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Antibiotics

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Checked: 04-03-2024 by Rob Adams Next Review: 03-03-2026

Antibiotic prescribing

Antimicrobial Prescribing Guidelines

Refer to the local Infection Guidelines which include a link to the latest BNSSG Antimicrobial Guidelines.

Cellulitis Prescribing Pathway

The BNSSG Cellulitis in Adults Pathway can be found in the Formulary section of Remedy.

Antibiotic resistance

How to Reduce Antibiotic Use in Primary Care - summary paper of research about antibiotic use in primary care from the NIHR

Key Points:

Around 70% of antibiotics are prescribed in general practice; research shows at least 20% of these antibiotic prescriptions are inappropriate.
Antibiotic resistance occurs naturally, but overuse or misuse of antibiotics accelerates the process. One study showed that rates of antibiotic resistance were higher in the European countries that prescribe the most antibiotics in primary care, compared with countries that prescribe fewer.
Individuals who are exposed to antibiotics are much more likely to harbour a resistant organism for the next infection they get.
For some groups of people, for instance those with chronic obstructive pulmonary disease and recurrent infections, it might not be safe to reduce antibiotic prescribing. The focus for reducing prescribing is on uncomplicated conditions.

The paper also addresses the following issues:

1. Do fewer antibiotic prescriptions result in more serious bacterial infections?

Researchers used electronic health records from 706 general practices, including data from more than 11 million people, to examine whether practices that prescribe fewer antibiotic prescriptions report more serious bacterial infections. Prescribing rates varied widely between general practices, but the team found no evidence that practices with lower rates of antibiotic prescribing saw more infection complications than those with higher prescribing rates.

2. Are antibioitcs needed for most children with chest infections?

Children taking antibiotics had around 1 day less with symptoms (5 days) than those who took placebo (6 days) - the difference was not significant. Costs (NHS and societal, such as parents’ time off work) were similar, regardless of whether the child had taken antibiotics or placebo.

The researchers considered separately those children with symptoms that commonly trigger antibiotic use (fever, a rattily chest, or shortness of breath, for example). The findings were similar even among children with these additional symptoms.

An assessment tool is being developed to predict which children are most likely to benefit from antibiotics (those with a breathing rate different to their peers; oxygen saturation of less than 95%; and rattily chest, for instance). This could help clinicians limit antibiotics to only those children likely to benefit most. But robust evidence is needed before widespread use.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.