June 2024 Latest Guideline Updates:

• AMT157 Bronchiectasis update: link added to new diagnosis and management section published in therapeutics section
• AMT158 Community Acquired Pneumonia (CAP) update: separate COVID-19 co-infection recommendations removed or merged, duration reduced to 5 days unless clinically unstable, reminder that duration is IV plus oral.
• AMT162 Bites update: more detail on when prophylaxis or treatment is recommended along with duration - 3 days for prophylaxis and 5 days for treatment
• AMT163 Cellulitis/Wound Infections update: duration reduced to 5 days and link added to OPAT pathway for admission avoidance or referral
• AMT168 Impetigo update: aligned with NICE and CKS with addition of hydrogen peroxide cream as first line. Recommendations stratified according to severity with topical for non-severe infections and systemic (oral) for severe infections.  Short update in next Formulary Update 
• AMT169 Leg Ulcer update: text updated to focus on cleansing wounds, taking samples after cleaning and from areas of infection and only treating infections as cellulitis when there are clear signs and symptoms.
• AMT171 Scabies update: added link to British Association of Dermatology expert guidance on management, including patient information leaflet on optimal application of topical therapy
• TAM456 Mastitis and breast abscess update: new advice on management of lactational mastitis (linked to NHS policy) and lowering of clindamycin dose.

Guidance reviewed with no changes:

• AMT116 Eradication of Helicobacter pylori
• AMT146 Bone and Joint Infections
• AMT170 Necrotising Fasciitis

MHRA advice: Flouroquinolone 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.