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[null,"Baseline assessment tool for bronchiectasis (non-cystic fibrosis), acute exacerbation: antimicrobial prescribing (NICE antimicrobial prescribing guideline NG117)"]
[]
[null,"This baseline assessment tool can be used to evaluate whether practice is in line with the recommendations in bronchiectasis (non-cystic fibrosis), acute exacerbation: antimicrobial prescribing.  It can also help to plan activity to meet the recommendations."]
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[null,"The tool can be used by individual services or organisations. Alternatively, an assessment completed with the involvement of all relevant services or organisations would help to develop a picture of activity in the local area."]
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[null,"It should be used in conjunction with bronchiectasis (non-cystic fibrosis), acute exacerbation: antimicrobial prescribing (NICE antimicrobial prescribing guideline NG117)."]
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[null,"In the first instance, consider whether the guideline is relevant and record the conclusion in the box below."]
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[null,"Is the guideline relevant?"]
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[]
[null,"The data sheet contains the recommendations from the guideline. Information can be entered about current activity relevant to the recommendation, actions needed to meet the recommendation, deadlines and the names of the responsible leads.  Useful documents can be added as hyperlinks."]
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[null,"The table can be adapted to include any other local information that is thought to be useful."]
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[null,"If it would be helpful to group the recommendations, for example those that are key priorities for implementation or by deadline, use the filter function in the data menu. "]
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[null,"Tools and resources to help put the guidance into practice are available on the NICE website. "]
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[null,"National Institute for Health and Care Excellence\nLevel 1A, City Tower, Piccadilly Plaza, Manchester M1 4BT; www.nice.org.uk\n\nCopyright\n© NICE 2018. All rights reserved. Subject to Notice of rights.\n"]

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[null,"Baseline assessment tool for bronchiectasis (non-cystic fibrosis), acute exacerbation: antimicrobial prescribing (NICE antimicrobial prescribing guideline NG117)"]
[]
[null,null,null,null,"Number of relevant recommendations",{"$f":"COUNTIF(D8:D998,\"Yes\")","v":0}]
[null,null,null,null,"Number of recommendations met",{"$f":"COUNTIF(F8:F998,\"Yes\")","v":0}]
[null,null,null,null,"Percentage of recommendations met",{"$f":"IF(ISERROR(F4/F3),\"\",F4/F3)","v":""}]
[]
[null,"NICE recommendation","Guideline reference","Is the recommendation relevant?","Current activity/evidence","Recommendation met?","Actions needed to implement recommendation","Is there a risk associated with not implementing this recommendation?","Is there a cost or saving?","Deadline","Lead"]
[null,"1.1 Managing an acute exacerbation of bronchiectasis (non-cystic fibrosis)"]
[null,"Be aware that an acute exacerbation of bronchiectasis is a sustained worsening of symptoms from a person’s stable state.","1.1.1"]
[null,"Treatment"]
[null,"Obtain a sputum sample from people with an acute exacerbation of bronchiectasis and send for culture and susceptibility testing.","1.1.2 "]
[null,"Offer an antibiotic to people with an acute exacerbation of bronchiectasis. When choosing an antibiotic (see the recommendations on choice of antibiotic), take account of: \n• the severity of symptoms\n• previous exacerbation and hospital admission history, and the risk of developing complications\n• previous sputum culture and susceptibility results.\n","1.1.3 "]
[null,"When results of sputum culture and susceptibility testing are available: \n• review the choice of antibiotic and\n• only change the antibiotic according to susceptibility results if bacteria are resistant and symptoms are not already improving (using a narrow-spectrum antibiotic wherever possible).\n","1.1.4 "]
[null,"With an antibiotic, give advice about: \n• possible adverse effects of antibiotics, particularly diarrhoea\n• seeking medical help if symptoms worsen rapidly or significantly at any time, or the person becomes systemically very unwell.","1.1.5 "]
[null,"Reassessment"]
[null,"Reassess people with an acute exacerbation of bronchiectasis if their symptoms worsen rapidly or significantly at any time, taking account of: \n• other possible diagnoses, such as pneumonia\n• any symptoms or signs suggesting a more serious illness or condition, such as cardiorespiratory failure or sepsis\n• previous antibiotic use, which may have led to resistant bacteria.\n\n","1.1.6 "]
[null,"Referral and seeking specialist advice"]
[null,"Refer people with an acute exacerbation of bronchiectasis to hospital if they have any symptoms or signs suggesting a more serious illness or condition (for example cardiorespiratory failure or sepsis).","1.1.7 "]
[null,"Seek specialist advice for people with an acute exacerbation of bronchiectasis if they: \n• have symptoms that are not improving with repeated courses of antibiotic treatment or\n• have bacteria that are resistant to oral antibiotics or\n• cannot take oral medicines (to explore locally available options for giving intravenous antibiotics at home or in the community, rather than in hospital, where this is appropriate).","1.1.8 "]
