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101. COVID-19 rapid guideline: managing COVID-19

can find and use them more easily. The guideline includes new recommendations on therapeutics, and we will update the guideline further as new evidence emerges. The guideline updates and replaces our COVID-19 rapid guidelines on critical care in adults, managing symptoms (including at the end of life) in the community, managing suspected or confirmed pneumonia in adults in the community, acute myocardial injury, antibiotics for pneumonia in adults in hospital, acute kidney injury in hospital (...) ? Managing medicines - In hospital ? Deciding when to escalate care ? Escalating and de-escalating care ? Delivering services in critical care and respiratory support units COVID-19 rapid guideline: managing COVID-19 (NG191) © NICE 2021. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 6 of 10• Therapeutics for COVID-19 - Antibiotics - Corticosteroids - Remdesivir - T ocilizumab - Sarilumab - Low molecular weight heparins - Vitamin D

2021 National Institute for Health and Clinical Excellence - Clinical Guidelines

102. COVID-19 rapid guideline: delivery of systemic anticancer treatments

and offering empiric antibiotic therapy immediately. 4.6 If COVID-19 is later diagnosed in someone not isolated from admission or presentation, follow UK government guidance on actions required when a case was not diagnosed on admission. © NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 8 of 135 5 Staff who are self-isolating Staff who are self-isolating 5.1 If a healthcare professional needs to self-isolate, ensure

2020 National Institute for Health and Clinical Excellence - Clinical Guidelines

103. COVID-19 rapid guideline: delivery of radiotherapy

sepsis as an acute medical emergency and offering empiric antibiotic therapy immediately. 4.5 If COVID-19 is later diagnosed in someone not isolated from admission or presentation, follow UK government guidance on actions required when a case was not diagnosed on admission. COVID-19 rapid guideline: delivery of radiotherapy (NG162) © NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 9 of 155 5 Grouping and separating

2020 National Institute for Health and Clinical Excellence - Clinical Guidelines

104. COVID-19 rapid guideline: community-based care of patients with chronic obstructive pulmonary disease (COPD)

. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 13Contents Contents Overview 4 1 Communicating with patients and minimising risk 5 Patients not known to have COVID-19 6 Patients known or suspected to have COVID-19 6 2 Treatment and care planning 8 Corticosteroids 8 Self-management for exacerbations 9 Smoking cessation 9 Pulmonary rehabilitation 9 Oxygen 9 Oral prophylactic antibiotic therapy 9 Airway clearance 10 3 Equipment 11 4 Modifications (...) for exacerbations Self-management for exacerbations 2.8 T ell patients that if they think they are having an exacerbation, they should follow their individualised COPD self-management plan and start a course of oral corticosteroids and/or antibiotics if clinically indicated. 2.9 T ell patients not to start a short course of oral corticosteroids and/or antibiotics for symptoms of COVID-19, for example fever, dry cough or myalgia. 2.10 Do not offer patients with COPD a short course of oral corticosteroids

2020 National Institute for Health and Clinical Excellence - Clinical Guidelines

105. COVID-19 rapid guideline: cystic fibrosis

assistance. This is because sputum generation is a potentially infectious aerosol generating procedure for COVID-19. Advise other family members not to enter the room until enough time has passed for aerosols to clear: follow UK government guidance on infection prevention and control. 1.14 Explain to patients, their families and carers that when a nebuliser is used to administer an antibiotic, the aerosol comes from the fluid in the nebuliser chamber and will not carry virus particles from the patient. T (...) patients, their families and carers to continue with all their usual self-care arrangements including, for example: • airway clearance techniques • prophylactic medication, including oral and inhaled antibiotics, and mucoactive agents • cystic fibrosis transmembrane conductance regulator (CFTR) therapies • diet, vitamins and pancreatic enzyme replacement therapy • home exercise (following UK government guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from

2020 National Institute for Health and Clinical Excellence - Clinical Guidelines

106. COVID-19 rapid guideline: haematopoietic stem cell transplantation

neutropenic sepsis immediately for assessment in secondary or tertiary care • treating suspected neutropenic sepsis as an acute medical emergency and offering empiric antibiotic therapy immediately. 2.4 If COVID-19 is later diagnosed in a patient not isolated from admission or presentation, follow UK government guidance for health professionals. 2.5 If a patient not previously known or suspected to have COVID-19 shows new symptoms suggestive of COVID-19, the general advice is to follow UK government

