Recently updated content on the website
Seasonal Influenza - December 2024
- Update terminology to align with WHO, complicated and non-complicated to severe and non-severe influenza
- Update to align with WHO classification, high risk of hospitalisation and extremely high risk of hospitalisation
- Use of antivirals for treatment of severe influenza
- Treatment for patients with non-severe influenza but at high risk of progression to severe disease based on clinical discretion following a risk benefit analysis.
- Prophylaxis for asymptomatic persons at extremely high risk for hospitalisation if they were to develop seasonal influenza
Lactational Mastitis - December 2024
- Additional advice on non-pharmacological management of lactational mastitis. Continuation or breastfeeding (and/or pumping) and anti-inflammatory measures are key interventions.
Postpartum Endometritis – December 2024
- Additional safety netting advice on suspected postpartum endometritis and referral
Respiratory tract infections - November 2024
C-section Wound Infection - Oct 2024
- updates to recommended duration of treatment (5-7 days in general, 10 days if Group A Strep isolated)
- additional advice on antibiotic treatment for mother and neonate if Group A Strep is isolated
Perineal Wound Infection - Oct 2024
- updates to recommended duration of treatment (5-7 days in general, 10 days if Group A Strep isolated)
- additional advice on antibiotic treatment for mother and neonate if Group A Strep is isolated
- advice on hygiene and wound care
Acute Cough / Bronchitis - Sept 2024
- The antibiotic treatment table has been removed to reflect international best practice. Acute cough / bronchitis is caused mainly by viruses and is a self-limiting condition. In the majority of cases, antibiotics are not indicated.
Sinusitis - Sept 2024
- Addition of dosing table for intranasal steroids to be considered for people with symptoms of around 10 days or more. Note added regarding duration of treatment for severe / worsening infection.
Pharyngitis, Sore Throat and Tonsillitis - Sept 2024
- Note added that FeverPain tool has not been assessed in children under 3 years.
- Recommended dose of cefalexin for adults amended.
COPD - Sept 2024
- Updates to expert advisory comments and removal of levofloxacin from the empiric treatment table.
Community Acquired Pneumonia (CAP) - Sept 2024
- Addition of information with advice on treatment of aspiration pneumonia. Recommended dose of amoxicillin amended.
Pneumonia in Residential Care Facilities - Sept 2024
- Updates to guidance on aspiration pneumonia. Some antibiotic dose amendments.
Lower UTI in Pregnancy - June 2024
- Amoxicillin has be removed from the empiric treatment table due to high rates of resistance and should only be prescribed when pathogen is confirmed to be sensitive to amoxicillin.
Asymptomatic Bacteriuria in Pregnancy - June 2024
- Updated information on screening for asymptomatic bacteriuria in pregnancy
- Additional advice from the expert advisory group in the case of isolation of group B Streptococcus
Acute Epididymo-orchitis- June 2024
- Update to advice in treatment table regarding testing and distinguishing between likely pathogen sources.
Acute Prostatitis - June 2024
- Information added on when to refer
- Updated advice from expert advisory group including:
- The most important investigation in the evaluation of a patient with acute bacterial prostatitis is mid-stream urine culture.
- Imaging of the urinary tract is also advisable in men with acute prostatitis because of high prevalence of structural abnormalities.
Genital Infections - May 2024
Anogenital warts
- Treatment table updated as some products no longer readily available:
- Condyline® (Podophyllotoxin) cutaneous solution removed as no longer marketed in Ireland. Warticon® (Podophyllotoxin) cream remains available.
- Aldara® cream no longer marketed in Ireland. Price and availability may vary.
Syphilis
- Guidance reviewed and expanded expert advisory comments on congenital syphilis.
Gonorrhoea
- Information added on importance of gonorrhoea culture sensitivity testing to identify resistant strains
- Updated treatment table
Chlamydia
- Advice on sexual contact after treatment updated
- Recommendation to seek specialist advice in cases of chlamydia in pregnant or breastfeeding patients added.
Pelvic Inflammatory Disease
- Updated expert advisory commentary, including:
- Recommendation to test for trichomonas in addition to other recommended STIs in all women presenting with suspected PID
- Gonorrhoea culture sensitivity testing to identify resistant strains
Approach to an STI consultation in primary care:
- Information added on the National HSE free home STI testing services. This service is available to anyone aged 17 or older in the Republic of Ireland and can be accessed via www.sexualwellbeing.ie/hometesting.
