5. Infections


First line drugs Second line drugs Specialist drugs Secondary care drugs
Recommended in both primary and secondary care Alternatives (often in specific conditions) in both primary and secondary care; Where a specialist input is needed (see introduction for definition) Prescribing principally within secondary care only

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only

 

Useful Sources of information:

1) Primary Care Antimicrobial Guidelines 

2) Management of Infections in Primary Care – 1 st line choices (To be read in conjunction with the full guidance in the link above)

3) Secondary Care Adult Antimicrobial Guidelines (Milton Keynes University Hospital NHS Foundation Trust)

Notes: 

1) Wherever possible antibiotics should be prescribed orally.

2) Antibiotics should be:
            ◦ Administered only for as long as necessary to treat the infection
            ◦ Changed from IV to oral as soon as possible

3) Sugar free liquids are preferred where available, and SF identifies where a sugar free product is available.

4) For young children requiring doses of less than 5ml an oral syringe will be dispensed

 

Suspected Meningitis

Pre-admission management for suspected meningitis can be found here: http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1194947389261

Notes: 

1) All GPs should carry benzylpenicillin for injection and administer it whilst arranging the transfer of the case to hospital, unless there is a history of immediate allergic reactions after previous penicillin administration.

2) GPs do not need to carry an alternative antibiotic. However, if other antibiotics are available, a 3rd generation cephalosporin may be used. If there is a history of immediate allergic reactions to penicillin or cephalosporins, chloramphenicol may be used.

3) Immediate dose of IV/IM benzylpenicillin for suspected meningococcal infection

            ◦  Adults and children aged 10 years or over - 1.2g

            ◦  Children aged 1 to 9 years - 600mg 

            ◦  Children aged under 1 year - 300mg                 

 

 

Prevention of Endocarditis

NICE CG64: Antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures (March 2008)

 

 

5.1    Antibacterial drugs  

 

 5.2    Antifungal drugs          

           For local treatment of fungal infections see section:       

                                        7.2.2 – genital

                                        7.4.4 – bladder

                                        11.3.2 – eye

                                        12.1.1 – ear

                                        12.3.2 – oropharynx

                                        13.10.2 – skin 

 

 

5.3    Antiviral drugs     

      

5.4    Antiprotozoal drugs 

5.5    Anthelmintics   

       

 

Appendices

Last updated by: Nikki Woodhall on 02-11-2017 11:33