1. health and fitness
2. therapy

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Antibiotic use in urinary tract infection
Aims of the clinical audit
To review your prescribing of antibiotics for
urinary tract infection
To compare your practice with the
recommendations of Therapeutic Guidelines:
Antibiotic, Version 12, 2003 and with the
practice of other participating doctors
Please tear off each
section carefully.
Registration form and
clinical audit forms
should be returned to NPS
by 9 September 2005.
How to participate
1. Select patients
5. When you receive your results
Prospectively as patients present for consultation,
or retrospectively from a search of electronic/paper
medical records, identify 20 patients who have a
diagnosis or have a provisional diagnosis of:
asymptomatic bacteriuria,
acute cystitis (lower urinary tract infection), or
acute pyelonephritis.
You will receive:
your original clinical audit forms
feedback on your individual results
the aggregate results of all participants’
management practices
commentary on the aggregate results
a Review Phase pack to complete and return
(see below).
Patients must be informed that data from their
medical records may be used for the purposes
of clinical audits, and written consent must be
obtained (see attached poster and patient
consent form).
3. Record patient data
(first data collection)
Use the Patient record form to record the patients
you have included. DO NOT send to NPS — keep
this record to assist in identifying patients for
second data collection (see No. 6).
Complete a clinical audit form for each patient.
See notes on pages 2–3.
Please note:
patient information must only be collected and
recorded by the participating doctor
both full-time and part-time GPs are required
to submit 20 completed clinical audit forms.
4. Submit the clinical audit forms
Return the 20 clinical audit forms
and Registration form to:
NPS Clinical Audit: Antibiotic 2005
Locked Bag 4888
STRAWBERRY HILLS NSW 2012
To be received at NPS not later than
9 September 2005
Please note: Unfortunately, late submissions
cannot be accepted.
6. Completing the clinical audit cycle
(including second data collection)
You are required to:
review your individual and the aggregate results
in the Feedback report
identify which of your original 20 patients
require follow-up
record additional patient data
reflect on changes in management
submit the Review Phase pack.
Professional development and PIP
NPS has applied for clinical audit points in the
2005–2007 triennium of the Royal Australian
College of General Practitioners (RACGP) Quality
Assurance & Continuing Professional Development
(QA&CPD) Program (Category 1 activity) and the
Australian College of Rural and Remote Medicine
(ACRRM) Professional Development Program
(practice improvement category).
The Review Phase pack must be completed and
returned to NPS for RACGP and/or ACRRM clinical
audit points to be allocated and for the clinical
audit to qualify for the Quality Prescribing Initiative
(QPI) of the Practice Incentives Program (PIP).
You will then be sent a certificate of completion.
Guide to clinical audit
2. Obtain patient consent
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Notes for clinical audit form
Additional information to assist you to review management
Patient details
Investigations for this presentation
(Q7) Dipstick tests are useful in guiding initial
Urinary tract infection (UTI) is a common bacterial
infection. It is the fifteenth most commonly managed
problem and the fourth most frequently managed new
problem in general practice.1 It can occur in males and
females of all ages, however it is more common in sexually
active women. The most common causative organisms
of urinary tract infection are Escherichia coli and
Staphylococcus saprophyticus.2
management. They cannot be relied on to definitely
exclude or confirm a diagnosis of a UTI. Culture the urine
if it is important to make an accurate diagnosis or to select
an effective antimicrobial agent.3
Urine culture2,3:
should be obtained from a clean-catch midstream
urine (MSU) sample for culture and sensitivity
IS NOT indicated when cystitis is suspected in
otherwise healthy women
IS indicated for
pregnant women
elderly people with clinical signs of UTI
recurrent cystitis
treatment failure (relapse)
males of any age
females under 5 years of age
premenarcheal females with recurrent UTI
should, where possible, be collected before antibiotic
treatment is commenced4,5
is recommended after the completion of antibiotic
therapy in:
pregnant women, men, children and patients
with acute pyelonephritis.