Genital Herpes
- Updated antiviral treatment guidance.
Genital Candida (Thrush)
- Treatment table updated in line with product availability.
- Treatment recommendations added for vulvovaginal candidiasis and recurrent vulvovaginal candidiasis in pregnancy.
- Recommend duration of treatment of candida balanitis updated.
- Advice that treatment of asymptomatic sexual partners is not recommended.
Bacterial Vaginosis
- Expanded advice for patients experiencing repeated episodes of bacterial vaginosis.
- Treatment table updated, including recommendation for treatment choice in pregnancy.
Trichomoniasis
- Information added to support diagnosis and reduce the risk of transmission.
- Treatment with a 7 day course of metronidazole is now recommended in preference to single-dose metronidazole due to higher risk of treatment failure with the shorter course.
- Minor update to highlight dose reduction required for oseltamivir in renal impairment.
Good Practice Points for Antibiotics (Adults) - April 2024
Bites (Human/Dog/Cat) - April 2024
- The durations for both antibiotic prophylaxis and treatment have been updated. In addition, antibiotic options for children have been added.
- Addition of the updated HSE Factsheet on Engorgement, Ductal narrowing, Mastitis and Abscess as a useful resource.
- These tables have been updated to highlight the intended audience is prescribers. Doses may vary from product information and healthcare professional guidance is necessary to ensure accurate measurement of dose.
Antibiotic Prophylaxis of Infective Endocarditis for Dental Procedures - Feb 2024
- Update to antibiotic choice and indications for infective endocarditis prophylaxis in dental procedures
Dental and oral infections – Dec 2023
- Advice for GPs on the management of acute dental pain now added
Macrolide Warnings - December 2023
- Risk of adverse cardiovascular events and related drug interactions outlined.
H. pylori infection - December 2023
- Minor revision to state bismuth salt for the dose specified.
Urinary Tract Infections - November 2023
- Deprescribing UTI Prophylaxis – Reviewed with no content changes
- Recurrent UTI in Adult, Non-Pregnant Females - Minor revisions to content
Dental and Oral Infections - November 2023
The following guidelines have been reviewed and updated:
- Introduction to oral and dental infection guidelines
- How to write a prescription: Guidelines for Dentists
- Acute Dento-Alveolar Infection (Dental abscess)
- Necrotising Periodontal Disease (Necrotising Ulcerative Gingivitis)
- Angular Cheilitis
- Dry Socket (Alveolar Osteitis)
- Fungal Infections (oral)
- Pericoronitis
- Periodontal Abscess
Main updates include:
- Change to the recommended duration of antimicrobial treatment for pericoronitis, necrotising periodontal disease (necrotising ulcerative gingivitis) and fungal oral infections.
- Addition of weight-based dosing option for antimicrobials in children with severe infection or at extremes of body weight.
- New “Summary of Guidance for Common Dental Conditions (Adults)” which summarises key recommendations and first-line antimicrobial choices for common dental conditions.
Drug Interactions – September 2023
- Drug interactions tables updated and grouped into individual classes of antimicrobials.
Urinary tract infection (UTI) - September 2023
- Catheter-associated UTI: Differentiation between lower CA-UTI (not systemically unwell) and upper CA-UTI (systemically unwell) treatment options. Nitrofurantoin is a first-choice option for lower CA-UTI.
Minor revisions to the following guidelines:
Antimicrobial use in Residential Care Facilities – August 2023
- Layout updated and a new section added on the SKIP THE DIP for UTI in over 65s campaign.The use of urine dipstick tests in older people to assess for evidence of urinary tract infection (UTI) can lead to unnecessary antibiotic prescribing. This new initiative aims to improve the management of suspected UTI in older persons in residential care facilities.
Traveller's Diarrhoea (Anticipatory Management) - July 2023
- Change in name from” Travellers’ Diarrhoea” to “Travellers’ Diarrhoea (Anticipatory Management)” to highlight that antibiotic treatment is only indicated for those patients who are at high risk of severe adverse outcomes if they contract travellers’ diarrhoea
Threadworms - July 2023
- Updated threadworms section including link to additional hygiene advice to prevent reinfection.
Infectious Diarrhoea - July 2023
- Addition of links to HPSC guidance as well as updated advice regarding considerations for faecal sampling
Fluoroquinolone Warnings - July 2023
- Cautions with use of fluoroquinolone antibiotics, highlighting rare but disabling and potentially long-lasting side effects.
