Table 2.
Recommendations on indications
| Topic | Recommendation | Society | Country |
|---|---|---|---|
| General indication | |||
| Do not initiate an antibiotic without an identified indication and a predetermined length of treatment or review date* | The Society of Hospital Pharmacists of Australia | Australia and New Zealand | |
| Society for Healthcare Epidemiology of America | United States of America | ||
| Society of Critical Care Medicine | United States of America | ||
| Do not prescribe antibiotics or opioid analgesics without an examination | The Canadian Association of Hospital Dentists | Canada | |
| Do not routinely suggest antimicrobial treatment for older persons unless they are consistent with their goals of care | Canadian Nurses Association - | Canada | |
| Canadian Gerontological Nursing Association | |||
| Do not treat an elevated C‑reactive protein (CRP) or procalcitonin in serum with antibiotics for patients not presenting signs or symptoms of infection | German Society for Infectious Diseases (DGI) | Germany | |
| In severe sepsis and septic shock, calculated and high-dose antibiotic therapy should be started quickly | German Society for Infectious Diseases (DGI) | Germany | |
| In patients with suspected severe infections, at least two pairs of blood cultures should be taken regardless of body temperature at separate puncture sites before antibiotics are administered. It is not required to maintain a minimum time interval between the sampling of the blood cultures** | German Society for Internal Medicine (DGIM) | Germany | |
| Do not prescribe antibiotics to prevent infectious complications from neutropenia in cancer patients treated with standard dose chemotherapy | Italian College of Chief Hospital Medical Oncologists (CIPOMO) | Italy | |
| Anatomical entities | |||
| Cardiac | Avoid routine use of infective endocarditis prophylaxis in mild to moderate native valve disease | Italian Association of Clinical, Preventive and Rehabilitative Cardiology | Italy |
| Avoid prophylactic antibiotics for the treatment of mitral valve prolapse | Infectious Diseases Society of America | United States of America | |
| Cerebral | Adult patients with suspected bacterial meningitis should be given dexamethasone and antibiotics after blood culture collection and prior to imaging** | German Society for Internal Medicine (DGIM) | Germany |
| Ear, Nose, Throat | Do not prescribe oral antibiotics for uncomplicated acute external otitis | Royal Australasian College of Surgeons | Australia and New Zealand |
| Swiss Society for Otorhinolaryngology, Neck and Facial Surgery | Switzerland | ||
| American Academy of Otolaryngology—Head and Neck Surgery Foundation | United States of America | ||
| Do not use antibiotics in adults and children with uncomplicated acute otitis media | Canadian Association of Emergency Physicians | Canada | |
| Do not use oral antibiotics as a first line treatment for patients with painless ear drainage associated with a tympanic membrane perforation or tympanostomy tube unless there is evidence of developing cellulitis in the external ear canal skin and pinna* | Royal Australasian College of Surgeons | Australia and New Zealand | |
| Canadian Society of Otolaryngology—Head & Neck Surgery | Canada | ||
| American Academy of Otolaryngology—Head and Neck Surgery Foundation | United States of America | ||
| Do not routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for ten or more days, or symptoms worsen after initial clinical improvement* | Canadian Society of Allergy and Clinical Immunology | Canada | |
| American Academy of Asthma, Allergy and Immunology | United States of America | ||
| American Academy of Family Physicians | United States of America | ||
| American Academy of Sleep Medicine | United States of America | ||
| Do not routinely use antibiotics in adults and children with uncomplicated sore throats | Canadian Association of Emergency Physicians | Canada | |
| Eyes | Don´t use topical antibiotics for viral or nonspecific conjunctivitis* | Swiss Ophthalmological Society | Switzerland |
| American Academy of Ophthalmology | United States of America | ||
| Do not routinely provide antibiotics before or after intravitreal injections* | The Royal Australian and New Zealand College of Ophthalmologists | Australia and New Zealand | |
| Swiss Ophthalmological Society | Switzerland | ||
| American Academy of Ophthalmology | United States of America | ||
| Gastrointestinal | Do not prescribe prophylactic antibiotics to prevent travellers’ diarrhea | Nurse Practitioner Association of Canada | Canada |
| Do not investigate or treat for fecal pathogens in the absence of diarrhea or other gastro-intestinal symptoms** | Australasian Society for Infectious Diseases | Australia and New Zealand | |
| Neutropenia | In patients with neutropenic fever (neutrophils < 0.5 G/L or < 1 G/L with a decreasing tendency), empiric therapy with broad-spectrum antibiotics should be started after taking 2 independent blood cultures and without delay due to further diagnostics** | German Society for Internal Medicine (DGIM) | Germany |
| Respiratory tract | Avoid prescribing antibiotics for upper respiratory infections* | Australasian Society for Infectious Diseases | Australia and New Zealand |
| Canadian Association of Emergency Physicians | Canada | ||
| German Society for Pneumology and Respiratory Medicine (DGP) | Germany | ||
| German Society for Infectious Diseases (DGI) | Germany | ||