Your patient code
(Q1) Choose your own unique identifying code for the
patient, e.g. a sequential number or the patient’s initials
(please do not use the patient’s name).
Provisional/confirmed diagnosis
(Q4) Please indicate one only for each patient:
asymptomatic bacteriuria
acute cystitis (lower urinary tract infection), or
acute pyelonephritis.
Signs and symptoms of urinary tract infection
Signs and symptoms include abdominal pain, behavioural
disturbance, chills, cloudy/foul smelling urine, confusion,
dysuria, failure to thrive, fever, frequency, haematuria,
incontinence, nocturia, secondary incontinence, suprapubic
discomfort, suprapubic tenderness and vomiting.3–5
A temperature of > 38.5°C is more characteristic
of pyelonephritis.3
Urinary tract infection in elderly people may present with
features such as secondary incontinence, confusion,
anorexia, high temperature or shock.
When cystitis is confirmed by a positive urine culture,
males of all ages, females under 5 years of age and
premenarcheal females with recurrent UTI should be
investigated further to exclude any underlying abnormality2
(e.g. vesico-ureteric reflux, reflux nephropathy, prostate
enlargement, urinary obstruction).
History of presentation
(Q5) Please indicate if the current presentation for urinary
tract infection for each patient is:
only episode within a 12 month period
within 2 weeks of previous infection
(i.e. relapse/treatment failure)3
second presentation within a 12 month period
(i.e. > 2 weeks after previous infection)
≥ 3 presentations within a 12 month period
(i.e. recurrent).3
Results of urine culture
(Q9) Review of the patient depends on the clinical
situation.
In all patients where an MSU has been sent for culture and
sensitivity, check results of the culture to ensure that
antibiotic treatment is appropriate.
2
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Management
Symptomatic and other management
(Q10)
Prophylactic antibiotic therapy
(Q12)
Paracetamol or ibuprofen can be used to relieve pain
and high temperatures.3
Cranberry juice has not been shown to be of benefit in
the treatment of acute urinary tract infection.3,6
There is some evidence to suggest that cranberry juice
may be effective in prevention by reducing the number
of symptomatic UTIs in women. Its effectiveness in
children, elderly women and elderly men remains
unclear.6
Urine-alkalinising agents (Atravescent, Citralite,
Citravescent, sodium bicarbonate, Uracol, Ural,
Uricalm, Uricosal, Urocite-K) are popular agents used in
the symptomatic management of urinary symptoms
which may relieve discomfort of UTIs.7 Urinealkalinising agents change the pH of the urine making
some antibiotics and antibacterials less effective (e.g.
hexamine hippurate [avoid concomitant use],
nitrofurantoin [avoid excessive alkalinisation of urine
pH > 8.0]) and increasing the risk of crystalluria when
used in combination (quinolones).7,8
Increased fluid intake is often recommended as
symptomatic management for urinary tract infection
but its effectiveness is unproven.3
In children with a positive urine culture and after the
initial infective episode, antibiotic prophylaxis (with
nitrofurantoin or trimethoprim) should be started
immediately after the treatment course and continued
until urinary tract imaging has been done.2
Women with frequent recurrences (e.g. ≥ 3
symptomatic episodes/year)3 may be considered for
intermittent self-treatment, at the onset of
characteristic symptoms, or prophylaxis with either:
continuous low dose antibiotic prophylaxis
within 2 hours after sexual intercourse.
Prophylaxis instituted after successful treatment can reduce
or prevent subsequent attacks and may be continued for
3–6 months, or in some cases longer.2
Prophylactic antibiotic treatment2
1. nitrofurantoin (child: 1–2.5 mg/kg up to) 50 mg orally,
at night (50 mg and 100 mg capsules only; avoid use in
moderate to severe renal impairment; caution in elderly)
2. cephalexin (child: 12.5 mg/kg up to) 250 mg orally,
at night
3. trimethoprim (child: 2 mg/kg up to) 150 mg orally,
at night (300 mg scored tablets only)
Antibiotic/antibacterial
(Q11)
Prophylactic antibiotic treatment of urinary tract infection
should be considered following successful treatment of
recurrent infection or where indicated in children.