Approach to an STI consultation in Primary Care - June 2023
- Shigellosis information added to Approach to an STI consultation in Primary Care page and the gastro and genital conditions pages.
- Links to updated HPSC Shigella guidance in the context of current antimicrobial resistant Shigella species associated with gbMSM
Clostridioides difficile - April 2023
- Updated antibiotic treatment guidance for community and hospital settings, including advice for patients and carers
Staphylococcal Nasal Carriage - March 2023
- Updated guidance about considerations for prescribing
Respiratory Infections 2023 Winter Season: Advice & Antibiotic Supply – April 2023
- The seasonal page “Respiratory Infections 2023 Winter Season: Advice & Antibiotic Supply” has been stood down as of 3rd April 2023. For more information on specific product shortages, please check the HPRA website.
Approach to an STI consultation in Primary Care - March 2023
- MSM Asymptomatic STI Screen Quick Reference Guide updated to reflect change in PrEP eligibility criteria. Update of links to HSE PrEP guidance webpage (HSE ‘Clinical management guidance for individuals taking HIV PrEP within the context of a combination HIV (and STI) prevention approach in Ireland’ updated in 2022)
Cellulitis - March 2023
- Updated antibiotic treatment guidance, including advice for patients or carers
Clostridioides difficile - March 2023
- New safety summary sheet for oral vancomycin including information for dispensing pharmacists on how to make extemporaneous oral solution.
Renal Impairment Antimicrobial Prescribing - February 2023
- Updated renal impairment dosing tables with new agents added (e.g. Paxlovid®) and changes to recommended doses for agents including cefalexin, fluconazole, terbinafine.
Impetigo - Feb 2023
- Updated antibiotic treatment guidance, including advice for patients or carers
Dermatophyte infections of fingernail and toenail - Feb 2023
- Updated guidance on antifungal treatment and nail sampling.
Pityriasis versicolor - Feb 2023
- Updated guidance on topical and oral antifungal treatment and skin sampling.
Infected eczema - Feb 2023
- Updated antibiotic treatment guidance for adults and children, guidance on signs and symptoms of bacterial infection and bleach baths.
Tinea capitis - Feb 2023
- Antifungal treatment for adults and children updated and guidance on skin scraping and hair samples added.
Candidiasis - Feb 2023
- Cutaneous and oropharyngeal candidiasis treatment options updated and self-management advice added.
Dermatophyte Skin Infections - Feb 2023
- Topical antifungal treatment updated, self-management advice and skin sampling guidance added.
Chickenpox - December 2022
- Prescribing considerations for antivirals, self-care measures and dosing guidance for aciclovir in children added.
Shingles - December 2022
- Prescribing considerations for antivirals, self-care measures and dosing guidance for immunocompromised patients added.
Pharyngitis / Sore Throat / Tonsillitis - December 2022
- For scarlet fever, it is advisable to treat for 10 days duration
- Amoxicillin added as a second choice treatment option
Headlice - December 2022
- Treatment application details and patient information for wet combing added.
Scabies - December 2022
- Due to ongoing supply issues with topical agents, benzyl benzoate has been added as a third-line option. For treatment-resistant scabies ivermectin dosing guidance included.
Conjunctivitis - October 2022
- Chloramphenicol 0.5% Redidrops can be used with caution in children under 2yrs (recent HPRA update).
About Us - October 2022
- Updated details of Antibiotic Guidelines Editorial Group and contributors.
Infection Prevention and Control - October 2022
- We are delighted to launch our new infection prevention and control (IPC) webpage. This page contains some helpful guidance for managing IPC in the community along with some recommended HSEland e-learning modules for healthcare staff
UTI in Children - August 2022
- Additional clinical information provided as well as guidance on dipstick testing. Addition of co-amoxiclav as a second line agent for Upper UTI.
Upper and Lower Respiratory: Acute Cough in Children - August 2022
- A new section on the management of Acute Cough in Children (less than 3 weeks duration) has been added and includes information on appropriate management.
Lower Respiratory: Bronchiolitis in Children - August 2022
- A new section on the management of Bronchiolitis has been added and includes information on appropriate management. Bronchiolitis is generally a self-limiting disease usually not requiring investigation or treatment.
