Table 1.

Summary comparison of 2016 and 2017 antibiogram clinical messaging, New Hampshire

Infection	2016 antibiogram messaging	2017 antibiogram messaging
Urinary tract infection	Asymptomatic bacteriuria should not be treated in most cases. • Nitrofurantoin and cephalexin are most likely to be active against Escherichia coli. • Fosfomycin can be considered for E coli and Enterococcus species.	• Nitrofurantoin and cephalexin are more likely to be active against E coli. • Most Enterococcus species are susceptible to amoxicillin/ampicillin. a • Fosfomycin can be considered for E coli and Enterococcus species. • Treatment for uncomplicated urinary tract infections can be as short as 3-5 days (depending on antibiotic). Treatment for complicated urinary tract infections or pyelonephritis can be as short as 7 days. a • Asymptomatic bacteriuria should not be treated in most cases.
Pneumonia	• Azithromycin should not be prescribed if there is concern for pneumococcal pneumonia. • Preferred antibiotics to treat pneumococcal pneumonia: ° Amoxicillin ° Amoxicillin-clavulanate ° Cefuroxime • Avoid fluoroquinolones due to toxicity. • Ceftriaxone PLUS doxycycline or azithromycin recommended for hospitalized patients with community-acquired pneumonia.	• Azithromycin should not be prescribed if there is concern for pneumococcal pneumonia. • Preferred antibiotics to treat pneumococcal pneumonia: ° Amoxicillin ° Amoxicillin-clavulanate ° Cefpodoxime (changed from 2016 due to increasing resistance) a • >Avoid fluoroquinolones due to toxicity. • Ceftriaxone PLUS doxycycline or azithromycin recommended for hospitalized patients with community-acquired pneumonia. • Vancomycin is not necessary for all episodes of hospital-acquired pneumonia. a • Treatment for community-acquired pneumonia can be as short as 5 days. Treatment for hospital-acquired pneumonia is 7 days. a
Skin and soft-tissue infection	• Most skin and soft-tissue infections are due to Streptococcus species or methicillin-susceptible Staphylococcus aureus, so first-line therapy is with cephalexin/cefazolin. • Trimethoprim-sulfamethoxazole or doxycycline are first-line therapy for methicillin-resistant S aureus skin and soft-tissue infections or abscess (clindamycin should not be used).	• Most skin and soft-tissue infections are due to Streptococcus species or methicillin-susceptible S aureus, so first-line therapy is with cephalexin/cefazolin. • Trimethoprim-sulfamethoxazole or doxycycline are first-line therapy for methicillin-resistant S aureus skin and soft-tissue infections or abscess (clindamycin should not be used). • Treatment can be as short as 5 days. a
Intra-abdominal infections	• Pseudomonas is not a common pathogen in intra-abdominal infections. • Ceftriaxone PLUS metronidazole recommended for empiric inpatient treatment. • Piperacillin-tazobactam or cefepime PLUS metronidazole recommended for serious life-threatening infections.	Not applicable
Other	• Restrict use of carbapenems. • Mild-moderate infections caused by extended spectrum beta-lactamase–producing organisms do not always require treatment with a carbapenem. Alternatives include trimethoprim-sulfamethoxazole, nitrofurantoin, fosfomycin, and ciprofloxacin. b	• Restrict the use of carbapenems. • Restrict fluoroquinolone use given toxicities. a • More than 90% of patients with a penicillin allergy listed in their medical record are not truly allergic; therefore, based on an assessment, providers should consider a ° De-labeling the penicillin allergy a ° Providing a supervised penicillin challenge a ° Penicillin skin testing a

^aMessage was added in 2017.

^bMessage not used in 2017.