What is new in this version?

New 13th August 2025

• Updated Asplenia prophylaxis guidance

New 11th July 2025

• Updated rabies post exposure prophylaxis guidance

New 2nd July 2025

• Updated notifiable diseases guidance

New 27th June 2025

• Updated to include Hibiwash the Skin decolonisation pre-procedure and MRSA decolonisation guidelines

New 17th June 2025

• Upper GI bleeding in patient with cirrhosis including variceal bleeding guideline updated

New 16th June 2025

• Updated guidelines:

  • Dermatophyte infection

  • Open Skull Fracture including CSF leak post skull fracture

  • Intracranial injury (penetrating)

  • Infected Cranioplasty

  • Community-acquired Brain Abscess

  • Spinal Infection: community acquired. Epidural or intraspinal abscess / Discitis / Vertebral osteomyelitis

  • Spinal infection: post-surgery or post instrumentation

• Neurosurgery prophylaxis - update of high risk neurosurgery guidance and addition of trans-sphenoidal surgery guidance. 

• Neutropenic sepsis guideline - addition of mention of neutropenic sepsis powerplan

 

New 20th May 2025

• Updated guidelines:

  • • Serious deep neck space infections

    • Otitis media (acute suppurative) + mastoiditis

    • Pelvic inflammatory disease

    • Ante-natal infection (chorioamnionitis, PROM with signs of infection, Sepsis of unknown cause)

       

New 19th May 2025

• Updated amphotericin B liposomal (Tillomed/Gilead/AmBisome) monograph
• Updated flucytosine monograph
• Updated itraconazole monograph

New 14th May 2025

• Updated guidelines:

  • Sepsis of unknown origin

  • Ante-natal or post-partum - severe sepsis / septic shock

  • Urosepsis

  • Pyelonephritis

  • Cancer, head & neck, after excision

  • Infected facial Internal fixator device

  • Facial injuries (traumatic) infected

  • Mandibular osteomyelitis, acute

  • Pharyngitis / tonsillitis (including peritonsillar abscess)

  • Suppurative parotitis (inc other salivary gland infection)

  • Sinusitis, acute bacterial

  • Pinna cellulitis / perichondritis

  • MRONJ (medication related osteonecrosis of the jaw

    Removed CAP sepsis guideline as now within the updated sepsis of unknown origin guideline.

New 13th May 2025

• Posaconazole drug monograph updated

New 12th May 2025

• Situations where antimicrobials may cause harm folder updated to include Amphotericin B liposomal MHRA Drug Safety alerts (2018 and 2020) and flucytosine MHRA Drug safety alert (2020)

New 9th May 2025

• Situations where antimicrobials may cause harm folder updated to include posaconazole MHRA Drug Safety alert (2016)

New 1st May 2025

• New isavuconazole drug monograph

New 29th April 2025

• Meropenem drug monograph updated

New 25th April 2025

• Updated soft tissue injury, significant contamination or established infection guideline to add cefazolin option

New 24th April 2025

• Vancomycin drug monograph updated
• Fluconazole drug monograph updated
• Voriconazole drug monograph updated

New 23rd April 2025

• Methenamine drug monograph updated

New 1st April 2025

• Updated cefazolin monograph 

New 25th March 2025

• Updated Audiometry and intravenous aminoglycosides guideline
• Updated Sepsis Identification and Management guideline
• Removed guidance about Influenza vaccination for long stay patients as campaign has ended
• Updated Recurrent UTIs guideline
  

New 21st March 2025

• Situations where antibiotics may cause harm folder updated to include antifungals - added voriconazole MHRA Drug Safety alert (2014)

New 20th March 2025

• Updated Alveolar bone grafting guideline
• Updated Dental infections guideline
• Updated Facial cellulitis (excluding pinna) guideline

New 19th March 2025

• New drug monograph for rezafungin

New 18th March 2025

• Updated Hepatic Encephalopathy guideline - no clinical changes to this guideline
• Updated Acute severe pancreatitis with no clear evidence of infection - no clinical changes to this guideline
  
• COVID folder updated. Several items removed. Thromboprophylaxis guideline updated
• Updated Pathogen specific therapy for intravascular catheter related infections guideline
  
• Updated flucloxacillin, meropenem and piperacillin-tazobactam drug monographs to include links to the continuous intravenous infusion protocols used in critical care

New 17th March 2025

• Updated Intra-abdominal infection guideline
• Updated Diverticulitis and appendicitis conservative management guideline
• Updated Penetrating abdominal trauma guideline
• Updated Cholecystitis or ascending cholangitis guideline
• Updated Appendicitis perforated or gangrene guideline
• Update Liver abscess guideline

New 14th March 2025

• Updated Cellulitis, lower or upper limb guideline
• Updated Leg ulcer - infected guideline
• Updated Management of patients with tetanus-prone wounds
• New probenecid drug monograph 

New 13th March 2025

• Updated aciclovir drug monograph
• Updated Meningitis: community-acquired guideline
• Updated Meningitis: post neurosurgical infection
• Updated Shunt (CNS) infection: VA/VP shunt, EVD or lumbar drain guideline
  
• New guideline Bacterial Meningitis and Meningococcal disease: Recognition and Management 

New 12th March 2025

• Updated linezolid drug monograph
• New guideline: Community Acquired Meningitis – Pathogen specific 

Information on 12th March 2025

• Between Mid January and 12th March all of the drug monographs have been updated to include AWaRe antibiotic classification and where appropriate a link has been added to the NetFormulary for restricted antimicrobials.

New 27th February 2025

• New AMS consultant dashboard user guide

New 26th February 2025

• New antimicrobials in pregancy and breastfeeding guideline

New 25th February 2025

• Updated IVPO switch section

New 24th February 2025

• Updated nitazoxanide drug monograph 
• Updated nystatin drug monograph
• Updated paromomycin drug monograph
• Updated pristinamycin drug monograph

New 14th February 2025

• HCID folder updated to include links to HCID sharepoint pages.

