News

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‘Unprecedented’ update to antibiotic guidelines

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Significant updates to GPs’ ‘go-to resource’ for antibiotic use are now out, Therapeutic Guidelines has announced.
 
Flagging changes on an ‘unprecedented’ scale, the not-for-profit publisher – which promotes the quality use of medicines – has confirmed the first of three updates to its Antibiotic Guidelines is now available, with new information relating to common infections treated in primary care.
 
The update also includes revisions for the treatment of serious infections managed in hospitals.
 
Covering more than 1400 drug recommendations, Therapeutic Guidelines described the process as ‘a comprehensive multidisciplinary review of more than 200 existing or new clinical topics’.

Therapeutic Guidelines managing editor Jessica Gibney said the scale of the updates is a response to a changing clinical environment.
 
‘The size of the update reflects both the increased complexity of the evidence base and a move towards more tailored multidisciplinary expert groups,’ she told newsGP.
 
She said six expert groups worked on the update, the result of ‘an end-to-end review’ of the existing guidelines, including one for infections mostly seen in primary care such as cystitis, otitis media and community-acquired pneumonia.
 
According to Ms Gibney, the primary care group included infectious diseases physicians, microbiologists, four GPs, a geriatrician and a range of other clinicians.
 
The newly released updates include new patient information, images and diagrams, as well as an aminoglycoside-dosing calculator.
 
She said the importance of the changes in the update varies, but editors working with the primary care group have identified those of particular significance for general practice:

• Nitrofurantoin is now recommended as the first-line treatment of acute cystitis in nonpregnant adults because of high trimethoprim resistance among Escherichia coli (E.coli). It is also recommended first for children who can swallow tablets and capsules and weigh 29 kg or more
• Increased dosages of beta lactams for pyelonephritis to ensure adequate antimicrobial exposure and activity against enterobacterales such as E. coli
• Increased dosage of amoxicillin+clavulanate for pyelonpehritis and diabetic foot, rising to 875+125 mg orally, eight-hourly to ensure adequate drug exposure
• An option to allow eight-hourly dosing of cefalexin for some cefalexin recommendations (such as for treating cellulitis and pyelonephritis) using a higher dose, due to the challenges of giving medicines every six hours to children

Professor Mark Morgan, Chair of RACGP Expert Committee – Quality Care, said there is an increasing need for clinical practice guidelines to have regular updates to keep up with scientific medical advances.
 
He described Therapeutic Guidelines as the ‘go-to resource for antibiotic use’ in Australia.
 
‘For antibiotic use there is also a changing landscape of resistance patterns and regional or seasonal variations exist,’ he told newsGP.
 
‘This means that GPs ideally need to check guidelines regularly to see if there have been changes.
 
‘This takes time, which is problematic when every minute counts for patient care.’
 
Professor Morgan said the list of changes and new content included in the updated guidelines is ‘extensive’ and unlikely to be memorised.
 
‘There is value in ensuring GPs have access to Therapeutic Guidelines whenever and wherever GPs provide healthcare,’ he said.
 
‘Access can be very clunky if it involves logging into training portals, institutional subscriptions or academic library services.’
 
Noting that some GPs access Therapeutic Guidelines via a mobile app which updates regularly, Professor Morgan also said there is a wider, untapped potential for technological innovations to help.
 
‘Dissemination of information about changes is important,’ he said.
 
‘News articles and landing pages aside, there is a burning need for slick computer decision support to pop up the relevant information at the moment of need.’
 
Professor Morgan said he now hopes it is not long before artificial intelligence (AI) scribes are linked with computer decision support to provide ‘contextual pop ups from trusted sources’.
 
‘I don’t want computer decision support to tell me what to do – but I would like it to provide excellent information from accepted guidelines better than my fallible memory,’ he said.
 
‘At the moment AI scribes have a tendency to fill in blanks by making stuff up which is of course risky.’
 
With a range of topics still being revised, a further update to the Antibiotic Guidelines is due to be released later this year, followed by a third in 2026.
 
For further details on changes to the Antibiotic Guidelines, see the Therapeutic Guidelines website.
 
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antibiotics quality care Therapeutic Guidelines

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