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[null,"Baseline assessment tool for urinary tract infection (catheter-associated): antimicrobial prescribing (NICE antimicrobial prescribing guideline NG113)"]
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[null,"This baseline assessment tool can be used to evaluate whether practice is in line with the recommendations in Urinary tract infection (catheter-associated): 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 Urinary tract infection (catheter-associated) (NICE antimicrobial prescribing guideline NG113)."]
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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 urinary tract infection (catheter-associated): antimicrobial prescribing (NICE  guideline NG113)"]
[]
[null,null,null,null,null,"Number of relevant recommendations",{"$f":"COUNTIF(E8:E995,\"Yes\")","v":0}]
[null,null,null,null,null,"Number of recommendations met",{"$f":"COUNTIF(G8:G995,\"Yes\")","v":0}]
[null,null,null,null,null,"Percentage of recommendations met",{"$f":"IF(ISERROR(G4/G3),\"\",G4/G3)","v":""}]
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[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 catheter-associated urinary tract infection"]
[null,"Be aware that:\n• a catheter-associated UTI is a symptomatic infection of the bladder or kidneys in a person with a urinary catheter\n• the longer a catheter is in place the more likely bacteria will be found in the urine; after 1 month nearly all people have bacteriuria\n• antibiotic treatment is not routinely needed for asymptomatic bacteriuria in people with a catheter.","1.1.1"]
[null,"Give advice about managing symptoms with self-care (see the recommendations on self-care) to all people with catheter-associated UTI. ","1.1.2"]
[null,"Treatment"]
[null,"Consider removing or, if this cannot be done, changing the catheter as soon as possible in people with a catheter-associated UTI if it has been in place for more than 7 days. Do not allow catheter removal or change to delay antibiotic treatment.","1.1.3"]
[null,"Obtain a urine sample before antibiotics are taken. Take the sample from the catheter, via a sampling port if provided, and use an aseptic technique (in line with the NICE guideline on healthcare-associated infection).\nhealthcare-associated infection).\n• If the catheter has been changed, obtain the sample from the new catheter.\n• If the catheter has been removed obtain a midstream specimen of urine.","1.1.4"]
[null,"Send the urine sample for culture and susceptibility testing, noting a suspected catheter-associated infection and any antibiotic prescribed.","1.1.5"]
[null,"Offer an antibiotic (see the recommendations on choice of antibiotic) to people with catheter-associated UTI. Take account of:\n• the severity of symptoms\n• the risk of developing complications, which is higher in people with known or suspected structural or functional abnormality of the genitourinary tract or immunosuppression \n• previous urine culture and susceptibility results\n• previous antibiotic use which may have led to resistant bacteria.","1.1.6"]
[null,"When urine culture and susceptibility results are available:\n• review the choice of antibiotic, and \n• change the antibiotic according to susceptibility results if the bacteria are resistant, using narrow spectrum antibiotics wherever possible.","1.1.7"]
[null,"Advice when an antibiotic prescription is given"]
[null,"When an antibiotic is given, as well as the general advice on self-care, give advice about:\n• possible adverse effects of antibiotics, 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.","1.1.8"]
[null,"Reassessment"]
[null,"Reassess people with catheter-associated UTI if symptoms worsen at any time, or do not start to improve within 48 hours of taking the antibiotic, taking account of:\n• other possible diagnoses\n• any symptoms or signs suggesting a more serious illness or condition, such as sepsis\n• previous antibiotic use, which may have led to resistant bacteria.","1.1.9"]
[null,"Referral and seeking specialist advice"]
[null,"Refer people with catheter-associated UTI to hospital if they have any symptoms or signs suggesting a more serious illness or condition (for example, sepsis).","1.1.10"]
[null,"Consider referring or seeking specialist advice for people with catheter-associated UTI if they:\n• are significantly dehydrated or unable to take oral fluids and medicines, or\n• are pregnant, or\n• have a higher risk of developing complications (for example, people with known or suspected structural or functional abnormality of the genitourinary tract or underlying disease [such as diabetes or immunosuppression]), or  \n• have recurrent catheter-associated UTIs, or\n• have bacteria that are resistant to oral antibiotics.","1.1.11"]
[null,"1.2  Self-care"]
[null,"Advise people with catheter-associated UTI about using paracetamol for pain.","1.2.1"]
[null,"Advise people with catheter-associated UTI about drinking enough fluids to avoid dehydration.","1.2.2"]
[null,"1.3  Choice of antibiotic"]