New 11th February 2025

• Updated encephalitis guideline

New 10th February 2025

• New guidelines superficial and invasive candida infections (to replace candida infections guideline)
• Updated management of candidaemia in critical care guideline

New 5th February 2025

• Updated Healthcare associated infection folder structure
• Updated Catheter associated infection folder - updated in response to advice from Continence team
• Updated Cardiac and thoracic surgery prophylaxis guidelines 
• New page in Situations where antibiotics may cause harm section re Co-trimoxazole and related prescribing points
• Updated co-trimoxazole drug monograph
• Updated Otitis externa guideline

 

New 4th February 2025

New 31st January 2025

• New guidelines: Penicillin Allergy: Assessment and Overview and Penicilin allergy: Challenge and Delabelling  
• Link to the penicillin allergy delabelling guidelines updated throughout the adults guidelines
• Statement related to gentamicin monitoring updated throughout relevant guidelines

New 30th January 2025

New 29th January 2025

• Updated Helicobacter pylori infection guideline
  
• Updated Post placement of bone-anchored hearing aid (BAHA) or cochlear implant guideline
• Updated Acute Porphyria guideline
• New guideline: Preparing and administering antimicrobial with heparin line locks
  

New 28th January 2025

• New TB Screening traffic lights (before biologic drug therapy) guideline
• New Latent TB Infection Screening (before biologic drug therapy) guideline
• Updated Prevention of secondary meningococcal disease guidance 

New 17th January 2025

• New section for Acute Hospital At Home guidelines

New 13th January 2025

• Addition of information about limited supplies of zanamivir iv to zanamivir drug monograph and influenza treatment guidance.

New 9th January 2025

• Inclusion of poster for RECOVERY trial in influenza section

New 6th January 2025

• Gentamicin statements updated throughout treatment guidelines containing gentamicin

New 2nd January 2025

• Influenza guidance split into 3 separate guidelines
• Trimethoprim drug monograph updated

New 20th December 2024

• Updated Head and Neck Surgical Prophylaxis name to include ENT and remove metronidazole for penicillin allergy severe 
• Amphotericin B liposomal nomenclature updated, dose updated and test dose removed.  
• Updated Post bowel transplant treatment guideline

Amphotericin B liposomal (Tillomed/Gilead/AmBisome) nomenclature updated

• Management of Candida Infections 
• CNS shunt infection (VA/VP, EVD or LD associated)  
• Amikacin monograph 
• Gentamicin monograph 
• Vancomycin monograph 
• Antifungal TDM antifungal  

Amphotericin B liposomal (Tillomed/Gilead/AmBisome) nomenclature updated, information regarding test dose removed, added information about using product from same manufacture for a single dose

• Amphotericin B liposomal (Tillomed/Gilead/AmBisome) monograph

New 12th December 2024 

• Updated Clostridioides Difficile Infection (CDI) guideline 

New 11th December 2024

• Updated Rabies Post Exposure guidance
• New TB folder which includes contact details for TB specialist team
• Addition of RECOVERY trial contact details to influenza guideline

New 2nd December 2024

• Updated Infection consults - how to access help section

New 28th November 2024

• Updated MRSA decolonisation guideline
• Updated Skin decolonisation guideline
• Addition of link to Correct Blood Culture Sampling Video and creation of a Blood Culture Folder.

New 18th November 2024

• Updated Infective Endocarditis Treatment guideline
• New 'Gentamicin - infective endocarditis monitoring' drug monograph 

New 15th November 2024

• Updated FESS and Rhinosinusitis, Chronic guideline
• Updated Rhinoseptoplasty and Septoplasty guideline
• Updated Post-tonsillectomy bleed guideline 
• Updated Epistaxis - Nasal packing guideline
• Updated Post placement of bone-anchored hearing aid (BAHA) or cochlear implant guideline

New 6th November 2024

• Update oseltamivir monograph table added regarding action to take depending on flu result  
• Update zanamivir monograph table added regarding action to take depending on flu result  

New 25th October 2024

• Update Tocilizumab preferred brand option to Roactemra due to Tyenne shortage

New 17th October 2024

• Updated FESS and Rhinosinusitis, Chronic guideline

New 16th October 2024

• Updated cardiothoracic surgery infections (post op) guideline

New 18th September 2024

• Updated remdesivir monograph within COVID section

New 12th September 2024

• New flucloxacillin continuous infusion for critical care areas drug monograph.

New in version 19.2 (19th July 2024)

• Updated within Legionnaires disease guideline the moxifloxacin dose.

New in version 19.1 (10th July 2024)

• No change to clinical content.

New in version 19 (10th July 2024)

• Updated Superficial eye infections guideline
• Updated Traumatic eye injury guideline
• Updated Keratitis guideline
• Updated Endophthalmitis guideline
• Updated Blebitis, Acute guideline
• Updated Viral conjunctivitis guideline
• Updated Acute bacterial conjunctivitis guideline
• Updated Acute diarrhoea guideline - updated Salmonella and Shigella to remove ciprofloxacin
• Updated Co-trimoxazole desensitisation guideline
• Updated Pouchitis guideline
• Updated Necrotising fascitis guideline
• Updated Penetrating chest trauma guideline
• Updated Endocarditis prophylaxis guideline
• Updated GIT & Biliary Surgery - Laparoscopic/open procedures guideline
• Updated Tocilizumab for in-patients guidelines to include information about the biosimilar product
• Updated Positive blood cultures, actions to take guideline
• Updated Sepsis identification and management guideline
• Updated hyperlinks throughout that refer to Sepsis identification and management guideline
• Updated hyperlinks throughout that refer to Legionnaires disease
• New How to take a blood culture guideline
• New Bleb-related endophthalmitis
• New Lacrimal infection guideline
• New Neisseria conjunctivitis guideline
• New Chlamydial conjunctivitis guideline
• New Bleb-related endophthalmitis
• New Viral (including atypical) eye infections guideline
• New Ocular Toxoplasmosis guideline 
• New Antifungal Therapeutic Drug Monitoring 