| International Society of Doctors for the Environment | Italy | ||
| Italian Society of General Medicine and Primary Care | Italy | ||
| Swiss Society for General Internal Medicine | Switzerland | ||
| Swiss Society for Infectious Diseases | Switzerland | ||
| Infectious Diseases Society of America | United States of America | ||
| Do not recommend antibiotics for infections that are likely viral in origin, such as an influenza-like illness |
Canadian Nurses Association Infection Prevention and Control Canada |
Canada | |
| College of Family Physicians of Canada | Canada | ||
| Do not treat adult cough with antibiotics even if it lasts more than 1 week, unless bacterial pneumonia is suspected (mean viral cough duration is 18 days) | Canadian Thoracic Society | Canada | |
| Do not use antibiotics for acute asthma exacerbations without clear signs of bacterial infection | The Thoracic Society of Australia and New Zealand | Australia and New Zealand | |
| Canadian Thoracic Society | Canada | ||
| Canadian Association of Emergency Physicians | Canada | ||
| Skin | Do not routinely swab open wounds and do not prescribe systemic antibiotics based on these results, without clinical features of local or systemic infection*/** | Australasian Society for Infectious Diseases | Australia and New Zealand |
| Burns Canada | Canada | ||
| Association of Medical Microbiology and Infectious Diseases Canada | Canada | ||
| American Podiatric Medical Association | United States of America | ||
| Do not routinely use antibiotics to treat bilateral swelling and redness of the lower leg unless there is clear evidence of infection* | Canadian Dermatology Association | Canada | |
| American Academy of Dermatology | United States of America | ||
| Infectious Diseases Society of America | United States of America | ||
| Do not routinely prescribe topical combination corticosteroid/antifungal products | Canadian Dermatology Association | Canada | |
| Do not routinely prescribe antibiotics for inflamed epidermoid cysts (formerly called sebaceous cysts) of the skin* | The Australasian College of Dermatologists | Australia and New Zealand | |
| American Academy of Dermatology | United States of America | ||
| Monotherapy for acne with either topical or systemic antibiotics should be avoided | The Australasian College of Dermatologists | Australia and New Zealand | |
| Do not use oral antibiotics for acne vulgaris for more than 3 months without assessing efficacy | Canadian Dermatology Association | Canada | |
| Do not routinely use oral antibiotics for treatment of atopic dermatitis | American Academy of Dermatology | United States of America | |
| Do not administer prophylactic antibiotics to patients presenting with acute burn injuries | Burns Canada | Canada | |
| Urinary tract | Do not prescribe antimicrobials to patients using indwelling or intermittent catheterization of the bladder unless there are signs and symptoms of urinary tract infection* | Canadian Association of Physical Medicine and Rehabilitation | Canada |
| American Urological Association | United States of America | ||
| Do not treat asymptomatic bacteriuria with antibiotics* | The Royal College of Pathologists of Australasia | Australia and New Zealand | |
| Australian and New Zealand Society for Geriatric Medicine | Australia and New Zealand | ||
| Australasian Society for Infectious Diseases | Australia and New Zealand | ||
| Canadian Urological Association | Canada | ||
| Canadian Nurses Association | Canada | ||
| Society of Hospital Medicine | Canada | ||
| American Geriatrics Society | Canada | ||
| German Society for Infectious Diseases (DGI) | Germany | ||
| International Society of Doctors for the Environment | Italy | ||
| Multidisciplinary Geriatrics Association | Italy | ||
| Swiss Society for Gynecology and Obstetrics | Switzerland | ||
| Swiss Society for Geriatrics | Switzerland | ||
| Infectious Diseases Society of America | United States of America | ||
| American Geriatrics Society | United States of America | ||
| Avoid presumptive antibiotic treatment of recurrent UTIs in women without first obtaining a UA C&S (urine analysis, culture & sensitivity)** | American Urogynecologic Society | United States of America | |
| Pathogens | |||
| Multi-resistant organisms | Do not prescribe antibiotic therapy to patients colonized by multi-resistant microorganisms without signs of infection | Scientific Society of Internal Medicine | Italy |
| Fungi | Do not treat Candida recovered from respiratory or gastrointestinal tract specimens | German Society for Infectious Diseases (DGI) | Germany |
| Do not treat recurrent or persistent symptoms of vulvovaginal candidiasis with topical and oral anti-fungal agents without further clinical and microbiological assessment | Australasian Society for Infectious Diseases | Australia and New Zealand | |
| Do not prescribe systemic anti-fungals for suspected onychomycosis without mycological confirmation of dermatophyte infection* | Canadian Dermatology Association | Canada | |
| Swiss Society for Dermatology and Venerology | Switzerland | ||
| American Academy of Dermatology | United States of America | ||
| Group A Streptococcus | Do not provide antibiotic prophylaxis to all contacts of severe invasive Group A Streptococcus (iGAS) infections | Public Health Physicians of Canada | Canada |
*For the exact wording of the Societies' recommendations, refer to the original recommendations
**Recommendation listed in two or more tables