[null,"When prescribing an antibiotic for catheter-associated UTI, take account of local antimicrobial resistance data and:\n• follow table 1 for non-pregnant women and men aged 16 years and over\n• follow table 2 for pregnant women aged 12 years and over\n• follow table 3 for children and young people under 16 years.","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,"1.4  Preventing catheter-associated urinary tract infections"]
[null,"Do not routinely offer antibiotic prophylaxis to prevent catheter-associated UTI in people with a short-term or a long-term (indwelling or intermittent) catheter.","1.4.1"]
[null,"Give advice about seeking medical help if symptoms of an acute UTI develop.","1.4.2"]

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[]
[null,"Table 1 Antibiotics for non-pregnant women and men aged 16 years and over"]
[]
[null,"Antibiotic1","Dosage and course length"]
[null,"First choice oral antibiotics if no upper UTI symptoms2"]
[null,"Nitrofurantoin – if eGFR ≥45 ml/minute3,4","100 mg modified-release twice a day for 7 days"]
[null,"Trimethoprim – if low risk of resistance5","200 mg twice a day for 7 days"]
[null,"Amoxicillin (only if culture results available and susceptible)","500 mg three times a day for 7 days"]
[null,"Second choice oral antibiotic if no upper UTI symptoms (when first choice not suitable)2"]
[null,"Pivmecillinam (a penicillin)4","400 mg initial dose, then 200 mg three times a day for a total of 7 days"]
[null,"First choice oral antibiotics if upper UTI symptoms2 "]
[null,"Cefalexin","500 mg twice or three times a day (up to 1 to 1.5 g three or four times a day for severe infections) for 7 to 10 days"]
[null,"Co-amoxiclav (only if culture results available and susceptible)","500/125 mg three times a day for 7 to 10 days"]
[null,"Trimethoprim (only if culture results available and susceptible)","200 mg twice a day for 14 days"]
[null,"Ciprofloxacin (consider safety issues6)","500 mg twice a day for 7 days"]
[null,"First choice intravenous antibiotics (if vomiting, unable to take oral antibiotics or severely unwell). Antibiotics may be combined if susceptibility or sepsis a concern2,7"]
[null,"Co-amoxiclav (only in combination, unless culture results confirm susceptibility)","1.2 g three times a day"]
[null,"Cefuroxime","750 mg to 1.5 g three or four times a day"]
[null,"Ceftriaxone","1 to 2 g once a day"]
[null,"Ciprofloxacin (consider safety issues6)","400 mg twice or three times a day"]
[null,"Gentamicin","Initially 5 to 7 mg/kg once a day, subsequent doses adjusted according to serum‑gentamicin concentration8"]
[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)8"]
[null,"Second choice intravenous antibiotics"]
[null,"Consult local microbiologist"]
[null,"1See BNF for appropriate use and dosing in specific populations, for example, hepatic impairment, renal impairment and breastfeeding, and administering intravenous antibiotics."]
[null,"2Check any previous urine culture and susceptibility results and antibiotic prescribing and choose antibiotics accordingly."]
[null,"3May be used with caution if eGFR 30–44 ml/minute to treat uncomplicated lower UTI caused by suspected or proven multidrug resistant bacteria and only if potential benefit outweighs risk (BNF, August 2018)."]
[null,"4Nitrofurantoin and pivmecillinam are only licensed for uncomplicated lower UTIs, and are not suitable for people with upper UTI symptoms or a blocked catheter."]
[null,"5A lower risk of resistance is likely if not used in the past 3 months, previous urine culture suggests susceptibility (but this was not used), and in younger people in areas where local epidemiology data suggest resistance is low. A higher risk of resistance is likely with recent use and in older people in care homes."]
[null,"6See 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,"7Review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible."]
[null,"8Therapeutic drug monitoring and assessment of renal function is required (BNF, August 2018)."]
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[]
[null,"Table 2 Antibiotics for pregnant women aged 12 years and over"]
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[null,"Antibiotic1","Dose and course length"]
[null,"First choice oral antibiotic2"]
[null,"Cefalexin","500 mg twice or three times a day (up to 1 to 1.5 g three or four times a day for severe infections) for 7 to 10 days"]
[null,"First choice intravenous antibiotic (if vomiting, unable to take oral antibiotics, or severely unwell)2,3"]
[null,"Cefuroxime","750 mg to 1.5 g three or four times a day"]
[null,"Second choice antibiotics or combining antibiotics if susceptibility or sepsis a concern"]
[null,"Consult local microbiologist"]
[null,"1See BNF for appropriate use and dosing in specific populations, for example, hepatic impairment and renal impairment, and administering intravenous antibiotics."]
[null,"2Check any previous urine culture and susceptibility results and antibiotic prescribing and choose antibiotics accordingly."]
[null,"3Review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible."]
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[]
[null,"Table 3 Antibiotics for children and young people under 16 years"]
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[null,"Antibiotic1","Dosage and course length2"]
[null,"Children under 3 months"]
[null,"Refer to paediatric specialist and treat with intravenous antibiotics in line with the NICE guideline on fever in under 5s."]
