Good Practice in Antimicrobial Prescribing

Empirical antibiotic prescribing guidance is provided to achieve two related aims:

1. Ensure effective treatment for an unwell patient by delivering antibiotics active against the pathogens most likely to be present
2. Avoid overuse of broad-spectrum antibiotics, which can promote antimicrobial resistance and thus make infections much more difficult to treat, as well as causing unwanted side-effects for the patient such as Clostridium difficile infection

When prescribing antibiotics:

• Follow these empirical guidelines
  • These are based partly on national guidance and partly on known sensitivity patterns amongst local isolates
• Culture before starting antibiotics
  • Identifying the pathogen responsible allows you to switch to focused treatment sooner
• Review all IV antibiotic prescriptions within 48-72 hours 
  • Is the diagnosis of infection secure, or is something else causing this illness?
  • Can you narrow treatment based on clinical findings or results from cultures?
  • If antibiotics are still needed, has the patient improved enough to switch to oral therapy?
• Don’t exceed the course length advised. Stated durations are for total duration of treatment including both IV and oral
• Doses stated are for normal renal function. You may need to consult the BNF, Pharmacy or Microbiology for dosing in impaired renal or hepatic function, extremes of body weight or pregnancy
• Check the BNF for drug interactions

These antibiotics (usually ciprofloxacin) have been reported to cause serious side effects involving tendons,
muscles, joints, and the nerves, and mental health effects which may include, but are not
necessarily limited to, anxiety, panic attacks, and memory impairment – in a small proportion of patients, these side effects caused long-lasting or permanent disability.  Please review the MHRA Safety Advice before prescribing  If these are prescribed, consider providing the patient with an information leaflet like this one from the MHRA. If any of these side-effects are noted, treatment should cease.

Additionally these antibiotics are now thought to be associated with slightly increased risk of developing valvular heart disease.