We asked you in January to update to v4.7.2. After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.
To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number.
To update to the latest release:
On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.
On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.
Welcome to the February 2025 update from the RDS team
A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:
The release will also incorporate a number of small fixes, including:
We will let you know when the date and time for the new release are confirmed.
There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.
The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.
Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.
At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .
We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.
Some important toolkits in development by the RDS team include:
The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.
To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)
To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form - also available in End-user and Provider sections of the RDS Learning and Support area. If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.
With kind regards
Right Decision Service team
Healthcare Improvement Scotland
January 2025 - IV alternative text added.
Oral therapy
Co-trimoxazole 960mg 12 hourly
+
Metronidazole 400mg 8 hourly if abdominal source suspected
IV Therapy
Hospital admission
Duration: depends on eventual diagnosis
If IV treatment is still needed after three days, discuss with Microbiology
True penicillin allergy: Discuss with Microbiology
Oral therapy
Co-trimoxazole 960mg 12 hourly
+
Metronidazole 400mg 8 hourly
IV Therapy
Hospital admission
Duration: depends on eventual diagnosis. Usually 5-7 days
PO Metronidazole is as good as IV if route available
If IV treatment is still needed after three days, discuss with Microbiology
True penicillin allergy: Discuss with Microbiology
Oral therapy
Amoxicillin 500mg 8 hourly
Or
Doxycycline 200mg stat, then 100mg 24 hourly
IV Therapy unless otherwise stated
Co-amoxiclav2 1.2g 8 hourly
Where it is not possible to give TDS IV dosing, the evening dose of co-amoxiclav could be replaced by an oral dose of Co-amoxiclav 625mg + amoxicillin 500mg if oral route available. See above3. Alternatively, discuss with Cons. Microbiologist.
Duration 5 days
If clinical failure of oral therapy, send sputum and consider Co-amoxiclav2 625mg TDS PO / 1.2g 8 hourly IV
Oral therapy
Amoxicillin 500mg -1g 8 hourly
Plus
Metronidazole 400mg 8 hourly
Or
Doxycycline 200mg stat, then 100mg 24 hourly
+
Metronidazole 400mg 8 hourly
IV Therapy unless otherwise stated
Amoxicillin 1g 8 hourly
+
Gentamicin5
+
Metronidazole 500mg 8 hourly (400mg 8 hourly PO if route is available)
True penicillin allergy:
Discuss with Microbiology
Where it is not possible to give TDS IV dosing, the evening dose of amoxicillin could be replaced by an oral dose of amoxicillin 1g if oral route available. See above3. Alternatively, discuss with Cons. Microbiologist
Duration 5-7 days
If IV treatment is still needed after three days, discuss with Microbiology
Oral therapy
Doxycycline 200mg stat, then 100mg 24 hourly
Or
Co-trimoxazole 960mg 12 hourly
IV Therapy unless otherwise stated
Amoxicillin 1g 8 hourly
+
Gentamicin5
True penicillin allergy: discuss with Microbiology
Where it is not possible to give TDS IV dosing, the evening dose of amoxicillin could be replaced by an oral dose of amoxicillin 1g if oral route available. See above3. Alternatively, discuss with Cons. Microbiologist
Duration 5-7 days
If IV treatment is still needed after three days, discuss with Microbiology
True penicillin allergy: discuss with Microbiology
CURB-65 score can help assess severity.
Score 1 point for each of:
- New confusion (AMT ≤ 8)
- Urea > 7 mmol / L
- Resp rate ≥ 30 / minute
- BP (diastolic ≤ 60 mmHg or systolic < 90 mmHg)
- Age ≥ 65
Treatment regimens are suitable for use in patients with or without suspected or known COVID-19 infection
Treat only if there is clinical suspicion of bacterial infection, such as purulent sputum, or evidence of consolidation
CURB-65 = 0 or 1
Oral therapy
Doxycycline 200mg stat, then 100mg 24 hourly
Or
Amoxicillin 500mg-1g 8 hourly
IV Therapy
Amoxicillin 1g 8 hourly
CURB-65 = 2
Oral therapy
Amoxicillin500mg-1g 8 hourly
True penicillin allergy
Doxycycline 200mg stat, then 100mg 24 hourly
IV Therapy (unless otherwise stated)
Seek medical advice
Amoxicillin 1g 8 hourly
+
If Legionella, Mycoplasma or other atypical bacterial pathogens suspected, add clarithromycin4 500mg 12 hourly
True penicillin allergy:
Clarithromycin4 oral 500mg 12 hourly
CURB-65 ≥ 3
Use IV
Seek medical advice
Co-amoxiclav2 1.2g 8 hourly
+
Clarithromycin4 oral 500mg 12 hourly
Where it is not possible to give TDS IV dosing, the evening dose of co-amoxiclav could be replaced by an oral dose of Co-amoxiclav 625mg + amoxicillin 500mg if oral route available. See above3. Alternatively, discuss with Cons. Microbiologist.
