CEPP National Audit – Focus on Antibiotic Prescribing

6. CEPHALOSPORIN PRESCRIBING

Background

AWMSG NPI: Cephalosporin items as a percentage of total antibacterial items.

Cephalosporin items per 1,000 patients

Information from PHEManagement of Infection Guidance for Primary Care for Consultation and Local Adaptation1:

Illness / Comments / Medicine / Dose / Duration of treatment
UTI in pregnancy
PHE URINE
CKS / Send MSU for culture and start antibiotics1A
Short-term use of nitrofurantoin in pregnancy is unlikely to cause problems to the foetus2C
Avoid trimethoprim if low folate status3 or on folate antagonist (e.g. antiepileptic or proguanil)2 / First line: nitrofurantoin
if susceptible, amoxicillin / 100 mg m/r BD
500 mg TDS / All for 7 days6C
Second line: trimethoprim
Give folate if 1st trimester / 200 mg BD (off-label)
Third line: cefalexin4C,5B- / 500 mg BD
UTI in children
PHE URINE
CKS
NICE / Child < 3 months: refer urgently for assessment1C
Child ≥ 3 months: use positive nitrite to guide
Start antibiotics1A+ also send pre-treatment MSU
Imaging: only refer if child < 6 months, or recurrent or atypical UTI1C / Lower UTI: trimethoprim1A or nitrofurantoin1A
If susceptible, amoxicillin1A
Second line: cefalexin1C / See BNF for dosage / 3 days1A+
Upper UTI:
co-amoxiclav1A
Second line: cefixime2A / 710 days1A+
Pelvic inflammatory disease
BASHH
CKS / Refer woman & contacts to GUM service1,2B+.
Always culture for gonorrhoea & chlamydia2B+.
28% of gonorrhoea isolates now resistant to quinolones3B+ If gonorrhoea likely (partner has it, severe symptoms, sex abroad) use ceftriaxone regimen or refer to GUM. / Metronidazole PLUS
Ofloxacin1,2,4,6B / 400 mg BD
400 mg BD / 14 days
14 days
If high risk of gonorrhoea:
Ceftriaxone3,5C PLUS
Metronidazole6 PLUS
Doxycycline1,2,4B+ / 500 mg IM
400 mg BD
100 mg BD / Stat
14 days
14 days
Suspected meningococcal disease
PHE Meningo / Transfer all patients to hospital immediately.
IF time before hospital admission, and non-blanching rash, give IV benzylpenicillin or cefotaxime1-3B+ unless definite history of hypersensitivity / IV or IM benzylpenicillin
OR
IV or IM cefotaxime / Age 10+ years: 1200mg
Children 1–9 yr: 600mg
Children <1 yr: 300mg
Age 12+ years: 1gram
Child < 12 yrs: 50 mg/kg / (give IM if vein
cannot be found)

Cephalosporins are not recommended by PHE for the treatment of acute cough, bronchitis or exacerbation of COPD;please see PHE guidance or acute cough/acute bronchitis section of the audit.

BNF

Long-term low dose therapy may be required in selected patients [with recurrent UTI] to prevent recurrence of infection; indications include frequent relapses and significant kidney damage. Trimethoprim, nitrofurantoin and cefalexin have been recommended for long-term therapy2.

Method

Assess a reasonable sample of records per prescriber with prescription of a cephalosporin against national guidelines (see section on Sample size). Start the searches using a 3-month window and extend it if necessary to reach the required number of cases.

Following the audit, complete the Review Sheet.

Data collection sheet

Patient / Cephalosporin prescribed(name) / UTI in children?(Y/N) / UTI in pregnancy?(Y/N) / Pelvic inflammatory disease?(Y/N) / Laboratorysensitive(Y/N) / Other(Please list) / Indicated?(According to national/local guidance or lab sensitivity)(Y/N)
Total
% Yes
Standard / 95%

REFERENCES

1 Public Health England. Management of infection guidance for primary care for consultation and local adaptation. 2014. Available at: Accessed Feb 2015.

2 British Medical Association, Royal Pharmaceutical Society of Great Britain. British National Formulary. No. 68. 2014.

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