[null,"Children aged 3 months and over"]
[null,"First choice oral antibiotics3"]
[null,"Trimethoprim – if low risk of resistance4","3 to 5 months, 4 mg/kg (maximum 200 mg per dose) or 25 mg twice a day for 7 to 10 days"]
[null,null,"6 months to 5 years, 4 mg/kg (maximum 200 mg per dose) or 50 mg twice a day for 7 to 10 days"]
[null,null,"6 to 11 years, 4 mg/kg (maximum 200 mg per dose) or 100 mg twice a day for 7 to 10 days"]
[null,null,"12 to 15 years, 200 mg twice a day for 7 to 10 days"]
[null,"Amoxicillin (only if culture results available and susceptible)","3 to 11 months, 125 mg three times a day for 7 to 10 days"]
[null,null,"1 to 4 years, 250 mg three times a day for 7 to 10 days"]
[null,null,"5 to 15 years, 500 mg three times a day for 7 to 10 days"]
[null,"Cefalexin","3 to 11 months, 12.5 mg/kg or 125 mg twice a day for 7 to 10 days (25 mg/kg two to four times a day [maximum 1 g per dose four times a day] for severe infections)"]
[null,null,"1 to 4 years, 12.5 mg/kg twice a day or 125 mg three times a day for 7 to 10 days (25 mg/kg two to four times a day [maximum 1 g per dose four times a day] for severe infections)"]
[null,null,"5 to 11 years, 12.5 mg/kg twice a day or 250 mg three times a day for 7 to 10 days (25 mg/kg two to four times a day [maximum 1 g per dose four times a day] for severe infections)"]
[null,null,"12 to 15 years, 500 mg twice or three times a day (up to 1 to 1.5 g three or four times a day for severe infections) for 7 to 10 days"]
[null,"Co-amoxiclav (only if culture results available and susceptible)","3 to 11 months, 0.25 ml/kg of 125/31 suspension three times a day for 7 to 10 days (dose doubled in severe infection)"]
[null,null,"1 to 5 years, 0.25 ml/kg of 125/31 suspension or 5 ml of 125/31 suspension three times a day for 7 to 10 days (dose doubled in severe infection)"]
[null,null,"6 to 11 years, 0.15 ml/kg of 250/62 suspension or 5 ml of 250/62 suspension three times a day for 7 to 10 days (dose doubled in severe infection)"]
[null,null,"12 to 15 years, 250/125 mg or 500/125 mg three times a day for 7 to 10 days"]
[null,"First choice intravenous antibiotics (if vomiting, unable to take oral antibiotics or severely unwell). Antibiotics may be combined if susceptibility or sepsis a concern3,5,6"]
[null,"Co-amoxiclav (only in combination unless culture results confirm susceptibility)","3 months to 15 years, 30 mg/kg three times a day (maximum 1.2 g three times a day)"]
[null,"Cefuroxime","3 months to 15 years, 20 mg/kg three times a day (maximum 750 mg per dose), (50 to 60 mg/kg three or four times a day [maximum 1.5 g per dose] for severe infections)"]
[null,"Ceftriaxone","3 months to 11 years (up to 50 kg), 50 to 80 mg/kg once a day (maximum 4 g per day)"]
[null,null,"9 to 11 years (50 kg and above), 1 to 2 g once a day"]
[null,null,"12 to 15 years, 1 to 2 g once a day"]
[null,"Gentamicin","Initially 7 mg/kg once a day, subsequent doses adjusted according to serum-gentamicin concentration7"]
[null,"Amikacin","Initially 15 mg/kg once a day, subsequent doses adjusted according to serum‑amikacin concentration7"]
[null,"Second choice intravenous antibiotic "]
[null,"Consult local microbiologist"]
[null,"1See BNF for children (BNFC) for appropriate use and dosing in specific populations, for example, hepatic impairment and renal impairment, and administering intravenous antibiotics. See table 2 if the young woman is pregnant."]
[null,"2The 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 being treated and the child’s size in relation to the average size of children of the same age."]
[null,"3Check any previous urine culture and susceptibility results and antibiotic prescribing and choose antibiotics accordingly. If a child or young person is receiving prophylactic antibiotics, treatment should be with a different antibiotic, not a higher dose of the same antibiotic."]
[null,"4A lower risk of resistance is likely if not used in the past 3 months, previous urine culture suggests susceptibility (but this was not used), and in younger people in areas where local epidemiology data suggest resistance is low. A higher risk of resistance is likely with recent use."]
[null,"5Review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible for a total antibiotic course of 10 days."]
[null,"6If intravenous treatment is not possible, consider intramuscular treatment if suitable."]
[null,"7Therapeutic drug monitoring and assessment of renal function is required (BNFC, August 2018)."]