HSE antimicrobial stewardship (AMS) guidance for all healthcare settings – August 2022
- New AMS guidance for all healthcare settings published
- Am of the document is to provide support and guidance to AMS teams, healthcare facility managers, and the individual healthcare worker by providing the evidence, expert guidance, and tools they need to initiate and sustain AMS programmes.
- Provides guidance to the development of curricula, educational courses, and training programmes
Antimicrobial stewardship – August 2022
- Updated content
- Updated AMS patient resources, resources for healthcare professionals and audit tools
- New antimicrobial explainer infographic
Otitis Externa - August 2022
- new guidance on treatment of acute otitis externa.
- advice of self-care and how to apply ear drops.
Otitis Media in Children - August 2022
- Additional clinical information provided.
Lower UTI and Asymptomatic Bacteriuria in Pregnancy - July 2022
- Nitrofurantoin Prolonged Release Capsules added as treatment option
- Caution added re dosing/frequency for the two different formulations of nitrofurantoin available- these are not interchangeable
Nipple and breast thrush - July 2022
- Treat both mother and baby even if one of pair has no symptoms
- Nystatin added as treatment option in infants
- Miconazole for infants information updated to include dosing advice, risk of choking in infants < 4 months. Additional counselling required if prescribed in infants < 4 months.
Antimicrobial use in Residential Care Facilities - April 2022
- Report from Point Prevalence Survey on Antimicrobial Use in HSE Mental Health Residential Care facilities, Nov 2021- Jan 2022 now available. Check out the ‘Prescribing in long-term care facilities/nursing homes’ section
Prescribing for Children - March 2022
- Additional clinical information provided including guidance on the management of pain and discomfort in children, with new paracetamol and ibuprofen dosing tables. The addition of new dosing tables for doxycycline and metronidazole as well as updated dosing tables for all other antibiotics recommended for children in the guidelines.
Otitis Media in Children - March 2022
- Additional clinical information, paracetamol and ibuprofen paediatric dosing tables, and, the addition of a second choice antibiotic option.
Community Acquired Pneumonia in Children - March 2022
- Additional clinical information provided as well as updated treatment tables. Doxycyline, for certain patients, is now recommended as a 2nd line option from 8 years of age.
UTI in Children - March 2022
- Additional clinical information provided as well as guidance on dipstick testing.
Azithromycin prophylaxis - March 2022
- New consensus guidance for use of azithromycin prophylaxis in reducing exacerbations of severe COPD, bronchiectasis and asthma in adults endorsed by the National Antimicrobial Stewardship Advisory Group.
- Includes initiation criteria and baseline assessment recommendations. It should be initiated by a consultant in respiratory medicine or a consultant with a special interest in respiratory medicine.
- Recommended review every 6-12 months and if there is no evidence of clinical benefit or there is evidence of adverse effects, it should be discontinued.
Lower Respiratory, Pneumonia and Aspiration Pneumonia in Nursing Homes / Residential Care Facilities - March 2022
- New guideline for antibiotic treatment of pneumonia and aspiration pneumonia in nursing homes/ residential care facilities.
- Recommendations take into consideration older age, polypharmacy, dysphagia and renal impairment.
- Empiric antibiotic treatment for aspiration pneumonia generally does not require cover for anaerobic organisms.
- Drive for five: If antibiotics warranted, the recommended duration to treat is 5 days therapy.
Genital Conditions, Chlamydia - March 2022
- Update on use of Azithromycin therapy for chlamydia- only recommended if doxycycline contra-indicated. If indicated, stat dose of azithromycin not recommended - 3-day course is required.
Skin Conditions: Scabies - February 2022
- General advice for diagnosis and management of scabies enhanced, with the inclusion of images to aid diagnosis.
- Technique of topical application of products added including dosing and contact time.
- Patient Information Leaflet added.
Genital Conditions - February 2022
Approach to an STI consultation in Primary Care
- New section on Vaginal discharge- includes Quick reference guide for Vaginal discharge (Bacterial Vaginosis, Vaginal Candidiasis and Trichomoniasis)
- Patient resources section consolidated
Candida, Genital Thrush
- Updated treatment recommendation for recurrent candidiasis in pregnant women
Skin/Soft Tissue: Hidradenitis Suppurativa - January 2022
- Content updated and expanded with Hurley system of staging for HS added with images
- Treatment options updated as per staging
- Lymecycline added as an oral treatment option for papules or nodules associated with Hurley stage I or mild Hurley stage II.
