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NICE warns against inappropriate antibiotic use for leg ulcers

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The National Institute for Health and Care Excellence has today issued draft guidance for healthcare professionals to help reduce inappropriate antibiotic use in adults with leg ulcers. 

The antimicrobial prescribing guidance warned nurses to be aware that although many ulcers were commonly colonised with bacteria, most were not infected.

Therefore, NICE  said it was important for staff to recognise that antibiotics did not help to promote healing when a leg ulcer was not clinically infected.

Antibiotics should only be offered when there were clear signs and symptoms of infection, which could include discharge, fever, malodour and cellulitis, the draft guidelines stated.

The guidance comes as part of a warning from the institute that the overuse of antimicrobials is contributing to a “global threat of worldwide antimicrobial resistance”.

Under the guidelines, NICE also provided staff with recommendations for when they were choosing an antibiotic to give to their patient. It noted that healthcare professionals should take into account the severity of symptoms, the risk of developing complications and previous antibiotic use.

Initially, oral antibiotics should be given, if the person was able to take them, stated NICE.

If intravenous antibiotics were given, it should be reviewed after 48 hours, according to the draft guidelines.

NICE recommend that Flucloxacillin was the first choice of oral antibiotic and should be administered at 500mg four times a day for seven days.

As part of the draft guidelines, NICE also suggested that when prescribing antibiotics, staff should give their patients advice about seeking medical help if symptoms of their infection worsened rapidly or significantly at any time, or if they did not start to improve within two to three days.

In addition, NICE has given recommendations for the reassessment of adults with an infected leg ulcer.

The institute stated that reassessments should take place if symptoms or signs of the infection worsened, or if the patient became systemically very unwell or had severe pain out of proportion to the infection.

When carrying out a reassessment, the draft guidance stated that staff should take into account any symptoms suggesting a more serious condition or illness, such as sepsis, necrotising fasciitis, osteomyelitis or lymphangitis.

Healthcare professionals should also consider other co-morbidities, such as diabetes, as well as the patients’ previous antibiotic use, which may had led to resistant bacteria, the guidance noted.

During a reassessment, NICE recommended that staff should consider sending a sample, from deep within the leg ulcer after cleaning, for microbiological testing if the infection was worsening or had not improved with a completed course of 20 antibiotics.

The guidance also comes as the Royal College of Nursing (RCN) welcomes government action in the ongoing fight against superbugs, which involves the appointment of Dame Sally Davies as the UK’s first special envoy on antimicrobial resistance.

The RCN announcement followed the publication earlier this year of the government’s 20-year vision and five-year national action plan, setting out how the UK will contribute to containing and controlling antimicrobial resistance by 2040.

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