[null,"1.2 Choice of antibiotic for treating an acute exacerbation of bronchiectasis"]
[null,"When prescribing antibiotic treatment for an acute exacerbation of bronchiectasis: \n• follow table 1 for adults aged 18 years and over\n• follow table 2 for children and young people under 18 years.\n","1.2.1 "]
[null,"Give oral antibiotics first line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics.","1.2.2 "]
[null,"Review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible.","1.2.3"]
[null,"1.3 Preventing acute exacerbations of bronchiectasis (non-cystic fibrosis)"]
[null,"Do not routinely offer antibiotic prophylaxis to prevent acute exacerbations of bronchiectasis. Give advice about seeking medical help if symptoms of an acute exacerbation develop.","1.3.1 "]
[null,"Seek specialist advice about options for preventing exacerbations in people with repeated acute exacerbations, which may include a trial of antibiotic prophylaxis. ","1.3.2 "]
[null,"Only start a trial of antibiotic prophylaxis (with oral or inhaled antibiotics) in people with repeated acute exacerbations on the advice of a specialist. To ensure shared decision-making, discuss the following with the person: \n• the potential benefits of antibiotics for reducing exacerbations (taking into account the uncertain evidence of benefit for inhaled antibiotics)\n• the risks of antimicrobial resistance with long-term antibiotics, which may mean fewer effective antibiotics for future exacerbations\n• the possible adverse effects of long-term antibiotics, such as:\n- diarrhoea, cardiac events, hearing loss or tinnitus with macrolide antibiotics\n- bronchospasm with inhaled antibiotics\n• the possible interactions of macrolide antibiotics with other medicines\n• the need to regularly review prophylaxis.\n","1.3.3"]

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["  ","Baseline assessment tool for bronchiectasis (non-cystic fibrosis), acute exacerbation: antimicrobial prescribing (NICE antimicrobial prescribing guideline NG117)"]
[]
[null,"Table 1. Antibiotics for adults aged 18 years and over"]
[]
[null,"Antibiotic1,2","Dosage and course length"]
[null,"First-choice oral antibiotics for empirical treatment in the absence of current susceptibility data (guided by most recent sputum culture and susceptibilities where possible)"]
[null,"Amoxicillin3","500 mg three times a day for 7 to 14 days4"]
[null,"Doxycycline","200 mg on first day, then 100 mg once a day for a 7 to 14-day course4"]
[null,"Clarithromycin","500 mg twice a day for 7 to 14 days4"]
[null,"Alternative choice oral antibiotics (if person at higher risk of treatment failure5) for empirical treatment in the absence of current susceptibility data (guided by most recent sputum culture and susceptibilities where possible)"]
[null,"Co-amoxiclav","500/125 mg three times a day for 7 to 14 days4"]
[null,"Levofloxacin6 (with specialist advice if co-amoxiclav cannot be used; consider safety issues7)","500 mg once or twice a day for 7 to 14 days4"]
[null,"First-choice intravenous antibiotics (if unable to take oral antibiotics or severely unwell) for empirical treatment in the absence of current susceptibility data (guided by most recent sputum culture and susceptibilities where possible)8"]
[null,"Co-amoxiclav","1.2 g three times a day"]
[null,"Piperacillin with tazobactam","4.5 g three times a day, increased if necessary to 4.5 g four times a day"]
[null,"Levofloxacin6 (with specialist advice if co-amoxiclav or piperacillin with tazobactam cannot be used; consider safety issues7)","500 mg once or twice a day"]
[null,"When current susceptibility data available, choose antibiotics accordingly"]
[null,"Consult local microbiologist as needed"]
[null,"1See BNF for appropriate use and dosing in specific populations, for example, hepatic impairment, renal impairment, pregnancy and breastfeeding, and administering intravenous antibiotics."]
[null,"2When a person is receiving antibiotic prophylaxis, treatment should be with an antibiotic from a different class."]
[null,"3Amoxicillin is the preferred choice for women who are pregnant."]
[null,"4Course length based on an assessment of the severity of bronchiectasis, exacerbation history, severity of exacerbation symptoms, previous culture and susceptibility results, and response to treatment."]
[null,"5People who may be at higher risk of treatment failure include people who have had repeated courses of antibiotics, a previous sputum culture with resistant or atypical bacteria, or a higher risk of developing complications."]
[null,"6Not licensed for acute exacerbation of bronchiectasis, so use would be off label. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council’s Good practice in prescribing and managing medicines and devices for further information."]
[null,"7See MHRA advice for restrictions and precautions for using fluoroquinolone antibiotics due to very rare reports of disabling and potentially long-lasting or irreversible side effects affecting musculoskeletal and nervous systems. Warnings include: stopping treatment at first signs of a serious adverse reaction (such as tendonitis), prescribing with special caution in people over 60 years and avoiding coadministration with a corticosteroid (March 2019). "]
[null,"8Review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible for a total antibiotic course of 7 to 14 days."]