New in version 18.9 (25th June 2024)

• Updated unlicensed / off label medicines section

New in version 18.8 (19th June 2024) 

• Updated Pharyngitis/tonsilitis (including peritonsillar abscess) guideline
• Updated Serious deep neck space infections guideline
• Updated Suppurative parotitis (including other salivary gland infection) guideline 
• Updated Dental infection guideline
• Updated Sinusitis, acute bacterial guideline 
• Updated Necrotising (malignant) otitis externa guideline 
• Updated BRONJ (bisphosphonate related osteonecrosis of the jaws) guideline - rename to MRONJ (medication related osteonecrosis of the jaw)
• Updated Mandibular osteomyelitis, acute guideline
• Updated Cardiac Surgery prophylaxis guideline including new Endobronchial valve (EBV) insertion prophylaxis guideline 

New in version 18.7 (6th June 2024 ) 

• Updated Pinna cellulitis / perichondritis guideline
• Updated Mass casualty events: infection considerations, antimicrobial prophylaxis guideline
• Updated Acute osteoarticular infection, including septic arthritis and acute osteomyelitis guideline
• Added link to Hepatitis B Reactivation Policy when initiating immunosuppression
• Reverted surgical prophylaxis guidelines due to stock availability of cefazolin

New in version 18.6 (17th May 2024)

• Updated Legionnaires disease
• Updated acute prostatitis

New in version 18.5 (7th May 2024)

• Formating - no clinical changes  

New in version 18.4 (2nd May 2024)

• Formating - no clinical changes  

New in version 18.3 (2nd May 2024)

• Add link to Measle post-exposure prophylaxis - prescribing, screening and dispensing guidance
• COVID sections updated in response to NICE TA
• Updated facial cellulitis excluding pinna guideline due to stock availablility of cefazolin  
• Updated cellulitis, lower or upper limb due to stock availablility of cefazolin  
• Updated Empirical management of intravascular catheter related infection due to stock availablility of cefazolin   

New in version 18.2 (17th April 2024)

• Spinal infection: post-surgical restrict ciprofloxacin and vancomycin to penicillin allergy severe
• Updated Prosthetic Joint Hip and Knee Surgery surgical prophylaxis 

New in version 18.1 (11th April 2024)

• Updated infection consults - how to access help 
• Review of surgical prophylaxis guideline in response to cefazolin shortage 
• Review of intra-partum prophylaxis for GBS in response to cefazolin shortage 

New in version 18 (9th April 2024 ) 

• Updated infection consults - how to access help 
• Updated Bacteriuria, asymptomatic (pregnant) guideline 
• Updated UTI, lower, non-severe (pregnant) guideline 
• Updated UTI, upper or acute pyelonephritis (pregnant) guideline
• New UTI, catheter associated (pregnant) guideline
• New Recurrent UTI (pregnant) guideline
• Remove acute pyelonephritis from ante-natal infection (chorioamnionitis,edometritis, PROM with signs of infection, suspected sepsis, pyrexia in labour) guideline
• Hyperlink PPROM antibiotic prophylaxis under obstetric body system
• Urology surgery prophylaxis added sentence "Prophylactic dose is not required if patients are already on UTI treatment antibiotics" for Change of urethral catheter
• Updated Soft tissue injury, clean guideline
• Updated Soft tissue injury, contaminated guideline
• Updated Soft tissue injury, significant contamination or established infection
• Updated ITU vancomycin guideline link on vancomycin monograph
• Updated periorbital cellulitis guideline to be included in infections of the soft tissue of the eye 
• New Surgical site infection, defination and classification
• Updated Surgical site infection, clean procedures guideline 
• Updated Surgical site infection, clean-contaminated, contaminated, or infected procedures guideline
• Updated Daptomycin monograph
• Update facial cellulitis excluding pinna guideline to replace cefazolin due to shortage 
• Update cellulitis, lower or upper limb to replace cefazolin due to shortage 
• Update Empirical management of intravascular catheter related infection to replace cefazolin due to shortage 

New in version 17.9 (28/3/24)

• Updated the gentamicin dose in ambulatory Care guidelines
• Updated cefalexin dose in UTI, lower treatment according to susceptibility tests
• Updated cefalexin dose in UTI, upper (acute pyelonephritis)
• Added erythromycin as alternative in pregnant patients in CAP guidelines (including in ambulatory guidelines)
• Updated gentamicin monograph to include advice about how to use EPR to prescribe for patients where actual body weight is less than ideal body weight

New in version 17.8 (26/3/24)

• New section - Ambulatory Care guidelines. 

New in version 17.7 (14/3/24)

• Updated link to MHRA patient information leaflet for fluoroquinolones.

New in Version 17.6 (07/03/24)

• Cidofovir monograph 
• IVOS link in Sepsis Identfication and Management updated 

New in version 17.5 (27/2/24)

• Updated chronic prostatitis guideline

New in version 17.4 (9/2/24)

• Updated antiretroviral guidelines
• Addition of statement regarding Blueteq completion needed added to Paxlovid, Sotrovimab and Tocilizumab guidance.