Influenza: December 2021
COVID-19 acute respiratory infection (Adults) Dec 2021
- This guidance has been reviewed and the “Interim Guidance on Potential Role of Inhaled Budesonide for Persons in Community with COVID-19” has been removed.
- Inhaled budesonide should no longer be considered a potential treatment option for individuals with COVID-19 infection.
Epididymo-orchitis: December 2021
- Additional guidance on diagnosis and referral
Acute Prostatitis: December 2021
- Additional guidance on symptoms, diagnosis and STI screening if relevant.
Rosacea: December 2021
- Significant update. New content for examination, diagnosis and images added to aid diagnosis.
- New guidance on dosage, duration, and place in therapy for topical and/or oral agents for moderate and severe papules/pustules.
- For moderate papules/pustules, topical ivermectin or azelaic acid recommended.
- For severe papules/pustules, topical ivermectin plus low-dose doxycycline (or lymecycline) recommended.
- Guidance on use of Brimonidine for temporary treatment of redness added.
Acne Vulgaris: December 2021
- Significant update. New content for examination, diagnosis and images added to aid diagnosis and staging.
- New guidance on dosage, duration, and place in therapy for topical and/or oral agents for mild, moderate and severe acne.
- For mild acne, all treatment options are topical with Benzoyl Peroxide recommended first-line. Other options listed dependent on presence of comedones and/or inflammatory lesions (pustules).
- For moderate acne not responding to topical treatment, use of oral lymecycline in combination with a non-antibiotic topical is recommended first-line. Oral antibiotics are not recommended in combination with topical antibiotics. Oral antibiotics should be reviewed and limited to 3months if possible (max 6 months).
- Referral considerations for Isoretinoin added.
Asymptomatic Bacteriuria in Pregnancy: Section update December 2021
Lower UTI in Pregnancy: December 2021
- Warning signs added for when to consider Upper UTI/ Pyelonephritis
- Cefalexin (2nd choice treatment option) dose changed to 500 mg every 8 hours for 7 days
- Fosfomycin guidance on when to prescribe in pregnancy and directions on how to take fosfomycin for best absorption
What’s new – Lyme disease November 2021
- Additional guidance added on when to test, when to treat and when to refer
- Update on recommended duration of antibiotic treatment
- New guidance of prophylaxis of Lyme disease in children
- Section added on safety of doxycycline in children and prescribing/administration of dispersible doxycycline in children
Toolkit for Antimicrobial Stewardship in Residential Care Facilities November 2021
- A collection of supporting tools, documents and practice points for AMS in residential care
- NEW Decision-aid for Management of Suspected UTI
- HSELand module for Prevention & Management of UTI signposted
- Report of findings of Extended PPS of Antimicrobial Use in HSE RCFs for Older Persons published (includes data for CHO 2, 6,7, 9)
Upper and Lower Respiratory Tract infections: November 2021
- Guidelines reviewed and updated for Sinusitis, Pharyngitis/Sore throat, Acute Bronchitis/Cough, Infective exacerbation of COPD, CAP in Adults, COVID-19
- Drive for five: If antibiotics are warranted, all these indications now recommended to treat with 5 days therapy.
- All CAP treated in community now recommended at duration of 5 days including CRB-65 score 1-2 (reduced from 7days).
- COPD: Link to new National NCEC Clinical Guideline added.
NEW: Position statements for ‘The use of dipstick urinalysis to assess for evidence of urinary tract infection in adults’. September 2021:
- Consensus best-practice statements for the use of dipstick urinalysis endorsed by the National Antimicrobial Advisory Group.
- Inappropriate use of dipstick urinalysis can lead to unnecessary antibiotic prescribing which does not benefit the patient and may cause considerable harm.