[]
[]
[]
[null,"Table 2. Antibiotics for children and young people under 18 years"]
[]
[null,"Antibiotic1,2","Dosage and course length3"]
[null,"First-choice oral antibiotics for empirical treatment in the absence of current susceptibility data (guided by most recent sputum culture and susceptibilities where possible)"]
[null,"Amoxicillin4","1 to 11 months, 125 mg three times a day for 7 to 14 days5"]
[null,null,"1 to 4 years, 250 mg three times a day for 7 to 14 days5"]
[null,null,"5 to 17 years, 500 mg three times a day for 7 to 14 days5"]
[null,"Clarithromycin","1 month to 11 years:"]
[null,null,"Under 8 kg, 7.5 mg/kg twice a day for 7 to 14 days5"]
[null,null,"8 to 11 kg, 62.5 mg twice a day for 7 to 14 days5"]
[null,null,"12 to 19 kg, 125 mg twice a day for 7 to 14 days5"]
[null,null,"20 to 29 kg, 187.5 mg twice a day for 7 to 14 days5"]
[null,null,"30 to 40 kg, 250 mg twice a day for 7 to 14 days5"]
[null,null," or"]
[null,null,"12 to 17 years, 250 mg to 500 mg twice a day for 7 to 14 days5"]
[null,"Doxycycline","12 to 17 years, 200 mg on first day, then 100 mg once a day for a 7 to 14-day course in total5"]
[null,"Alternative choice oral antibiotics (if person at higher risk of treatment failure6) for empirical treatment in the absence of current susceptibility data (guided by most recent sputum culture and susceptibilities where possible)"]
[null,"Co-amoxiclav","1 to 11 months, 0.25 ml/kg of 125/31 suspension three times a day for 7 to 14 days5"]
[null,null,"1 to 5 years, 5 ml of 125/31 suspension three times a day or 0.25 ml/kg of 125/31 suspension three times a day for 7 to 14 days5"]
[null,null,"6 to 11 years, 5 ml of 250/62 suspension three times a day or 0.15 ml/kg of 250/62 suspension three times a day for 7 to 14 days5"]
[null,null,"12 to 17 years, 250/125 mg three times a day or 500/125 mg three times a day for 7 to 14 days5"]
[null,"Ciprofloxacin (on with specialist advice if co-amoxiclav cannot be used; consider safety issues)7","1 to 17 years, 20 mg/kg twice daily (maximum 750 mg per dose) for 7 to 14 days5"]
[null,"First-choice intravenous antibiotics (if unable to take oral antibiotics or severely unwell) for empirical treatment in the absence of current susceptibility data (guided by most recent sputum culture and susceptibilities where possible)8"]
[null,"Co-amoxiclav","1 to 2 months, 30 mg/kg twice a day"]
[null,null,"3 months to 17 years, 30 mg/kg three times a day (maximum 1.2 g three times a day)"]
[null,"Piperacillin with tazobactam","1 month to 11 years, 90 mg/kg three or four times a day (maximum per dose 4.5 g four times a day)"]
[null,null,"12 to 17 years, 4.5 g three times a day, increased if necessary to 4.5 g four times a day"]
[null,"Ciprofloxacin (with specialist advice if co-amoxiclav or piperacillin with tazobactam cannot be used; consider safety issues7)","1 to 17 years, 10 mg/kg three times a day (maximum 400 mg per dose)"]
[null,"When current susceptibility data available, choose antibiotics accordingly"]
[null,"Consult local microbiologist as needed"]
[null,"1See BNF for children for appropriate use and dosing in specific populations, for example hepatic impairment and renal impairment, and administering intravenous antibiotics."]
[null,"2When a person is receiving antibiotic prophylaxis, treatment should be with an antibiotic from a different class."]
[null,"3The age bands apply to children of average size and, in practice, the prescriber will use the age bands in conjunction with other factors such as the severity of the condition and the child’s size in relation to the average size of children of the same age."]
[null,"4Amoxicillin is the preferred choice in young women who are pregnant."]
[null,"5Course length based on an assessment of the severity of bronchiectasis, exacerbation history, severity of exacerbation symptoms, previous culture and susceptibility results, and response to treatment."]
[null,"6People who may be at higher risk of treatment failure include people who have had repeated courses of antibiotics, a previous sputum culture with resistant or atypical bacteria, or a higher risk of developing complications."]
[null,"7See MHRA advice for restrictions and precautions for using fluoroquinolone antibiotics due to very rare reports of disabling and potentially long-lasting or irreversible side effects affecting musculoskeletal and nervous systems. Warnings include: stopping treatment at first signs of a serious adverse reaction (such as tendonitis), prescribing with special caution in people over 60 years and avoiding coadministration with a corticosteroid (March 2019)."]
[null,"8Review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible for a total antibiotic course of 7 to 14 days."]