New in version 17.3 (8/2/24)

• Update measle at glance link 

New in version 17.2 (2/2/24)

• Removal of folder related to patient and staff influenza and COVID vaccines.
• Measles guidance added

New in version 17.1 (25/1/24 pm)

• No clinical changes 

New in version 17 (25/1/24)

• Updated Fluoroquinolone antibiotics - severe adverse effects section
• Fluoroquinolone drug monographs updated
• Temocillin drug monograph updated
• Neutropenic sepsis - review period changed to 24 - 48 hours 
• Review date updated - adnexal procedures, complex, post-op treatment
• Review date updated - blebitis, acute 
• New: Rabies Post Exposure Prophylaxis - link added to information sheet
• New: Varicella Post Exposure Prophylaxis  - link added to information sheet
• New: Hepatitis B Immunoglobulin access  - link added to information sheet

New in version 16.9 (28th December 2023)

• New guideline: Cystoscopic detrusor botulinum
• Clostridioides Difficile Infection guideline updated with addition of table summarising interpretation of C difficile lab results and additional information section

New in version 16.8 (21st December 2023)

• Reinstated folder related to patient and staff influenza and COVID vaccines

New in version 16.7 (20th December 2023)

• Oseltamavir monograph - no change to clinical content, edited to aid reader

New in version 16.6 (18th December 2023)

• Removal of folder related to patient and staff influenza and COVID vaccines.

New in version 16.5 (15th December 2023)

• Influenza - testing, treatment and prophylaxis updated
• Oseltamavir and zanamivir monograph updated

New in version 16.4 (14th December 2023)

• Pivmecillinam monograph updated
• Blood borne viruses (Mass casualty) updated 

New in version 16.3 (14th November 2023)

• Empiric treatment of open fracture guideline updated

New in version 16.2 (13th November 2023)

• Urosepsis hyperlinked to sepsis folder
• UTI, catheter-associated guideline updated
• UTI, upper (acute pyelonephritis) guideline updated
• C diff guideline updated
• Gentamicin monograph updated to reflect need to apply the dose generated by the EPR calculator
• MRSA decolonisation - statement added re Naseptin undergoing formulation change

New in version 16.1 (18th October 2023)

Remdesivir entries updated to reflect that is it non-formulary

New in version 16 (11th October 2023)

• Further update to Fluoroquinolone antibiotics MHRA drug safety updates in 'Situations where antibiotics cause harm' folder
• Updated Prophylaxis Peritoneal dialysis catheter - Placement, manipulation or removal  to remove cefazolin dosing for CrCl greater than 10 
• Vancomycin monograph - added a statement for patient needing more than 2g BD IV vancomycin
• Meningitis: community-acquired guideline updated
• Gentamicin monograph updated
• Gentamicin table removed from Surgical Prophylaxis (General Principles). 

New in version 15.9 (28th September 2023)

• Fluoroquinolone drug monographs updated to reflect MHRA drug safety update.
• Removal of Clarithromycin shortage information throughout guidelines (shortage resolved)

New in version 15.8 (27th September 2023)

• Updated Fluoroquinolone antibiotics MHRA drug safety updates in 'Situations where antibiotics cause harm' folder

New in version 15.7 (26th September 2023)

• No clinical changes formating update

New in version 15.6 (25th September 2023)

• Updated COVID-19 in-patient section
• Reviewed Use of dipsticks when diagnosing UTI - no change 
• Updated Asymptomatic bacteriuria (not pregnant) guideline
• Updated UTI, lower (female, not pregnant, non-severe) guideline 
• Updated UTI, lower (male) guideline
• Updated UTI, lower: treatment according to susceptibility tests guideline 
• Updated Epididymo-orchitis guideline 
• Updated Malaria- severe
• Updated Malaria- uncomplicated
• Updated Malaria in Pregnancy
• Reviewed Malaria due to Plasmodium vivax or ovale
• Dosing in obesity (New guideline)
• New folder: Patient and staff vaccination Winter 2023 - influenza and COVID-19 vaccines
• Teicoplanin drug monographs updated
• Other drug monographs updated - amoxicillin, benzylpenicillin, co-amoxiclav, flucloxaxillin,phenoxymethylpencillin and piperacillin-tazobactam

New in version 15.5 (27th July 2023) 

• Updated asplenia guideline Update July 2023 for emergency splenectomy vaccinate patients at least 2 weeks after the procedure.
• Penicillin allergy - New antibiotics added to table July 2023 

New in version 15.4 (25th July 2023) 

Updated guidelines:

• Infection Prevention and Control Precautions
• Influenza and other respiratoty viruses
• MRSA
• e-prescribing of antimicrobials

New in version 15.3 (30th June 2023)

• Updated Delabelling of spurious penicillin allergy guideline to remove the need to prescribe PRN adrenaline before de-labelling
• IVOS guidance updated following publication of UKHSA National Guidance 
• Use of dipsticks when diagnosing UTI

New in version 15.2 ( 20th June 2023)

• Updated nitrofurantoin section in the 'situations where antibiotics may cause harm' folder in response to MHRA drug safety update. Alert is now referenced where nitrofurantoin is included in a guideline.
• New guideline: recurrent UTI
• Updated H.pylori guideline 
• Community acquired meningitis choramphenicol dose updated 
• New Delafloxacin monograph 
• New Oritavancin monograph
• New Methenamine monograph
• Chloramphenicol monograph updated
• Prostate bracytherapy added to Urological surgery guideline

New in version 15.1 (27th April 2023)

• Mpox guidance update (change of name from monkeypox to Mpox)
• Ceftolozane tazobactam drug monograph update
• Chloramphenicol IV -  addition of maximum dose for meningitis and information about dosing in obese patients 

New in version 15 (20th April 2023)

New guideline - Sensitive at higher doses

Doxycycline doses updated throughout guidelines.