Clearly mark the antibiotic or antibacterial prescribed,
the dose, route of administration, frequency, and
length of treatment used to manage this presentation.
Where there is a combination product prescribed (e.g.
amoxycillin+clavulanate or
trimethoprim+sulfamethoxazole) only indicate the dose
of the first named compound in the combination (i.e.
amoxycillin or trimethoprim).
If the antibiotic prescribed is not listed please specify
and indicate the reason for your choice.
Guidelines
Consistency with Therapeutic Guidelines: Antibiotic
(Q16) Use the summary chart of antibiotic treatment in urinary tract infection to compare your responses to Therapeutic
Guidelines: Antibiotic, 2003 recommendations. Indicate if current management was consistent with Therapeutic Guidelines:
Antibiotic by marking the box.
3
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Summary of recommended antibiotic treatment in urinary tract infections2
Asymptomatic bacteriuria
In school-aged children, non-pregnant women and those over 60 years of age, asymptomatic
bacteriuria probably does not require treatment if the urinary tract is normal (see Therapeutic
Guidelines: Antibiotic, Version 12, 2003 for further information).
Acute cystitis (lower urinary tract infection)
Antibiotic
Non-pregnant women
Any of the regimens is expected to cure
the majority of acute non-complicated
lower UTI in non-pregnant women.
Single dose therapy is not as reliable
as multiple dose therapy in preventing
relapse.
If relapse occurs after appropriate and
adequate antibiotic treatment, consider
pyelonephritis and treat for 10–15 days.
1. trimethoprim 300 mg orally, daily
OR
2. cephalexin 500 mg orally, 12-hourly
OR
3. amoxycillin+clavulanate 500+125 mg orally, 12-hourly
OR
4. nitrofurantoin 50 mg orally, 6-hourly
(avoid use in moderate to severe renal impairment; caution in elderly)7
Amoxycillin without clavulanate is only recommended if susceptibility of the organism
is proven.
If the culture is positive for Pseudomonas aeruginosa or resistance to all the above drugs
has been proven consider norfloxacin 400 mg orally, 12-hourly for 3 days.
Pregnant women
1. cephalexin 500 mg orally, 12-hourly (category A)*
OR
It is important to consider the category
of risk posed by the use of the particular 2. nitrofurantoin 50 mg orally, 6-hourly (category A)*
(avoid use in moderate to severe renal impairment; do not use at or near term)7
antibiotic during pregnancy.
OR
Urine culture should be repeated after
3. amoxycillin+clavulanate 500+125 mg orally, 12-hourly (category B1)**
treatment.
Amoxycillin without clavulanate (category A)* is only recommended if susceptibility of the
organism is proven.
Men
1. trimethoprim 300 mg orally, daily
OR
(if there is no underlying abnormality)
2. cephalexin 500 mg orally, 12-hourly
All males with a UTI should be
OR
investigated to exclude underlying
3. amoxycillin+clavulanate 500+125 mg orally, 12-hourly
abnormality which determines the
OR
duration of antibiotic therapy.
4. nitrofurantoin 50 mg orally, 6-hourly
(avoid use in moderate to severe renal impairment; caution in elderly)7
Children†#
1. cephalexin 12.5 mg/kg up to 500 mg orally, 12-hourly
OR
For children with a positive urine culture
2. trimethoprim 6 mg/kg up to 300 mg orally, daily (300 mg scored tablets only)
consider pyelonephritis and/or an
OR
underlying abnormality in males of any
††
12.5+3.1 mg/kg up to 500+125 mg orally, 12-hourly
3.