- Best-practice statements include advice on the use of dipstick urinalysis to assess for evidence of UTI in several patient cohorts such as:
- Females (non-pregnant) <65yrs
- Males <65yrs
- Pregnant females
- All persons >65yrs
- All persons with a urinary catheter
- Asymptomatic persons
Treatment of urinary tract infections in adults reviewed and updated, September 2021:
Guidelines on genital conditions updated July 2021, of particular note:
- Chlamydia: Additional information on rectal infection with invasive chlamydia types (Lymphogranuloma (LGV) types), test of cure and window period
- Anogenital warts: Updated HPV vaccine recommendations and drug treatment option
- Genital Herpes: Patient resources updated
- Candida: Update on use of high vaginal swab and treatment options
- Gonorrhea: Referral criteria to GUM clinic; window period; treatment options and resistance information
- Trichomoniasis: Updates on referral criteria; window period, test of cure information; drug counselling points
- Bacterial Vaginosis: Update on use of high vaginal swab and drug counselling points
- PID: Referral criteria to GUM clinic, including Mycoplasma genitalium guidance
Approach to an STI consultation in Primary Care, July 2021
- Incudes quick reference guides for asymptomatic screening in primary care
- Additional information on sexual history and STI testing
- Window period explained, lookback periods/partner notification information listed for the different STIs
- Also includes information on non-specific urethritis, HIV pre-exposure prophylaxis and genital care resources available for patients
- Links to further resources for healthcare professionals and patients
Conjunctivitis: May 2021
- The use of Chloromycetin® Eye Drops contraindicated in children under 2 years (due to presence of excipient Boron).
- Printable content added regarding self-care advise for the patient presenting with sticky eye/conjunctivitis.
- Content added regarding when to swab, refer or seek specialist input.
Antimicrobial Stewardship in Community July 2021
Suspected Meningococcal Disease May 2021
Section updated with administration information added
COVID-19 acute respiratory tract infection May 2021
Interim guidance on role for inhaled budesonide.
Oral Infections (previously Dental infections) March 2021
Treatment of oral and dental infections revised and updated.
Acute Dento-Alveolar Abscess:
If antibiotics are indicated, phenoxymethylpenicillin now preferred option instead of amoxicillin (unless adherence likely to be challenging)
Angular Cheilitis:
- Additional guidance provided regarding eradication of bacterial or fungal reservoir.
- Terbinafine 1% provided as option for patients on warfarin where use of miconazole should be avoided.
Fungal Infections
- Additional guidance provided regarding management of breastfeeding mother for an infant with oral candida infection.
- Use of oral fluconazole should be reserved for severe cases or those who are non-responsive to first-line therapies.
- All patients who require fluconazole should be seen by their GP for investigation into possible underlying causes.
Gastro Conditions March 2021
Clostridium difficile
Name change: Clostridium difficile → Clostridioides difficile. Criteria for assessing non-severe versus severe C. Diff added.
Threadworms
- Removal of piperazine as a treatment option – no longer available in Ireland
- Additional information re. 2nd dose of mebendazole administered after 2-4 weeks
- Mebendazole is unlicensed in < 2year olds but some evidence to support use at > 6 months of age.
Travelers' Diarrhoea
- Change from Ciprofloxacin to Azithromycin as recommended antibiotic if treatment is required.
- Additional clinical information and links have been added.
Respiratory tract infections February 2021
For pregnancy, if macrolide considered necessary, azithromycin added as an option for all trimesters.
Pregnancy and Postpartum infections February 2021
- Additional Patient information resources added to all sections
- Additional Healthcare Professional information resources added to Prescribing Antimicrobials in Pregnancy and Lactation page
Asymptomatic Bacteriuria in Pregnancy new content! February 2021
- Advice on when and how to test for and treat asymptomatic bacteriuria in pregnancy
- Urine culture remains the gold standard for detection of asymptomatic bacteriuria
- Dipstick testing is not sufficient to screen for bacterial UTIs in pregnancy.
- Drug treatment based on the bacteria isolated in urine culture and trimester of pregnancy
Nipple and breast thrush: February 2021
- The use of all-purpose nipple ointment is not recommended as treatment option.
- Additional information points on use of miconazole for mother and baby.
Helicobacter pylori: December 2020
- H. Pylori duration of treatment for all treatment regimens has been increased from 7 days to 14 days in line with published national guidelines.
- A Bismuth quadruple regimen, if available, has been added as a 1st line treatment option. A levofloxacin regimen has also been added but should be reserved as a 2nd line option for failed treatment eradication.
Pharyngitis/ sore throat / tonsillitis: December 2020
- Cefalexin is an option for non-severe penicillin allergy, if antibiotic deemed necessary.
- Majority are viral however if antibiotics deemed necessary, recommended duration now 5 days (instead of 10 days)
Lyme Disease, Nov 2020
- Criteria for post-exposure prophylaxis updated
Seasonal Influenza, Nov 2020
- Seasonal Influenza page updated for 2020/2021 season.
