The third set of practice-changing updates to the Antibiotic Guidelines have been released.
The updates outlined changes in the areas of perinatal infections, surgical prophylaxis, skin and soft tissue infections and traumatic wounds.
The Antibiotic Guidelines provide advice on managing almost 200 unique infections. These latest changes follow updates in March and September.
Perinatal infections
Among the changes to perinatal infections treatments, there are new alternatives to penicillin included to support combination prophylaxis in patients who have penicillin hypersensitivity.
The septic abortion topic has been expanded to include drug recommendations for treatment of non-severe and severe septic abortion and advice on modification and duration of therapy.
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The combination of amoxicillin (or ampicillin) plus macrolide continues to be recommended for prophylaxis for preterm prelabour rupture of membranes (PPROM). Azithromycin is now an alternative to erythromycin and metronidazole is now included in the first line regimen for intra-amniotic infection to target a broader range of anaerobic bacteria.
Surgical prophylaxis
In regard to surgical prophylaxis, a cefazolin dose of 3g is now recommended for adults who weigh 120kg or more and have a glomerular filtration rate more than 40mL/min.
Cefazolin is now recommended in patients with a history of severe immediate penicillin hypersensitivity who are undergoing a procedure in hospital and there has been a complete revision of aminoglycoside dosing.
The guidelines now point out that evidence on alternative routes of administration – other than oral, intramuscular, and intravenous – for surgical prophylaxis is limited.
They also include a new topic on surgical prophylaxis for emergency exploratory laparotomy provides guidance on indications for prophylaxis, recommended antibiotic regimens and other key considerations.
Vascular and wounds
The vascular procedures covered in the guidelines have been expanded to include endovascular and hybrid procedures commonly performed in modern vascular surgical practice.
The updates on skin and soft tissue infections include expanded guidance on lactational mastitis to include clearer diagnostic criteria to distinguish it from localised breast inflammation.
RELATED: Sweeping updates to antibiotic guidelines
The new guidelines also include comprehensive nonantibiotic management advice, detail on intravenous antibiotic regimens and advice for patients not responding to treatment, including when and how to collect a sample of expressed breastmilk for culture.
Choice of empirical antibiotic therapy for surgical site infections now depends on the surgical wound stratification and the risk of methicillin-resistant Staphylococcus aureus (MRSA) infection.
To improve usability, the traumatic wound topics have been significantly restructured.
Trimethoprim+sulfamethoxazole is now the oral antibiotic recommended for all water-immersed traumatic wound infections and choice no longer depends on whether the water was fresh, brackish, or salt. However, metronidazole should still be included in the treatment regimen for infected wounds immersed in soil- or sewage-contaminated water.
Practitioners may also be interested in the Therapeutic Guidelines summary, of which a number have been updated.
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