NHS Antibiotic Guidelines for Primary Care


These guidelines are intended to provide advice on the effective and safe treatment of infections commonly presenting in primary care (doses are for adults unless otherwise stated) in mainly Wessex, but also Surrey Heath, Berkshire East and West, Coastal West Sussex and Oxfordshire CCG. The guidelines also promote the use of narrow-spectrum antibiotics in preference to broad- spectrum antibiotics where safe and appropriate. The audience of users is anticipated to be general practitioners, GP trainees, GP practice nurses, non-medical prescribers, paramedics, hospital emergency department staff and community pharmacists.

These guidelines were drafted by a multi-disciplinary group of health professionals with an interest in infection from around the region. The 2017 update was led by pharmacists from the South Central Antimicrobial Network group in close partnership with consultant medical microbiologists from local hospitals – a list of stakeholders is available below. The draft guidelines were published for consultation in December 2017 and feedback was received from a number of GPs, consultant medical microbiologists and pharmacists, before the final guidelines were published in February 2018.The guidelines have been updated from the previous version, published in 2014, taking into consideration feedback from users, emerging evidence and changing epidemiology of antimicrobial resistance. The guidelines are based largely on the Management of Infection Guidance for Primary Care, published jointly by the Health Protection Agency and the British Infection Association, updated in November 2017, and the guideline development group gratefully acknowledges the work of Dr Cliodna McNulty, Sarah Alton and her colleagues in the PHE and BIA.

Recommendations for when antimicrobial treatment is indicated, based upon cited national or international evidence-based guidelines, have been expanded from the PHE/BIA Guidance, along with recommendations and practical advice for taking specimens for microbiological investigations and interpreting culture and sensitivity laboratory reports. Clinically relevant information on cautions and warnings associated with antimicrobial treatment has also been expanded from the PHE/BIA Guidance including information about risk of Clostridium difficile infection. All statements were fully referenced.

This updated version of the guidelines has been developed during 2017 and the next update will be scheduled for review in November 2019. This version also includes new areas not previously covered and hopefully will be useful. Comments and feedback are welcome; please e-mail ruth.ellenby@nhs.net

Reference: Shaneyfelt TM, Mayo-Smith MF & Rothwangl J. Are Guidelines Following Guidelines? The Methodological Quality of Clinical Practice Guidelines in the Peer-Reviewed Medical Literature. JAMA. 1999; 281: 1900-1905.

Purely Paediatrics – Basis for Recommendations

This is a very challenging area because under-dosing of Abs in children is a well-recognised problem when age-bands are used, https://www.bmj.com/content/351/bmj.h5447 . The consensus of the guideline development group was to base antibiotic doses on the upper limit of BNFc recommendations. The rationale for this is to avoid treatment failures due to under-dosing.

The use of unpalatable suspensions and frequent dosing regimens is associated with poor adherence with treatment in children. To address this, the guideline authors have reduced dosing frequency where possible (i.e. bd amoxicillin) and have avoided the use of unpalatable suspensions (such as penicillin V and flucloxacillin

However, the guideline development group reiterate the importance of not prescribing antibiotics when they are unlikely to confer benefit to the child.

TARGET WEBINAR No 6, Antibiotics for Children, http://www.target-webinars.com/webinars/antibiotics-for-children

Antimicrobial Stewardship: From Principles to Practice http://bsac.org.uk/antimicrobial-stewardship-from-principles-to-practice-e-book/ebook-download

There has been an MHRA warning about a small increased risk of aortic aneurysm and dissection with the use of Fluoroquinolones, in high risk patients. Read about the warning here.


NEW GUIDLINES UPDATED : The updates include an amendment to the Chlamydia guidelines and the paediatric section now contains a wealth of background evidence.


Paed AB Important Changes:

Evidence Supporting updated Paed Prescribing Guidelines:

Last updated 4th Dec 2018