2020 National Institute for Health and Clinical Excellence - Clinical Guidelines

107. COVID-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community

is likely to be the cause and • symptoms are mild. Inappropriate antibiotic use may reduce availability if used indiscriminately, and broad-spectrum antibiotics in particular may lead to Clostridioides difficile infection and antimicrobial resistance. 4.7 Offer an oral antibiotic for treatment of pneumonia in people who can or wish to be treated in the community if: • the likely cause is bacterial or • it is unclear whether the cause is bacterial or viral and symptoms are more concerning (...) a day for 5 days. 4.9 Do not routinely use dual antibiotics. 4.10 For choice of antibiotics in penicillin allergy, pregnancy and more severe disease, or if atypical pathogens are likely, see the recommendations on choice of antibiotic in the NICE antimicrobial prescribing guideline on community- acquired pneumonia. COVID-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community (NG165) © NICE 2020. All rights reserved. Subject to Notice of rights (https

2020 National Institute for Health and Clinical Excellence - Clinical Guidelines

108. Joint replacement (primary): hip, knee and shoulder

that the use of antibiotic and antiseptic agents in wash-out solutions varies across the NHS. They were concerned about the risk of increasing antimicrobial resistance through the use of these agents. They agreed that, because of this risk, other means of preventing infection in joint replacement surgery, such as prophylactic antibiotics and ultra-clean air ventilation in operating theatres, should be used, and included a cross reference to the NICE guideline on surgical site infections. Ultra-clean air (...) tranexamic acid on its own. For a short explanation of why the committee made the recommendations on tranexamic acid to minimise blood loss and how they might affect practice, see rationale and impact. Full details of the evidence and the committee's discussion are in evidence review G: tranexamic acid to minimise blood loss. 1.5 1.5 Preventing infections Preventing infections Antibiotic or antiseptic agents in wound wash-out solutions Antibiotic or antiseptic agents in wound wash-out solutions 1.5.1

2020 National Institute for Health and Clinical Excellence - Clinical Guidelines

109. Diverticular disease: diagnosis and management

also help to solidify loose stools in people with constipation. Paracetamol is indicated for pain and the committee highlighted the importance of avoiding NSAIDs and opioid analgesia because of the risk of diverticular perforation. Some people experience abdominal cramping, and anti-spasmodics may help with this. In line with best practice in antimicrobial stewardship, the committee made a recommendation not to use antibiotics in the absence of acute diverticulitis. Diverticular disease: diagnosis (...) disease and how they might affect practice, see rationale and impact. Management and advice Management and advice 1.2.4 Do not offer antibiotics to people with diverticular disease. 1.2.5 Advise people to avoid non-steroidal anti-inflammatory drugs and opioid analgesia if possible, because they may increase the risk of diverticular perforation. 1.2.6 For advice on diet, fluid intake, stopping smoking, weight loss and exercise, follow the recommendations in section 1.1 on diverticulosis. 1.2.7 Advise

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

110. Crohn’s disease: management

not responded to conventional therapy (including antibiotics, drainage and immunosuppressive treatments), or who are intolerant of or have contraindications to conventional therapy. Infliximab should be given as a planned course of treatment until treatment failure (including the need for surgery) or until 12 months after the start of treatment, whichever is shorter. People should then have their disease reassessed (see recommendation 1.2.16) to determine whether ongoing treatment is still clinically (...) of drug treatment are to reduce symptoms, promote mucosal healing, and maintain or improve quality of life, while minimising toxicity related to drugs over both the short- and long-term. Glucocorticosteroid treatment, aminosalicylate treatment, antibiotics, immunosuppressants and tumour necrosis factor (TNF)-alpha inhibitors are currently considered to be options for treating Crohn's disease. Enteral nutrition has also been used widely as first-line therapy in children and young people to facilitate

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

111. Cerebral palsy in adults

. Pr Proph ophylactic tr ylactic treatments for r eatments for respir espiratory infections atory infections 1.4.26 Offer vaccinations to adults with cerebral palsy and their carers, in line with the national immunisation programme (see the Green Book for further information). 1.4.27 Do not offer prophylactic antibiotics for lower respiratory tract infections in adults with cerebral palsy, unless: the person is at high risk of respiratory impairment (see recommendation 1.4.23

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

112. Intrapartum care for women with existing medical conditions or obstetric complications and their babies

monitoring for women in labour with sepsis or suspected sepsis 84 Antimicrobial treatment for women in labour with sepsis or suspected sepsis 85 Care for women with sepsis or suspected sepsis immediately after the birth 86 Intrapartum haemorrhage 86 Breech presenting in labour 87 Small-for-gestational-age baby 89 Large-for-gestational-age baby 89 No antenatal care 90 Previous caesarean section 91 Labour after 42 weeks of pregnancy 93 Context 94 Finding more information and resources 95 Update information