Updated guidelines:

• Neutropenic sepsis and systemic sepsis after organ transplantation guidelines - piperacillin-tazobactam stat dose information included and link to legionnaires guide for patient at risk 
• Clostridioides Difficile Infection guideline
• Haematology oncology: links to guidelines 
• Each of the Community-acquired pneumonia guidelines
• Healthcare-associated pneumonia including aspiration pneunmonia guideline
• COPD:infective exacerbation guideline

New in version 14.95 (4th April 2023)

New guideline on national oral clarithromycin shortage - suggested alternative 

New in version 14.9 (29th March 2023)

Updated COVID guidelines to reflect that there is no stock of remdesivir within OUH.

Updated Peri-procedure Antibiotic Prophylaxis: General Principles - Statement added regarding patients already on treatment dose antibiotics. 

Updated Paxlovid® (Nirmatrelvir(PF-07321332)/ritonavir) for in-patients - image of table from Liverpool Interaction Checker removed.

New in version 14.8 (22nd March 2023)

Updated Paxlovid® (Nirmatrelvir(PF-07321332)/ritonavir) for in-patients - image of table from Liverpool Interaction Checker updated.

Updated Influenza - Hospital in-patients Vaccination and Staff Vaccination Programme 2022/2023 to remove staff influenza vaccination as staff campaign has ended.

New in version 14.7 (28th February 2023)

New GUIDE: Audiometry and Intravenous aminoglycosides guideline 

Updated guidelines:

• Sepsis identification and management
• Systemic sepsis of unknown source
• Ante-natal or post-partum - severe sepsis/septic shock
• Neutropenic sepsis
• Systemic sepsis after organ transplantation
• Prophylaxis of colorectal surgery in GIT & Bilary Surgery - Laproscopic/open procedures

Doxycycline dose updated in CAP:non severe (CURB65=0-1)

New in version 14.6 (15th February 2023)

NEW GUIDE: Interventional Radiology Antibiotic Prophylaxis, including use of cefazolin as first line prophylaxis in certain procedure

Separated gastrointestinal and biliary surgery into GIT& Bilary endoscopic procedures and GIT& Bilary laparoscopic / open procedures

Updated Colorectal surgery peri-procedure antibiotic prophylaxis in GIT& Bilary laparoscopic / open procedures guide

Delabelling of spurious penicillin allergy guideline - SPACE study information removed as study closed to recruitment.

Doxycycline doses updated throughout guidelines.

Ceftazidime monograph CrCl cut off updated as per renal drug database 

COVID vaccine guidance removed as winter booster campaign stopped February 12th 2023.

New in version 14.5 (30th January 2023)

Intra-partum prophylaxis for group B streptococcus (GBS) guideline - cefazolin dose updated to reflect IDSA guidance

New in version 14.4 (16th January 2023)

Doxycycline doses updated throughout guidelines.

Thromboprophylaxis in COVID-19 folder updated.

New in version 14.3 (20th December 2022)

New guideline: Paxlovid^® for in-patients (NEW December 2022)

New guideline: Group A streptococcus

New in version 14.2 (19th December 2022)

COVID-19 folder updated - all guidelines reviewed and updated.

New guidelines:

Therapies for adult and paediatric patients with symptomatic hospital-onsest COVID-19 

Therapies for patients hospitalised due to COVID-19

Drug monographs in COIVD-19 folder updated.

New in version 14.1 (13th December 2022)

Dose of doxycycline in Bites, human+animal guidelines updated

Clostridioides Difficile Infection (CDI) guideline updated as per OUH safety message for GDH positive toxin negative 

GIT and Biliary Surgery guideline updated to add transanal surgery

New in version 14 (7th December 2022)

New Diphtheria guidance

New in version 13.9 (25th November 2022)

Updated Influenza - testing, treatment and prophylaxis guideline

Updated oseltamivir drug monograph

Updated zanamivir drug monograph.

New in version 13.8 (22nd November 2022)

Updated Delabelling of spurious penicillin allergy guideline

Updated Influenza - Hospital in-patients Vaccination and Staff Vaccination Programme 2022/2023 to say that 'Influenza vaccines MUST be administered by a trained flu vaccinator.'

Influenza - testing, treatment and prophylaxis guideline - added links for renal dosing of oseltamivir.

Pseudomonas aeruginosa - MDR treatment (DTR-PSAR) guideline - removed statement re ceftolozane-tazobacatam being unavailable as this can be accessed now.

New in version 13.7 (18th November 2022)

New guidance re Access, Watch and Reserve antibiotic classification

New in version 13.6 (15th November 2022)

Updated asplenia guideline

World Antimicrobial Awareness Week 2022 page

Patient and Staff vaccination -Influenza and COVID guideline updated

Updated Clostridioides Difficile Infection (CDI) guideline - FMT criteria for use clarified.

New in version 13.5 (24th October 2022)

New COVID BOOSTER vaccination (in-patients and out-patients) folder

New in version 13.4 (19th October 2022)

Updated Peri-procedure Antibiotic Prophylaxis in obstetric surgery including use of cefazolin as first line prophylaxis in specific procedures

Updated Intra-partum prophylaxis for group B streptococcus (GBS) including use of cefazolin as alternative for non severe penicillin allergy 

Update to mastitis/breast abscess guideline

New in version 13.3 (3rd October 2022)

Update to the Bites - human and animal guideline

Update to the Peritoneal dialysis related infection guideline

Update to general principles in perioperative antibiotic prophylaxis

Update influenza vaccination section for 2022/23

Update to HIV PEP and PEPSE: post exposure prophylaxis guideline 

New in version 13.2 (4th August 2022)

Update to:

'Transplant peri-procedure guideline' to change micafungin to caspofungin

'Organ perfusion fluid - Candida cultured' to change micafungin to caspofungin

Theatre take- back (pancreas transplant) renamed to 'Infected abdominal collections associated with pancreatic transplant' and changed micafungin to caspofungin

Monkeypox guidance

Surgical prophylaxis - general principles section

New in version 13.1 (4th June 2022)

New Caspofungin drug monograph

Updated management of candidaemia in critical care secondary to micafungin switch to caspofungin 

