ANTIMICROBIAL GUIDANCE

September 2024 Latest Guideline Updates:

• AMT107 Mucosal Ulceration and Inflammation (Simple Gingivitis) update:
  • amended saline mouthwash to 'sodium chloride (saline) mouthwash.
  • added 'See Drug Prescribing in Dentistry section on ulceration and inflammation from SDCEP'.
  • amended simple saline mouthwash to 'simple salt mouthwash'.
• AMT108 Acute Necrotising Ulcerative Gingivitis and Pericoronitis update:
  • title changed.
  • now incorporates AMT109 Pericoronitis guidance.
  • added in 'Refer to dental services for local measures in the first instance.  See Drug Prescribing in Dentistry from SDCEP section on NUG and pericoronitis.'
  • added 'First choice' to metronidazole and included 'Alternative Amoxicillin 500mg three times a day.'
• AMT110 Dental Abscess update:
  • Updated SDCEP reference.
  • Bullet points updated.
  • Penicillin allergy amended with clarithromycin and clindamycin being removed.
  • Second line options statement added.
• AMT167 Eczema update:
  • reference to Scottish National Dermatology Pathway for atopic eczema in adults added.
  • information added regarding skin swabs.
  • information added regarding patients who are not systemically unwell and for secondary infection.
• AMT151 Acute Sore Throat update:
  • added reference to TAM ENT sore throat guidance.
  • added 'Scottish Antimicrobial Prescribing Group: resources for the management of children with respiratory tract infections.  Includes advice on delayed prescriptions in children and parent/carer safety netting information.'
  • included information on penicillin allergy in pregnancy.

Guidance deleted

• AMT109 Pericoronitis (Antimicrobial): Replaced by: Acute Necrotising Ulcerative Gingivitis and Pericoronitis

MHRA advice: Fluoroquinolone antibiotics: must now only be prescribed when other commonly recommended antibiotics are inappropriate.  Updated safety advice is available here including a patient information leaflet.  Side effects may be disabling, long-lasting and sometimes irreversible.  Systems affected include musculoskeletal (tendonitis/rupture), neurological (muscle weakness), sensory (peripheral neuropathy) and psychiatric (tiredness, anxiety, depression and suicidal thoughts).  Fluoroquinolones should not be prescribed for self-limiting or mild to moderate infections or non-bacterial (chronic) prostatitis.