options Display options Format Share Permalink Copy Page navigation Allergol Select Actions . 2020 May 28;4:11-43. doi: 10.5414/ALX02104E. eCollection 2020. Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics: Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) in collaboration with the German Society of Allergology (AeDA), German Society for Pediatric Allergology and Environmental Medicine

2020 German Clinical Guidelines

28. Impetigo: antimicrobial prescribing

T erms used in the guideline 11 Recommendation for research 13 1 Antiseptics compared with antibiotics for impetigo 13 Rationales 14 Advice to reduce the spread of impetigo 14 Initial treatment 14 Reassessment and further treatment 16 Referral and seeking specialist advice 17 Choice of antimicrobial 18 Context 21 Summary of the evidence 22 Antimicrobials 22 Choice of antibiotics 23 Course length 25 Route of administration 25 Other considerations 27 Medicines safety 27 Medicines adherence 27 (...) Resource implications 27 Impetigo: antimicrobial prescribing (NG153) © NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 28Overview Overview This guideline sets out an antimicrobial prescribing strategy for adults, young people and children aged 72 hours and over with impetigo. It aims to optimise antibiotic use and reduce antibiotic resistance. For managing other skin and soft tissue infections, see our web pages

2020 National Institute for Health and Clinical Excellence - Clinical Guidelines

29. Leg ulcer infection: antimicrobial prescribing

26 Medicines safety 26 Medicines adherence 27 Resource implications 27 Leg ulcer infection: antimicrobial prescribing (NG152) © NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 28Overview Overview This guideline sets out an antimicrobial prescribing strategy for adults with leg ulcer infection. It aims to optimise antibiotic use and reduce antibiotic resistance. See a 2-page visual summary (...) antibiotic use. 1.1.4 Give oral antibiotics if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics. 1.1.5 If intravenous antibiotics are given, review by 48 hours and consider switching to oral antibiotics if possible. T o find out why the committee made the recommendations on treatment for adults with an infected leg ulcer, see the rationales. Leg ulcer infection: antimicrobial prescribing (NG152) © NICE 2020. All rights reserved. Subject

2020 National Institute for Health and Clinical Excellence - Clinical Guidelines

30. Insect bites and stings: antimicrobial prescribing

bites and stings 5 T erms used in the guideline 7 Rationales 9 Assessment and advice 9 Treatment 9 Referral and seeking specialist advice 10 Context 12 Summary of the evidence 13 Antibiotics for infected arthropod bites in adults 13 Oral antihistamines for uninfected mosquito bites in adults 14 Antihistamines for uninfected mosquito bites in children 15 Treatments for uninfected brown recluse spider bites 15 Insect bites and stings: antimicrobial prescribing (NG182) © NICE 2020. All rights reserved (...) . Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 16Overview Overview This guideline sets out an antimicrobial prescribing strategy for insect and spider bites and stings in adults, young people and children aged 72 hours and over, including those that occurred while travelling outside the UK. It aims to limit antibiotic use and reduce antibiotic resistance. See a 1-page visual summary of the recommendations. The recommendations in this guideline

2020 National Institute for Health and Clinical Excellence - Clinical Guidelines

31. Human and animal bites: antimicrobial prescribing

and committee details 27 Human and animal bites: antimicrobial prescribing (NG184) © NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 27Overview Overview This guideline sets out an antimicrobial prescribing strategy for human and animal bites (excluding insect bites) in adults, young people and children aged 72 hours and over. It aims to optimise antibiotic use and reduce antibiotic resistance. See a 3-page visual summary (...) ), that you are unfamiliar with. For a short explanation of why the committee made these recommendations, see the rationale section on assessment. For more details, see the evidence review. Human and animal bites: antimicrobial prescribing (NG184) © NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 5 of 27Antibiotic prophylaxis for uninfected bites Antibiotic prophylaxis for uninfected bites Human bites Human bites 1.1.4 Do

