Therapeutic Guidelines Antibiotic Chapter: Summary of Key Updates Relevant for General Practice
Urinary tract infections in adults
- Promotes non-antibiotic therapy for acute cystitis in non-pregnant women < 65 years. Non-antibiotic therapy includes symptom management (e.g., pain relief with a non-steroidal anti-inflammatory drug), providing information on when to seek medical advice, and considering a delayed prescription for antibiotic therapy.
- Nitrofurantoin is now the first-line treatment for acute cystitis, with Fosfomycin added as the second-line option. Fosfomycin offers substantially lower E. coli resistance and a strong global safety record, with no significant emergence of resistance despite extensive use overseas. Trimethoprim is no longer first line due to rising E. coli resistance, but remains an alternative option when cost or availability limits Fosfomycin use.
- Acute pyelonephritis may start with oral therapy.
- To minimise the use of continuous antibiotic prophylaxis for recurrent urinary tract infection (UTI) in nonpregnant adults, nonantibiotic strategies, intermittent postcoital prophylaxis and patient-initiated treatment are emphasised.
Respiratory infections other than pneumonia
- Bronchiectasis is potentially reversible in children so there is greater emphasis on referral to paediatric respiratory specialists, discussing management decisions with the treating specialist, using individualised management plans and eradicating newly identified Pseudomonas aeruginosa.
- For both adults and children, new directed therapy recommendations are included for bronchiectasis exacerbations caused by Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae and P. aeruginosa.
- Antibiotic therapy is not routinely recommended for chronic obstructive pulmonary disease exacerbations. A new step-by-step guidance helps clinicians determine when to use antibiotic therapy.
- Two new antivirals are included as treatment options for influenza. If antiviral therapy is indicated, Baloxavir can be considered for non-severe influenza and postexposure antiviral prophylaxis. Peramivir can be considered for patients with severe influenza who cannot tolerate or absorb Oseltamivir.
Managing multidrug-resistant gram-negatives, penicillin hypersensitivity and special populations
- New section on multidrug-resistant gram-negative infections – risk mapping and likely antimicrobials.
- In penicillin hypersensitivity management, validated allergy-assessment tools and clearer criteria for skin-prick/oral challenge have been added to guide safer cephalosporin use when appropriate.