- Duration of treatment for oseltamivir in immunocompromised patients changed to 10 days.
- Links to Coronavirus COVID-19 information added.
COVID-19 acute respiratory infection, Nov 2020
- Link to HSE COVID-19 repository added
- Updated re advice on penicillin allergy in pregnancy.
Drug Interactions Table update, Nov 2020
Drug interactions information updated for Neuraminidase inhibitors
Upper Respiratory Tract Infections, Nov 2020
- Pharyngitis: Majority are viral however if antibiotics deemed necessary, recommended duration now 5 days (instead of 10 days)
- Sinusitis (adults): Majority are viral however if antibiotics deemed necessary, doxycycline (first line if penicillin allergy) can be dosed at 200mg daily.
Lower Respiratory Tract Infections Nov 2020
- Doxycycline (often first line if penicillin allergy) can be dosed at 200mg daily across the range of lower respiratory tract infections.
- Duration of recommended therapy for community-acquired pneumonia reduced; 5 days for CRB-65 score 0 (instead of 5-7days), 7 days for CRB-65 score 1-2 (instead of 7-10 days)
- Recommend higher dose amoxicillin (1g tds as opposed to 500mg tds) for community-acquired pneumonia CRB-65 score 1-2
New content to support deprescribing UTI prophylaxis, Nov 2020
- All UTI prophylaxis should be reviewed at 3-6mths with a view to stopping as many patients can stop without a return of symptoms.
- There is no evidence of additional benefit beyond 3-6 months but there is significant evidence of harm.
About Us, Nov 2020
- Contact details for community antimicrobial pharmacists added.
- List of contributors updated
UTI in Long Term Care Residents over 65, Nov 2020
Diagnosis & Management of Urinary Tract Infection (UTI) in Residential/Long Term Care/Nursing Home Residents (non-catheter associated)
- Nitrofurantoin now first choice for uncomplicated UTI (Trimethoprim removed), or Cefalexin if nitrofurantoin unsuitable.
- Recommended duration for uncomplicated UTI is 3 days for females, 7 days for males
- Cefalexin now recommended first choice for acute pyelonephritis (duration 7-10 days)
Diagnosis & Management of Catheter-Associated Urinary Tract Infection (CA-UTI) in Residential/Long-Term Care/Nursing Home Residents
- Non-specific signs & symptoms of CA-UTI in elderly residents included (but consider COVID-19)
- Cloudy urine or foul-smelling urine do not indicate an infection in absence of signs and symptoms of infection.
- CA-UTI to be treated like an upper UTI, with cephalexin 1st choice (unless guided otherwise by culture). Use of nitrofurantoin or trimethoprim for CA-UTI removed.
Green/Red antibiotic quality improvement initiative. Nov 2020
Includes background information and a summary of positive key trends observed with this important quality improvement initiative.
Videos on safe Antibiotic use - Nov 2020
Renal Impairment Summary Sept 2020
- Medicines list expanded to include anti-fungals and anti-helmintics
- Advice on Fosfomycin updated (avoid if CrCl <10ml/min)
- Advice on Nitrofurantoin updated (contraindicated if CrCl <30ml/min, caution in use if CrCl 30-45ml/min)
Animal and Human Bites Sept 2020
- Content of both pages merged
- Expanded advice on general management and antibiotic prophylaxis
- Duration of prophylaxis 5 days, duration of treatment 7 days
COVID-19 acute respiratory infection May 2020
COVID-19 is a viral infection.
Antivirals or agents with antiviral properties for COVID-19 should not be prescribed for treatment or prophylaxis in the community, unless as part of a clinical trial.
Secondary bacterial infection appears uncommon in COVID-19 patients.
Key messages from AMRIC to community prescribers March 2020
Tips on safe us of clarithromycin, and important safety concerns for fluoroquinolones especially moxifloxacin are just some of the items covered
Recurrent UTI in Adult, Non-Pregnant Females March 2020
This guideline refers to symptomatic culture-proven recurrent urinary tract infection (UTI)
It covers non-antimicrobial measures, antibiotic prophylaxis. It is important to remember that recurrent or persistent lower urinary tract symptoms are not always due to recurrent UTI. Other conditions such as STI, postmenopausal atrophic vaginitis and dermatological conditions often cause similar symptoms.
Antimicrobial prophylaxis should be reviewed after 3-6 months with a view to stopping