2020 National Institute for Health and Clinical Excellence - Clinical Guidelines

32. Cough (acute): antimicrobial prescribing

1.1 Managing acute cough 5 1.2 Self-care 8 1.3 Choice of antibiotic 9 T erms used in the guideline 11 Acute cough 11 Acute bronchitis 11 Self-care treatments 11 Summary of the evidence 12 Self-care 12 Bronchodilators 22 Corticosteroids 23 Mucolytics 24 No antibiotic 25 Back-up antibiotics 29 Choice of antibiotic 33 Antibiotic course length 35 Other considerations 36 Medicines adherence 36 Resource implications 36 Cough (acute): antimicrobial prescribing (NG120) © NICE 2019. All rights reserved (...) . Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 36Ov Overview erview This guideline sets out an antimicrobial prescribing strategy for acute cough associated with an upper respiratory tract infection or acute bronchitis in adults, young people and children. It aims to limit antibiotic use and reduce antibiotic resistance. See a 2-page visual summary of the recommendations, including tables to support prescribing decisions. For treating coughs

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

33. Bronchiectasis (non-cystic fibrosis), acute exacerbation: antimicrobial prescribing

Reassessment 14 Referral and seeking specialist advice 14 Choice of antibiotic for treating an acute exacerbation of bronchiectasis 15 Preventing acute exacerbations of bronchiectasis (non-cystic fibrosis) and choice of antibiotic 17 Bronchiectasis (non-cystic fibrosis), acute exacerbation: antimicrobial prescribing (NG117) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 19Ov Overview erview This guideline sets out (...) an antimicrobial prescribing strategy for managing and preventing acute exacerbations of bronchiectasis (non-cystic fibrosis). It aims to optimise antibiotic use and reduce antibiotic resistance. See a 3-page visual summary of the recommendations, including tables to support prescribing decisions. NICE has also produced a guideline on antimicrobial stewardship: systems and processes for effective antimicrobial medicine use. Who is it for? Health professionals People with bronchiectasis, their families

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

34. Cellulitis and erysipelas: antimicrobial prescribing

. It aims to optimise antibiotic use and reduce antibiotic resistance. See a 3-page visual summary of the recommendations, including tables to support prescribing decisions. For managing other skin conditions, see our web page on skin conditions. NICE has also produced a guideline on antimicrobial stewardship: systems and processes for effective antimicrobial medicine use. Who is it for? Healthcare professionals People with cellulitis and erysipelas, their families and carers Cellulitis and erysipelas (...) Staphylococcus aureus (MRSA) status if known. 1.1.5 Give oral antibiotics first line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics. Cellulitis and erysipelas: antimicrobial prescribing (NG141) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 5 of 361.1.6 If intravenous antibiotics are given, review by 48 hours and consider switching to oral antibiotics

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

35. Pneumonia (community-acquired): antimicrobial prescribing

37 Resource implications 37 Pneumonia (community-acquired): antimicrobial prescribing (NG138) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 37Ov Overview erview This guideline sets out an antimicrobial prescribing strategy for adults, young people, children and babies aged 72 hours and over with a confirmed diagnosis of community-acquired pneumonia. It aims to optimise antibiotic use and reduce antibiotic (...) disease or immunosuppression local antimicrobial resistance and surveillance data (such as flu and Mycoplasma pneumoniae infection rates) recent antibiotic use recent microbiological results, including colonisation with multidrug-resistant bacteria. 1.1.2 Start antibiotic treatment as soon as possible after establishing a diagnosis of community-acquired pneumonia, and certainly within 4 hours (within 1 hour if the person has suspected sepsis and meets any of the high risk criteria for this – see