New in version 13 (17th June 2022)

Updated Monkeypox guidance

New in version 12.9 (20th May 2022)

New Monkeypox guidance

New Baricitinib guidance

Endoscopic procedures (Gastroenterology) folder in prophylaxis updated to link to GIT & Biliary Surgery 

New in version 12.8 (4th May 2022)

Obstetric surgery surgical prophylaxis guidance returned to guidance as per version 12.6

New in version 12.7 ( 4th May 2022)

Updated Peri-procedure Antibiotic Prophylaxis, including use of cefazolin as first line prophylaxis in specific procedures

Updated definition of Life-threatening CDI in the Clostridioides Difficile Infection guideline

Updated CPE (Carbapenemase- producing Enterobacterales) guideline

New in version 12.6 (March 2022)

Updated MRSA decolonisation guideline

New Skin decolonisation pre-procedure guideline

New in version 12.5 (March 2022)

Font changed throughout to Helevetica

MHRA Drug Safety alert re macrolides with hydroxychloroquine or chloroquine added to 'situations where antibiotics may cause harm' folder

Azithromycin, clarithromycin and erythromycin drug monographs updated to include the MHRA Drug Safety alert re macrolides with hydroxychloroquine or chloroquine 

Tobramycin, gentamicin monographs update to include statement "Patients should be advised to report immediately the onset of any sign of deafness or vestibular dysfunction."

Delabelling of spurious penicillin allergy folder updated to include information about the NIHR funded SPACE study

New in version 12.4 (18th January 2022)

No clinical changes - formatting issue.

New in version 12.3 (18th January 2022)

Amikacin drug monograph updated to include antibiotic serum level monitoring guidance

New in version 12.2  (17th January 2022)

Thromboprophylaxis in COVID-19 section updated

New in version 12.1 (17th January 2022)

Thromboprophylaxis in COVID-19 section updated

New in version 12 (December 2021)

Ronapreve, Sotrovimab and Molnupiravir folder updated to include link to the new Interim Clinical Commissioning Policy: Neutralising monoclonal antibodies and intravenous antivirals in the treatment of COVID-19 in hospitalised patients.

New in version 11.95 (December 2021)

Remdesivir in COVID-19 section updated with information from Interim Clinical Commissioning Policy: Neutralising monoclonal antibodies and intravenous antivirals in the treatment of COVID-19 in hospitalised patients.

New in version 11.9 (December 2021)

Tocilizumab  in COVID-19 section updated to include link to new Tocilizumab for the treatment of COVID-19 in pregnancy and breastfeeding guideline.

New in version 11.8 (December 2021)

Remove Ronapreve (casirivimab+imdevimab) in COVID-19 section. New folder created for nMABs and Molnupiravir 

New in version 11.7 (December 2021)

Ronapreve (casirivimab+imdevimab) in COVID-19 section updated to remove pharmacy supply information

New in version 11.6 (December 2021)

Addition of a folder for Ronapreve (casirivimab+imdevimab) in COVID-19 section.

Treatment of Infections due to CPE - co-trimoxazole dose updated

New in version 11.5 (November 2021)

World Antimicrobial Awareness Week 2021 sectionmoved position in spine to highlight WAAW

New in version 11.4 (November 2021)

Specific treatment of COVID-19 section updated to include Ronapreve (casirivimab+imdevimab)

New folders created within Coronavirus section for remdesivir and tocilizumab

World Antimicrobial Awareness Week 2021 section updated.

New drug monographs for:

Cefiderocol

Dalbavancin

Meropenem-vaborbactam

Updated drug monographs for:

fosfomycin

temocillin

 

New in version 11.3 (October 2021)

Treatment of Infections due to CPE - dose of temocillin adjusted in response to EUCAST guidance.

Clostridioides Difficile Infection (CDI) guideline updated in response to NICE guidance. 

Vancomycin drug monograph: oral vancomycin dosing information updated to reflect new C diff. guidance.

New in version 11.2

New guideline: Treatment of DTR- PSAR infection

Updated guidelines:

• Specific Treatment of COVID-19 (tocilizumab guidance updated)
• Treatment of Infections due to CPE 
• Cellulitis, lower or upper limb
• TRUS biopsy prophylaxis (updated management of MRSA positive patients)
• Fiducial prostatic implants prophylaxis (updated management of MRSA positive patients)
• Prevention of secondary meningococcal disease (updated to include link to MHRA patient information leaflet for fluoroquinolone)

New drug monograph for Recarbrio (Imipenem-cilastatin-relebactam)

New in version 11.1 (16/6/21)

Specific treatment of COVID-19 guideline - remdesivir section updated

New in version 11 (15/6/21)

No change to clinical content. Small formating amendment to Specific treatment of COVID-19 guideline

New in version 10.9 (15/6/21)

Updated transplant prophylaxis guideline - intestinal transplants removed

Specific treatment of COVID-19 guideline - remdesivir section updated

Penicillin allergy document in AMS folder updated to include antibiotics added to formulary

New in version 10.8 ( 12/5/21)

Cefazolin drug monograph renal dosing information updated

New in version 10.7 (20th April 2021)

C diff guidance returned to recommendations in v10.5

New in version 10.6 (20th April 2021)

Pivmecillinam monograph updated to reflect a national review of  avoiding use in late pregnancy and in breastfeeding mothers before the new born screening has been undertaken.

Ceftolozane-tazobactam monograph updated to reflect international shortage and absence of supply.

