Aims and Principles of Treatment

Aims: To provide guidance for the treatment of common infections in adults within Primary Care, taking into account the bacterial susceptibility patterns in Grampian. To minimise the emergence of bacterial resistance and healthcare-associated infection in the community and to encourage the rational and cost-effective use of antibiotics.

      Principles of Treatment

1. Prescribe an antibiotic only when there is likely to be a clear clinical benefit.
2. It is important to use correct dose and appropriate course length modified as required for age, weight, renal function and infection severity.
3. Do not prescribe an antibiotic for viral sore throat, simple coughs and colds.
4. Consider delayed prescriptions for acute self-limiting upper respiratory tract infections if symptoms suggest an antibiotic may be indicated.
5. Lower the threshold for prescribing antibiotics in immunocompromised or those with multiple co-morbidities; consider culture and seek advice.
6. Limit prescribing for telephone consultations to exceptional cases.
7. Use simple generic antibiotics if possible. Avoid broad spectrum antibiotics (eg. co-amoxiclav, quinolones and cephalosporins) when narrow spectrum antibiotics remain effective, as they increase risk of Clostridium difficile, MRSA and resistant UTIs. Be aware of MHRA Quinolone Warnings Jan 2024 Nov 2018
8. Where a 'best guess' therapy has failed or special circumstances exist, microbiological advice can be obtained from the duty microbiologist via ARI switchboard (0345 456 6000)

Doses are oral unless otherwise stated, and apply to normal renal and hepatic function.

For information on the use of antibiotics in pregnant or breastfeeding women or in patients with renal or hepatic impairment, please refer to BNF and www.medicines.org.uk 

Clarithromycin is now preferred over erythromycin due to more convenient twice daily dosing, better tolerability and similar cost. However, there is more evidence supporting the safety of erythromycin in pregnancy.

Prescribers are reminded that any treatment choices should be patient specific. If the treatment choices listed are unsuitable for the patient or the indication is not listed please consult NICE Antimicrobial Guidelines or seek specialist advice from the duty microbiologist via ARI switchboard or antibiotic pharmacists via email gram.antibioticpharmacists@nhs.scot or page 3933.

Click here to view a pdf of the NHS Grampian Guidance Notes on the Treatment of Common Infections in Children in Primary Care