Dialogue Volume 14 Issue 4 2018 - Page 39

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 D 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 D likely viral in origin, such as an influenza-like illness.  ON’T use antimicrobials to treat bacteriuria in older D adults unless specific urinary tract symptoms are present.  ON’T routinely prescribe intravenous forms of highly D bioavailable antimicrobial agents for patients who can reliably take and absorb oral medications.  ON’T prescribe alternate second-line antimicrobials D 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- D age of uncomplicated skin abscesses unless extensive cellulitis exists.  ON’T order peri-operative antibiotics beyond a D 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 D 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