Update Antimicrobial Management Team contact details in Useful Contact Numbers

New in version 10.5 (March 2021)

Link in porphyria section to Welsh guidance updated

New in version 10.4 (March 2021)

New section - Situations where antibiotics may cause harm (Acute prophyria and MHRA drug safety updates for fluoroquinolones, aminoglycosides and carbapenems)

MHRA drug safety updates added to the drug monographs for:

• aminoglycosides (amikacin, gentamicin and tobramycin)
• fluoroquinolones (ciprofloxacin, moxifloxacin and ofloxacin)
• carbapenems (ertapenem and meropenem)
• erythromycin

Small updates to drug monographs for: 

• flucytosine
• daptomycin
• AmBisome liposomal
• quinine dihydrochloride and qunine sulphate
• nitrofurantoin

Acute Diarrhoea guideline - Tinidazole removed as therapetic option for Giardia lamblia due to discontinuation of product. Replaced by metronidazole.

New in version 10.3 (February 2021)

Specific treatment of COVID-19 section updated to include tocilizumab

Infection Prevention and Control Measure guidance updated

Pelvic inflammatory disease guideline updated 

Encephalitis (viral) - requirement to ring ID micro for all cases started on IV aciclovir removed

Meningitis:community-acquired guideline - Dexamethasone changed to base presentation and requirement to ring ID micro for all cases started on IV aciclovir removed 

New in version 10.2 (January 2021)

Updated Sepsis Identification & Management

Updated criteria for remdesivir use in "Guidelines for adjunctive antimicrobial therapy and dexamethasone for suspected/ confirmed Covid-19 in adult patients"

Voriconazole drug monograph renal dosing updated

New in version 10.1 (January 2021)

Further update to Covid management guidelines and new section on out-patient and radiological follow up of covid cases

New in version 10 (January 2021)

Updated criteria for remdesivir use in "Guidelines for adjunctive antimicrobial therapy and dexamethasone for suspected/ confirmed Covid-19 in adult patients"

New in version 9.9 (January 2021)

Updated criteria for remdesivir use in "Guidelines for adjunctive antimicrobial therapy and dexamethasone for suspected/ confirmed Covid-19 in adult patients"

New in version 9.7 (December 2020)

Updated remdesivir and thromboprophylaxis in covid

New in version 9.6 (December 2020)

Updated Antiretroviral Guidelines

Ceftolozane-tazobactam renal dosing information updated in drug monograph

New in version 9.5 (December 2020)

Updated Thromboprophylaxis in COVID-19 section

Updated information about criteria required for approrpriate use of remdesivir in Guidelines for adjunctive antimicrobial therapy guideline

New Co-trimoxazole desensitisation guidance

New in version 9.4 (Nov 2020)

World Antimicrobial Awareness Week (WAAW) announced

Cefazolin added to treatment of positive blood cultures

CSF Shunt guidelines updated

Covid19 guidelines updated

New in version 9.3 (August 2020)

NEW -  PCP prophylaxis guidelines

Update nomenclature of Ambisome to AmBisome liposomal amphotericin in response to safety alert

Management of patients with tetanus-prone wounds guideline updated

PEP and PEPSE (Post Exposure Prophylaxis) for HIV - link to patient information leaflet updated

Updating of Covid guidelines

New in Version 9.2 (July 2020)

Useful contact numbers updated

New in version 9.1 (July 2020)

New folder - Use and intepretation of microbiological tests

Updated leg ulcer infection guideline

Updated guideline for adjunctive antimicrobial therapy and dexamethasone for suspected/confirmed COVID-19 in adult patients

Updated rifampicin dose in Early prosthetic valve Endocarditis guideline

New in version 9.0

Updated guidance on prophylaxis/ pre-emptive therapy of instrumental delivery
New in version 8.95

Updated Guidelines for adjunctive antimicrobial therapy and dexamethasone for suspected/confirmed covid-19 in adult patients

Pelvic Inflammatory Disease - ceftriaxone IM dose updated 

New in version 8.9

Updated thromboprophylaxis in COVID-19 guidelines

New in version 8.7

Updated adjunctive antimicrobial therapy for suspected/confirmed Covid-19 

New in version 8.5, 8.6, 8.65

Updated guidance on Covid-19 - linking to national documents

New in version 8.4

Added adjunctive antimicrobial therapy for suspected/confirmed Covid-19

Useful contact numbers updated

Updated drug monographs for amikacin, ciprofloxacin, colistimethate sodium, daptomycin, fosfomycin to include information historically held within Trust injectable monographs.

New in version 8.3

No change to guidance 

Links inserted from paediatric COVID-19 MicroGuide entries to the adult COVID-19 entries.

New in version 7.97, 7.98, 7.99

Updated guidance on Covid-19

Delabelling of spurious penicillin allergy

New in version 7.95 (February 2020)

technical update - no change to clinical content

New in version 7.9   (January 2020)

Updated guidance on WN-nCoV

New in version 7.8 (January 2020)

New guidance on WN-nCoV

New in version 7.7 (January 2020)

Update of the following guidelines in response to NICE guidance NG141:

• cellulitis, lower or upper limb,
• pinna cellulitis/perichondritis,
• facial cellulitis (excluding pinna),
• peri-orbital cellulitis

Influenza - testing, treatment and prophylaxis

New in version 7.61 (December 2019)

Inluenza - antiviral agents for treatment and prophlaxis folder added with links to PHE guidelines.

New in version 7.6 (December 2019)

Intravascular catheter management (line infections inc TPN) guidelines updated with a new section 'preparing and administering antimicrobial line locks'

PPROM antibiotic prophylaxis guidance updated

Termination of pregnancy antibiotic prophylaxis guidance updated

New monographs for paromomycin and nitazoxanide

New in version 7.52 (December 2019)

No change to content 

New in  version 7.51 (December 2019)

Useful contact numbers updated

New in version 7.5 (November 2019)

Correction of bullet point location in iv vancomycin renal impairment dosing advice table.

