1.
Do not use antibiotics in asymptomatic bacteriuria.
Antibiotic treatment of patients with asymptomatic bacteriuria is generally not indicated as it does not decrease the incidence of symptomatic urinary tract infection. This also includes patients with indwelling urinary catheters. Exceptions to this are pregnant women and those undergoing an urological procedure.
Supporting evidence
- Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A , Hooton TM. Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults. Clinical Infectious Diseases 2005;40:643-54.
- Ariathianto Y. Asymptomatic bacteriuria: Prevalence in the elderly population. Australian Family Physician. 2011:40(10):805-9.
- Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2014.
- Jarvis TR, Chan L, Gottlieb T. Assessment and management of lower urinary tract infection in adults. Australian Prescriber 2014;37:7-9.
How this list was made
An initial list of 10 low value interventions was compiled by the Lead Fellow of the Australasian Society for Infectious Diseases (ASID) Inc following an online discussion in ASID's discussion forum, Ozbug. The Royal Australasian College of Physicians (RACP) then facilitated a consultation of all ASID members via a survey distributed through the society’s e-newsletter. In the survey, members were asked to rank the 10 suggested interventions and suggest additional items for consideration. A subsequent shortlist of items was created by selecting the top 7 interventions as ranked by the members from the initial list.
The shortlist was sent to ASID’s special interest groups and selected members who had agreed to assist, who were asked to recommend the items to comprise the ‘top 5’. This final list was endorsed by ASID Council on 31 July 2015. The Top 5 was then circulated again to the ASID members for final comments before being signed off by ASID’s Executive Committee.
- 1 Do not use antibiotics in asymptomatic bacteriuria.
- 2 Do not take a swab or use antibiotics for the management of a leg ulcer without clinical infection.
- 3 Avoid prescribing antibiotics for upper respiratory tract infection.
- 4 Do not investigate or treat for faecal pathogens in the absence of diarrhoea or other gastro-intestinal symptoms.
- 5 In a patient with fatigue, avoid performing multiple serological investigations, without a clinical indication or relevant epidemiology.