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[null,"Baseline assessment tool for prostatitis (acute) (NICE antimicrobial prescribing guideline NG110)"]
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[null,"This baseline assessment tool can be used to evaluate whether practice is in line with the recommendations in prostatitis (acute): 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 prostatitis (acute) (NICE antimicrobial prescribing guideline NG110)."]
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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 prostatitis (acute) (NICE antimicrobial prescribing guideline NG110)"]
[]
[null,null,null,null,null,"Number of relevant recommendations",{"$f":"COUNTIF(E8:E999,\"Yes\")","v":0}]
[null,null,null,null,null,"Number of recommendations met",{"$f":"COUNTIF(G8:G999,\"Yes\")","v":0}]
[null,null,null,null,null,"Percentage of recommendations met",{"$f":"IF(ISERROR(G4/G3),\"\",G4/G3)","v":""}]
[]
[null,"NICE recommendation","Guideline reference","Year of recommendation","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 acute prostatitis"]
[null,"Be aware that acute prostatitis:\n• is a bacterial infection of the prostate needing treatment with antibiotics\n• is usually caused by bacteria entering the prostate from the urinary tract\n• can occur spontaneously or after medical procedures such as prostate biopsy\n• can last several weeks\n• can cause complications such as acute urinary retention and prostatic abscess.","1.1.1"]
[null,"Treatment"]
[null,"Offer an antibiotic (see the recommendations on choice of antibiotic) to people with acute prostatitis. Take account of:\n• the severity of symptoms\n• the risk of developing complications or having treatment failure, particularly after medical procedures such as prostate biopsy\n• previous urine culture and susceptibility results\n• previous antibiotic use, which may have led to resistant bacteria.","1.1.2"]
[null,"Obtain a midstream urine sample before antibiotics are taken and send for culture and susceptibility testing.","1.1.3"]
[null,"When results of urine cultures are available:\n• review the choice of antibiotic, and \n• change the antibiotic according to susceptibility results if the bacteria are resistant, using a narrow spectrum antibiotic wherever possible.\n","1.1.4"]
[null,"Advice when an antibiotic prescription is given"]
[null,"When an antibiotic is given, give advice about:\n• the usual course of acute prostatitis (several weeks)\n• possible adverse effects of the antibiotic, particularly diarrhoea and nausea\n• seeking medical help if:\n- symptoms worsen at any time, or\n- symptoms do not start to improve within 48 hours of taking the antibiotic, or\n- the person becomes systemically very unwell.","1.1.5"]
[null,"Reassessment"]
[null,"Reassess if symptoms worsen at any time, taking account of:\n• other possible diagnoses\n• any symptoms or signs suggesting a more serious illness or condition, such as acute urinary retention, prostatic abscess or sepsis \n• previous antibiotic use, which may have led to resistant bacteria.\n","1.1.6"]
[null,"Referral"]
[null,"Refer people with acute prostatitis to hospital if:\n• they have any symptoms or signs suggesting a more serious illness or condition (for example sepsis, acute urinary retention or prostatic abscess), or\n• their symptoms are not improving 48 hours after starting the antibiotic.\n","1.1.7"]
[null,"1.2 Self-care"]
[null,"Advise people with acute prostatitis about using paracetamol (with or without a low dose weak opioid, such as codeine) for pain, or ibuprofen if this is preferred and suitable.","1.2.1"]
[null,"Advise people with acute prostatitis about drinking enough fluids to avoid dehydration.","1.2.2"]
[null,"1.3 Choice of antibiotic"]
[null,"When prescribing an antibiotic for acute prostatitis, take account of local antimicrobial resistance data and follow table 1 for adults aged 18 years and over.","1.3.1"]
[null,"Give oral antibiotics first-line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics.","1.3.2"]
[null,"Review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible.","1.3.3"]
[null,"Review antibiotic treatment after 14 days and either stop the antibiotic or continue for a further 14 days if needed, based on an assessment of the person’s history, symptoms, clinical examination, urine and blood tests.","1.3.4"]

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["  "]
[null,"Table 1. Antibiotics for adults aged 18 years and over"]
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[null,"Antibiotic1","Dosage and course length"]
[null,"First-choice oral antibiotics (guided by susceptibilities when available)2"]
[null,"Ciprofloxacin (consider safety issues3)","500 mg twice a day for 14 days then review4"]
[null,"Ofloxacin (consider safety issues3)","200 mg twice a day for 14 days then review4"]
[null,"Alternative first-choice oral antibiotic if a fluoroquinolone antibiotic is not appropriate (seek specialist advice; guided by susceptibilities when available)2"]
[null,"Trimethoprim  ","200 mg twice a day for 14 days then review4"]
[null,"Second-choice oral antibiotics (after discussion with specialist)"]
[null,"Levofloxacin (consider safety issues3)","500 mg once a day for 14 days then review4"]
[null,"Co‑trimoxazole5","960 mg twice day for 14 days then review4"]
[null,"First-choice intravenous antibiotics (if unable to take oral antibiotics or severely unwell; guided by susceptibilities when available). Antibiotics may be combined if sepsis a concern2,6"]
[null,"Ciprofloxacin (consider safety issues3)","400 mg twice or three times a day"]
[null,"Levofloxacin (consider safety issues3)","500 mg once a day"]
[null,"Cefuroxime","1.5 g three or four times a day"]
[null,"Ceftriaxone","2 g once a day"]
[null,"Gentamicin","Initially 5 to 7 mg/kg once a day, subsequent doses adjusted according to serum gentamicin concentration7"]
[null,"Amikacin","Initially 15 mg/kg once a day (maximum per dose 1.5 g once a day), subsequent doses adjusted according to serum amikacin concentration (maximum 15 g per course)7"]
[null,"Second-choice intravenous antibiotics"]
[null,"Consult local microbiologist"]
[null,"1 See BNF for appropriate use and dosing in specific populations, for example, hepatic impairment and renal impairment, and administering intravenous antibiotics."]
[null,"2 Check any previous urine culture and susceptibility results and antibiotic prescribing and choose antibiotics accordingly."]
[null,"3 See 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 serious adverse reaction (such as tendonitis), prescribing with special caution in people over 60 years and avoiding coadministration with a corticosteroid (March 2019)."]
[null,"4 Review treatment after 14 days and either stop the antibiotic or continue for a further 14 days if needed based on clinical assessment."]
[null,"5 Co-trimoxazole should only be considered when there is bacteriological evidence of sensitivity and good reasons to prefer this combination to a single antibiotic (BNF, August 2018)."]
[null,"6 Review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible for a total of 14 days then review."]
[null,"7 Therapeutic drug monitoring and assessment of renal function is required (BNF, August 2018)."]