New in version 7.4 (November 2019):

Cellulitis guideline updated to include Eron classification

Diabetic foot mild, moderate and severe guidelines updated

HAP and CAP guidelines updated

Neutropenic sepsis guidelines - additional cautions for penicillin use with high dose methotrexate, including patients with a diagnosis of osteosarcoma with planned high dose methotrexate treatment.

New in version 7.32 (October 2019):

Variceal bleeding guidelines updated

New in version 7.31 (August 2019):

Updated treatment of CPE

Prescribing of antibiotics for lower UTI guidance

ARK section updated

VP shunt prophylaxis

 

Version 7.3 was not published

New in version 7.2 (January 2019)

Review of Empirical Antimicrobial Guidelines for Surgical Prophylaxis in response to gentamicin being available again.

Antiretroviral Guidelines have been updated

New in version 7.1 (December 2018)

• Revision of Clostridium difficile infection guideline to include vancomycin tapering regimen
• Clarification of synergistic gentamicin dosing and target levels in endocarditis guidelines
• Revision of tetanus prone wound guidelines in response to updated guidance from Public Health England

New in version 7.0

• New sections:
  • UTI treatment according to susceptibility tests
  • Infectious diseases of high consequence (MERS, Ebola, Monkey pox)
• Changes in multiple guides:
  • Vancomycin has changed to Co-trimoxazole as the additional agent of choice in MRSA positive patients with infections. Guides updated include Acute pyelonephritis, Catheter-associated UTI, Cellulitis, Parotitis,  Surgical site infection, and Healthcare-associated pneumonia
• Doxycycline replaces clarithromycin in the CURB-65 2-5 guidance
• HIV PEP and PEPSE: post exposure prophylaxis section has been amended 
• The sepsis identification and management section has been updated
• Co-trimoxazole monograph updated to include a warning on using with potassium-sparing drugs

New in version 6.4

Improved guidance for Clostridium difficile infection and septic arthritis, native joint. 

New in version 6.3: unchanged guide

New in Version 6.3

• Updated CPE guidance

New in version 6.2

• Revision to necrotising fasciitis pen allergy guideline
• Updating of GBS prevention in accordance with RCOG (green top CG No. 36)
• Diabetic foot moderate and severe guidelines revised
• Clostridium difficile infection - Alteration to course length for fidaxomicin
• TRUS biopsy prophylaxis guidelines updated to include advice for patients with ciprofloxacin resistance or where ciprofloxacin contra-indicated 
• Teicoplanin dosing guidance now includes advice for patients weighing over 125kg
• Teicoplanin sampling points have been amended
• Penicillin allergy section in AMS folder updated to include antibiotics recently added to formulary
• Drug monographs aciclovor to clindamycin have been reviewed with some minor alterations
• Clarithromycin monograph updated to reflect FDA advise for caution before prescribing clarithromycin to patients with heart disease
• The sepsis guideline has been updated to reflect the Trust's new electronic interfaces and national/regional guidance about investigation and escalation of patients with sepsis

New in version 6.1

Links to UK TB Drug Monographs

Antiretroviral Guidelines have been added to MicroGuide

Alterations to Malaria guidance to aid clarity 

Minor modifications to ceftazidime dosing in elderly and to aciclovir use in meningitis/ encephalitis 

New in version 6.0

New in version 5.9

• CA-UTI guidance
• ARK hospital info
• Update warnings for ciprofloxacin and use in epilepsy 

New in Version 5.8

• Updated Candida guidelines in line with 2016 IDSA update

New in version 5.7:

• Mass casualty events: infection considerations

• Changes to dosing of colistin

• Links to Regional haematology-oncology guidelines

• New teicoplanin dosing guidance

• Updated MRSA section because triclosan® no longer available 

New in version 5.4

Updated CDI guidance

Updated abdominal infection guidance (use of metronidazole rationalised)

Updated gentamicin dosing for treatment of IE

Changes to doing of teicoplanin

New in version 5.2

• Updated sepsis guidelines
• Dosing of flucloxacillin now 2g for most indications

New in version 5.0: due to a shortage of piperacillin-tazobactam, some indications have been changed to ceftazidime (diabetic foot (severe), transplant medicine pyelonephritis and necrotising otitis externa)

New in version 4.9 peritoneal dialysis update

New in version 4.8 Helicobacter update

New in version 4.2

New guidelines for gastroenterology (especially acute diarrhoea, liver abscess, amoeba and prophylaxis associated with endoscopic (GI) procedures)

Alterations to urology prophylaxis

New guideline for management of pneumocystis jirovecii infection. 

New in version 4.1

New section in prophylaxis: HIV PEP and PEPSE post exposure prophylaxis

New in version 4.0

Improved terminology, with "preferred" and "alternative" replacing first and second line for antibiotic choices to improve clarity. Updating of Sepsis after organ transplantation, renal prophylaxis, vascular device placement, open fracture management and prophylaxis.

New in version 3:

• Restructuring of headings with new headings for frailty syndromes, obstetrics, STDs, cardiac and vascular.
• There is a new section called "Speciality Medicine" which has sub-headings of Transplant Medicine, Renal Medicine and Infectious Diseases (including malaria guidelines).
• Restructuring of Sepsis section with new heading for Sepsis Identification & Management and updated content.
• Asplenia prophylaxis
• Updated Infection Control Advice in Healthcare associated infection section, including for CPE
• Modified antibiotic prophylaxis for Urological surgery

New in version 2.1: 

Adoption of 800mg teicoplanin dose for all surgical antibacterial prophylaxis

New in version 2.0:

Ebola triage document

Antimicrobial Prophylaxis for Surgery Guidelines

CPE (carbapenemase-producing enterobacteriaceae) in Healthcare Associated Infections

Updated tetanus Guidelines

For any comments, enquiries or suggestions for improvement, please contact the Antimicrobials Pharmacist - 01865 741166 bleep (JR)1549 or AMT@ouh.nhs.uk