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

36. Pneumonia (hospital-acquired): antimicrobial prescribing

of 23Contents Contents Overview 4 Who is it for? 4 Recommendations 5 1.1 Managing hospital-acquired pneumonia 5 1.2 Choice of antibiotic 6 T erms used in the guideline 13 Hospital-acquired pneumonia 13 Summary of the evidence 14 Antibiotic prescribing strategies 14 Choice of antibiotics 15 Antibiotic course length, dosage and route of administration 22 Other considerations 23 Medicines adherence 23 Resource implications 23 Pneumonia (hospital-acquired): antimicrobial prescribing (NG139) © NICE 2019. All (...) rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 23Ov Overview erview This guideline sets out an antimicrobial prescribing strategy for adults, young people, children and babies aged 72 hours and over with a confirmed diagnosis of hospital-acquired pneumonia. It does not cover ventilator-associated pneumonia. It aims to optimise antibiotic use and reduce antibiotic resistance. See a 3-page visual summary of the recommendations

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

37. Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use

(including antibiotics) in children, young people and adults. It aims to change prescribing practice to help slow the emergence of antimicrobial resistance and ensure that antimicrobials remain an effective treatment for infection. Who is it for? Health and social care practitioners Organisations commissioning, providing or supporting the provision of care People who are taking antimicrobials and their families and carers. Antimicrobial stewardship: systems and processes for effective antimicrobial (...) Antimicrobial stewardship Antimicrobial stewardship The term 'antimicrobial stewardship' is defined as 'an organisational or healthcare-system-wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness' . Antimicrobial resistance Antimicrobial resistance The term 'antimicrobial resistance' is defined as the 'loss of effectiveness of any anti-infective medicine, including antiviral, antifungal, antibacterial and antiparasitic medicines' . Antimicrobials

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

38. Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing

implications 24 Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing (NG114) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 24This guideline should be read in conjunction with NG115. Ov Overview erview This guideline sets out an antimicrobial prescribing strategy for acute exacerbations of chronic obstructive pulmonary disease (COPD). It aims to optimise antibiotic use and reduce (...) antibiotic resistance. See a 2-page visual summary of the recommendations, including tables to support prescribing decisions. See the NICE guideline on COPD in over 16s for other recommendations on preventing and managing an acute exacerbation of COPD, including self-management. Who is it for? Health professionals People with COPD, their families and carers Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing (NG114) © NICE 2019. All rights reserved. Subject to Notice

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

39. Otitis media (acute): antimicrobial prescribing

is it for? 4 Recommendations 5 1.1 Managing acute otitis media 5 1.2 Self-care 7 1.3 Choice of antibiotic 8 Summary of the evidence 10 Self-care 10 Oral corticosteroids 11 No antibiotic 12 Back-up antibiotics 14 Choice of antibiotic 16 Antibiotic course length 18 Antibiotic dose frequency 19 Other considerations 21 Medicines adherence 21 Resource implications 21 Otitis media (acute): antimicrobial prescribing (NG91) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk (...) /terms-and- conditions#notice-of-rights). Page 3 of 21Ov Overview erview This guideline sets out an antimicrobial prescribing strategy for acute otitis media (ear infection). It aims to limit antibiotic use and reduce antimicrobial resistance. Acute otitis media can be caused by viruses or bacteria. It lasts for about a week, and most children get better in 3 days without antibiotics. Serious complications are rare. See a 2-page visual summary of the recommendations, including tables to support

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

40. Prostatitis (acute): antimicrobial prescribing

is it for? 4 Recommendations 5 1.1 Managing acute prostatitis 5 1.2 Self-care 6 1.3 Choice of antibiotic 7 Summary of the evidence 9 Self-care 9 Antibiotics 9 Choice of antibiotic 11 Antibiotic course length 14 Antibiotic prophylaxis for preventing infective complications, including acute prostatitis, after biopsy 16 Other considerations 17 Medicines adherence 17 Resource implications 17 Prostatitis (acute): antimicrobial prescribing (NG110) © NICE 2019. All rights reserved. Subject to Notice of rights (...) (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 17Ov Overview erview This guideline sets out an antimicrobial prescribing strategy for acute prostatitis. It aims to optimise antibiotic use and reduce antibiotic resistance. See a 2-page visual summary of the recommendations, including a table to support prescribing decisions. NICE has also produced a guideline on antimicrobial stewardship: systems and processes for effective antimicrobial medicine use. Who is it for? Health

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

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