PRACTICE PARTNER
The campaign also provided specific recommendations for
Prescribers in Long-Term Care Settings and in Hospitals
DON’T prescribe antibiotics for asymptomatic bacteri-
uria (ASB) in non-pregnant patients. O NOT treat asymptomatic urinary tract infections in
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catheterized patients.
DON’T treat adult cough with antibiotics even if it lasts
more than 1 week, unless bacterial pneumonia is sus-
pected (mean viral cough duration is 18 days). ON’T recommend antibiotics for infections that are
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likely viral in origin, such as an influenza-like illness.
ON’T use antimicrobials to treat bacteriuria in older
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adults unless specific urinary tract symptoms are
present.
ON’T routinely prescribe intravenous forms of highly
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bioavailable antimicrobial agents for patients who can
reliably take and absorb oral medications.
ON’T prescribe alternate second-line antimicrobials
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to patients reporting non-severe reactions to penicil-
lin when beta-lactams are the recommended first-line
therapy.
establish a diagnosis of pneumonia and initi-
ate antibiotics in the majority of situations.
Patients with no vital sign abnormalities and
a normal respiratory examination are unlikely
to have pneumonia and most likely don’t
need a chest x-ray.
Acute exacerbation of Chronic
Obstructive Pulmonary Disease
DON’T routinely prescribe antibiotics for exac-
erbations of Chronic Obstructive Pulmonary
Disease unless there is clear increase in spu-
tum purulence with either increase in sputum
volume and/or increased dyspnea.
In most cases, oral corticosteroids are
beneficial, whether or not the patient meets
criteria for antibiotics. Short course of cor-
ticosteroids (5 days) is as effective as longer
course for COPD exacerbations.
ON’T prescribe antibiotics after incision and drain-
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age of uncomplicated skin abscesses unless extensive
cellulitis exists.
ON’T order peri-operative antibiotics beyond a
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24-hour post-operative period for non-complicated
instrumented cases in patients who are not at high risk
for infection or wound contamination. Administration
of a single pre-operative dose for spine cases without
instrumentation is adequate.
ON’T use antibiotics for acute asthma exacerbations
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without clear signs of bacterial infection.
Upper respiratory infection
(Common cold)
DON’T prescribe antibiotics unless there is
clear evidence of secondary bacterial infec-
tion.
Influenza like illness
prescribe antibiotics unless there is
clear evidence of secondary bacterial
infection.
DON’T
Bronchitis/asthma
DON’T prescribe antibiotics for
bronchitis/asthma/bronchiolitis
exacerbations.
MD
ISSUE 4, 2018 DIALOGUE
39