Recommendations and resources
1) Do not use antibiotics in asymptomatic bacteriuria.
Antibiotic treatment of patients with asymptomatic bacteriuria is generally not indicated as it does not decrease the incidence of symptomatic urinary tract infection. This also includes patients with indwelling urinary catheters. Exceptions to this are pregnant women and those undergoing an urological procedure.
2) Do not take a swab or use antibiotics for the management of a leg ulcer without clinical infection.
Lower leg ulcers, most commonly venous ulcers are often treated with oral antibiotics, even in the absence of evidence of clinical infection. There is no evidence to support this use, except if screening for carriage of multi-resistant organisms. Also a swab for microscopy and culture, in the absence of signs of infection is not recommended. Unnecessary antibiotics and swabbing will add to healthcare costs, antimicrobial resistance and patient allergy.
3) Avoid prescribing antibiotics for upper respiratory tract infection (with the exception of sore throat in populations at high risk for complication of group A infection, such as acute rheumatic fever or post-streptococcal glomulornephritis).
Most uncomplicated upper respiratory infections are viral in aetiology and antibiotic therapy is not indicated. Oral antibiotic therapy of presumed URTI in febrile young infants is not only ‘low value’ but can be actively dangerous, in delaying presentation to hospital (inappropriately reassuring parents and confounding investigations of sepsis). This is a major issue for paediatrics primary care and ED presentations. Patient education is an important component of management together with symptomatic treatment. Infections with Streptococcus pyogenes and Bordetella pertussis do require antibiotic therapy. Refer to Therapeutic Guidelines: Antibiotic for further details.
4) Do not investigate or treat for faecal pathogens in the absence of diarrhoea or other gastro-intestinal symptoms.
Testing of faeces for microscopy and culture or by PCR methods should not be performed in the absence of diarrhoea or other gastro-intestinal symptoms. Similarly antimicrobial treatment for a gastrointestinal pathogen is not indicated in the absence of symptoms. For immunocompetent non-traveller children with acute gastroenteritis, there are very few circumstances when a stool test for infection would alter clinical management. Possible exceptions include refugee screening and some neurological syndromes such as enteroviral testing for acute flaccid paralysis.
5) In a patient with fatigue, avoid performing multiple serological investigations, without a clinical indication or relevant epidemiology.
Multiple serological testing as investigation for a patient with fatigue, is not recommended. If such testing is not clinically indicated there is a risk of false positive results leading to further unnecessary investigations and useless treatments.