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

113. Surgical site infections: prevention and treatment

or implant clean-contaminated surgery contaminated surgery. [2008] [2008] For advice on antibiotic prophylaxis before caesarean section, see the section on surgical techniques for caesarean section: timing of antibiotic administration in NICE's guideline on caesarean section. For information on antimicrobial stewardship programmes see the NICE guideline on antimicrobial stewardship: systems and processes for effective antimicrobial medicine use. 1.2.13 Do not use antibiotic prophylaxis routinely (...) #notice-of-rights). Page 11 of 271.3.19 Consider using gentamicin-collagen implants in cardiac surgery. [2019] [2019] T o find out why the committee made the 2019 recommendations on antiseptics and antibiotics before wound closure and how they might affect practice, see rationale and impact. Closure methods Closure methods 1.3.20 When using sutures, consider using antimicrobial triclosan-coated sutures, especially for paediatric surgery, to reduce the risk of surgical site infection. [2019] [2019

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

114. Urinary incontinence and pelvic organ prolapse in women: management

of urinary tract infection (UTI) and their urine tests positive for both leucocytes and nitrites, send a midstream urine specimen for culture and analysis of antibiotic sensitivities. Prescribe an appropriate course of antibiotic treatment pending culture results. See the NICE guideline on urinary tract infection (lower): antimicrobial prescribing for more information. [2006, amended 2019] [2006, amended 2019] 1.3.7 If women have symptoms of UTI and their urine tests negative for either leucocytes (...) or nitrites, send a midstream urine specimen for culture and analysis of antibiotic sensitivities. Consider the prescription of antibiotics pending culture results. [2006] [2006] 1.3.8 If women do not have symptoms of UTI, but their urine tests positive for both leucocytes and nitrites, do not offer antibiotics without the results of midstream urine culture. [2006] [2006] Urinary incontinence and pelvic organ prolapse in women: management (NG123) © NICE 2019. All rights reserved. Subject to Notice

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

115. Fever in under 5s: assessment and initial management

aged under 5. It aims to improve clinical assessment and help healthcare professionals diagnose serious illness among young children who present with fever in primary and secondary care. This guideline should be read in conjunction with NICE's guidance on sepsis, neonatal infection, meningitis (bacterial) and meningococcal septicaemia in under 16s, urinary tract infection in under 16s, diarrhoea and vomiting caused by gastroenteritis in under 5s and antimicrobial prescribing for common infections (...) not routinely have a chest X-ray. [2007] [2007] 1.4.7 T est urine in children with fever as recommended in NICE's guideline on urinary tract infection in under 16s. [2007] [2007] 1.4.8 When a child has been given antipyretics, do not rely on a decrease or lack of decrease in temperature to differentiate between serious and non-serious illness. [2017] [2017] Use of antibiotics b Use of antibiotics by the non-paediatric pr y the non-paediatric practitioner actitioner 1.4.9 Do not prescribe oral antibiotics

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

116. Abortion care

are having an abortion, see the NICE guideline on preventing sexually transmitted infections and under-18 conceptions. 1.4.2 Do not routinely offer antibiotic prophylaxis to women who are having a medical abortion. 1.4.3 Offer antibiotic prophylaxis to women who are having surgical abortion. 1.4.4 When using doxycycline for antibiotic prophylaxis in medical or surgical abortion, consider oral doxycycline 100 mg twice a day for 3 days. 1.4.5 When using metronidazole for antibiotic prophylaxis in medical (...) or surgical abortion, do not routinely offer it in combination with another broad-spectrum antibiotic such as doxycycline. T o find out why the committee made the recommendations on preventing infection and how they might affect practice, see rationale and impact. 1.5 Venous thromboembolism prophylaxis 1.5.1 For women who need pharmacological thromboprophylaxis, consider low-molecular-weight heparin for at least 7 days after the abortion. 1.5.2 For women who are at high risk of thrombosis, consider

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

120. Uterine Transplantation Full Text available with Trip Pro

into the vaginal lumen, concomitantly removing adherent micro‐organisms. Vaginal epithelium also contributes to the innate immune response by facilitating the recognition of pathogens and stimulating the production of antimicrobial peptides and proinflammatory cytokines. These immunomodulatory mechanisms contribute to the maintenance of a commensal microbiome, which have clinical and reproductive implications that may impact outcomes in UTx. For example, the second global UTx case was performed in a woman (...) ratio in women with this condition is clearly increased which has led to their exclusion from certain research studies, but inclusion in others. Other complications have included a subchorionic haematoma that resolved spontaneously, and an episode of pyelonephritis that required inpatient management with intravenous antibiotics. To date all offspring have been delivered by lower section caesarean section. This is primarily owing to uncertainty regarding structural support and vascular supply

2021 Royal College of Obstetricians and Gynaecologists

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