I recently read a few interesting articles around the use of antibiotics and treating common conditions. Below is a summary of two very interesting articles from the Choosing wisely initiative. They have highlighted some recommendations for practice.
The "Choosing Wisely" initiative in infectious diseases
Antibiotics should not be administrated unless microbiologic confirmation of streptococcal infection has been carried out
If a throat culture is performed, susceptibility tests on isolates should not be executed
Antibiotic course should not be shortened; because penicillin V is not available in Italy, amoxicillin (50 mg/kg/d in 2-3 doses orally for 10 days is the first choice treatment; and
Steroids should not be administered for the risk of masking possible underlying severe condition.
Annual influenza vaccination should be given to individuals with age >60 years, patients with specific co-morbidities and to contact persons who may spread influenza to others.
All children should receive measles vaccine.
Prefer oral formulations of highly bioavailable antimicrobials whenever possible.
Avoid prescribing antibiotics for uncomplicated upper respiratory tract infections.
Do not treat asymptomatic bacteriuria with antibiotics.
Chiappini E, Bortone B, Di Mauro G, Esposito S, Galli L, Landi M, Novelli A, Marchisio P, Marseglia GL.(2017); Choosing Wisely: The Top-5 Recommendations from the Italian Panel of the National Guidelines for the Management of Acute Pharyngitis in Children.
Clin Ther. 2017 Mar; 39(3): 646-649. doi: 10.1016/j.clinthera.2017.01.021. Epub 2017 Feb 6.
Lehmann C, Berner R, Bogner JR,Cornely OA de With K, Herold S, Kern WV, Lemmen S, Pletz MW, Ruf B, Salzberger B, Stellbrink HJ, Suttorp N, Ullmann AJ, Fätkenheuer G. Jung N.(2017)The “Choosing Wisely” initiative in infectious disease Infection Mar 13. doi: 10.1007/s15010-017-0997-0. [Epub ahead of print]