Update to antibiotic guidelines

The North East and Cumbria antimicrobial prescribing guideline for primary care and quick reference guideline have been updated in line with new guidance from Public Health England around treatment of urinary tract infections (UTIs) and use of antibiotics in pregnancy.

Urinary Tract Infections

Guidance has been updated in response to increases in antimicrobial resistance and community multi-resistant extended spectrum beta-lactamase (ESBL) E.coli.  Nitrofurantoin is now recommended as first line antibiotic for treatment of lower urinary tract infections in adults.

Antibiotics in Pregnancy

Following a review of new evidence detailing increased risk of spontaneous abortion with azithromycin, clarithromycin, metronidazole, tetreacyclines, quinolones and sulphonamides PHE guidance has been updated on antibiotic use pregnancy.

PHE highlight that specimens should be taken to inform treatment.  Penicillins, cephalosporins and erythromycin are not associated with increased risks. If possible, avoid tetracyclines, quinolones, aminoglycosides, azithromycin, clarithromycin, high dose metronidazole (2g stat) unless the benefits outweigh the risks. Short-term use of nitrofurantoin is not expected to cause foetal problems (theoretical risk of neonatal haemolysis). Trimethoprim is also unlikely to cause problems unless poor dietary folate intake, or taking another folate antagonist

Erythromycin is now the recommended treatment of acute sore throat in pregnancy in penicillin allergic patients.