True penicillin allergy
Levofloxacin 2, 6 oral 500mg 12 hourly
Duration 5 days
If treated for UTI in the last 6 months, check Microbiology history for suitable antibiotic choice
Oral therapy
Nitrofurantoin1
100mg MR 12 hourly
Or
Trimethoprim 200mg 12 hourly
IV Therapy
See upper UTI
Duration
Females 3 – 5 days
Males 7 days
Oral therapy
Co-trimoxazole 960mg BD for 7 days
Or, if eGFR<30, Ciprofloxacin 2, 6 see BNF for dosing in renal impairment
IV Therapy (unless otherwise stated)
Amoxicillin 1g 8 hourly
+
Gentamicin5
Where it is not possible to give TDS IV dosing, the evening dose of amoxicillin could be replaced by an oral dose of amoxicillin 1g if oral route available. See above3. Alternatively, discuss with Cons. Microbiologist
True penicillin allergy
Gentamicin5 as a single agent
Duration
Oral: as per antibiotic choice
IV: aim to convert to oral and complete total duration as per IV choice
If IV treatment is still needed after three days discuss with Microbiology
True penicillin allergy: Discuss with Microbiology
Do not use dipsticks with catheter samples. Treat only if symptomatic
Assess need for ongoing therapy after stat dose of gentamicin
Catheter change AND
Amoxicillin IV 1g 8 hourly
+
Gentamicin5
Where it is not possible to give TDS IV dosing, the evening dose of amoxicillin could be replaced by an oral dose of amoxicillin 1g if oral route available. See above3. Alternatively, discuss with Cons. Microbiologist
Or, if true penicillin allergy
Gentamicin5 as a single agent
If no features of systemic infection or osteomyelitis and infection is localised, PO can be used
Therapeutic drug monitoring of teicoplanin is not required for short courses
Duration 7-14 days
Oral therapy
Flucloxacillin 1g 6 hourly
If true penicillin allergy
Clarithromycin4 500mg 12 hourly
If MRSA suspected or known
Doxycycline 100mg 12 hourly
(check isolate is sensitive)
IV Therapy
Teicoplanin
NOTE: there are other teicoplanin regimens in use in NHS Borders. This guideline is for HOSPITAL AT HOME USE ONLY
Teicoplanin is loaded over three consecutive days (Days 1, 2 and 3) and this will provide equivalent to 5 days of treatment.
Teicoplanin should not be extended past the initial 5 days loading duration without input from an Infection specialist.
Patient’s age, height, weight and a stable serum creatinine are required to calculate the teicoplanin loading dose using the following steps:
|
Step 1: Calculate creatinine clearance |
• Use Cockroft-Gault formula CrCl (ml/min)=[(140-Age) X weight* X 1.23(male)or 1.04(female) ] Serum creatinine (micromol/L)** *Use total body weight (Kg) **If Cr <60 micromol/L , use a value of 60 micromol/L |
|
Step 2: Decide on using Ideal or Actual Body Weight |
• Use SAPG weight tables
• Use either Ideal or Total bodyweight, whichever is LOWER |
|
Step 3: Prescribe doses |
Prescribe daily for first 3 days:
See Medusa monograph for reconstitution guidance. Doses <800mg as IV infusion in 100ml over 30 minutes Doses ≥800mg as IV infusion in 100ml over 60 minutes |
|||||||||||||||
Reference
Lamont et al. Journal of Antimicrobial Chemotherapy 2009; 64 : 181-187
*1 May be used with caution if eGFR 30-44 ml/minute as a short course only (3-7 days) to treat uncomplicated lower UTI if caused by suspected or proven multidrug resistant bacteria only if potential benefit outweighs risk.
2These antibiotics are associated with a higher risk of developing Clostridium difficile infection, particularly in elderly patients
3Substitution of the evening IV dose of co-amoxiclav or amoxicillin with an oral dose is suboptimal treatment and should only be considered where the clinician considers the risk versus benefit of the alternative of hospital admission to be outweighed by the benefits of treatment via Hospital at Home. The patient or their appropriate representatives should give consent to this regimen and this should be recorded in the patient’s medical notes.
4Significant drug interactions
5See Gentamicin dosing calculator. Do not give more than 3 days of Gentamicin unless advised by Microbiology. Check culture results to guide ongoing treatment
6Fluroquinolones
Refer to important safety information for all quinolones prior to prescribing.
See MHRA Drug Safety Update January 2024: Fluoroquinolones must only be used in situations when other antibiotics, that are commonly recommended for the infection, are inappropriate such as:
Patients should be advised to stop fluoroquinolone treatment at the first signs of a serious adverse reaction, such as tendinitis or tendon rupture, muscle pain, muscle weakness, joint pain, joint swelling, peripheral neuropathy and central nervous system effects, and to contact their doctor immediately
Refer to MHRA’s sheet for patients (regular print or large print) for further advice
Antimicrobial prescribing: NHS Borders