amoxycillin+clavulanate
age, females under 5 years of age and
premenarcheal females with recurrent UTI. OR
4. trimethoprim+sulfamethoxazole 4+20 mg/kg up to 160+800 mg orally, 12-hourly
Length of
treatment
3 days
5 days
5 days
5 days
10 days
10 days
10 days
14 days
14 days
14 days
14 days
5 days
5 days
5 days
5 days
Acute pyelonephritis
Mild to moderate infection
1. cephalexin (child: 12.5 mg/kg up to) 500 mg orally, 6-hourly
10 days
OR
2. amoxycillin+clavulanate†† (child: 22.5+3.2 mg/kg up to) 875+125 mg orally, 12-hourly 10 days
OR
10 days
3. trimethoprim (child: 6 mg/kg up to) 300 mg orally, daily
If the culture is positive for Pseudomonas aeruginosa or resistance to all the above drugs
has been proven consider ciprofloxacin 500 mg orally, 12-hourly.†
Severe infection – parenteral treatment amoxycillin/ampicillin (child: 25 mg/kg up to) 1 g IV, 6-hourly
10–14 days
should be given initially, substituting oral PLUS
therapy as soon as possible for a total of gentamicin (child: < 10 years: 7.5 mg/kg; ≥ 10 years: 6 mg/kg) 4–6 mg/kg IV, daily
10–14 days.
(adjust dose for renal function)
Treatment should be guided by antibiotic In patients with hypersensitivity to penicillin, gentamicin alone will usually be adequate.
sensitivity results.
Where gentamicin is undesirable (e.g. the elderly, presence of significant renal failure or
following a previous adverse reaction), as a single drug use:
cefotaxime (child: 50 mg/kg up to) 1 g IV, 8-hourly
10–14 days
OR
ceftriaxone (child: 50 mg/kg up to) 1 g IV, daily
Please note:
In patients with moderate to severe renal impairment a reduced antibiotic dose may be required (see also Australian Medicines Handbook, 2005).7
* Category A: drugs which have been taken by a large number of pregnant women and
women of child bearing age without any proven increase in the frequency of
malformations or other direct or indirect harmful effects on the foetus have been observed.
**Category B1: drugs which have been taken by only a limited number of pregnant women
and women of child bearing age without any proven increase in the frequency of
malformations or other direct or indirect harmful effects on the foetus have been observed.
† Quinolones should be avoided in children unless deemed necessary on
microbiological grounds.
††Please note there are two strengths of amoxycillin+clavulanate oral liquid available
(i.e. amoxycillin 25 mg/mL + clavulanate 6.25 mg/mL in 75 mL [Augmentin, Clamohexal,
Clamoxyl, Clavulin] or amoxycillin 80 mg/mL + clavulanate 11.4 mg/mL in 60 mL
[Augmentin Duo, Clamohexal Duo, Clamoxyl Duo, Clavulin Duo]).
# After the initial infective episode, antibiotic prophylaxis (with nitrofurantoin or
trimethoprim) should be commenced immediately after the cessation of the
treatment course until urinary tract imaging has been done.
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Generic and brand names for selected antibiotics
Class
Generic
Aminoglycosides
gentamicin
Brand name
Cephalosporins
cephalexin
Cilex, Ialex, Ibilex, Keflex, Sporahexal
ceftriaxone
Rocephin
cefotaxime
Penicillins
amoxycillin
Alphamox, Amohexal, Amoxil, Amoxil Duo, Bgramin, Cilamox,
Ibiamox, Fisamox, Maxamox, Moxacin
amoxycillin+clavulanate
Augmentin, Augmentin Duo, Augmentin Duo Forte,
Augmentin Duo 400, Ausclav, Ausclav Duo, Ausclav Duo
Forte, Ausclav Duo 400, Clamoxyl, Clamoxyl Duo, Clamoxyl
Duo Forte, Clamoxyl Duo 400, Clavulin, Clavulin Duo,
Clavulin Duo 400, Clavulin Duo Forte, Curam, Muric
ampicillin
Alphacin, Ampicyn, Aspen, Austrapen, Ibimicyn
ciprofloxacin
C-Flox, Ciprol, Ciproxin, Profloxin, Proquin
norfloxacin
Insensye, Norflohexal, Noroxin, Nufloxib, Roxin
Quinolones
Other antibacterials
hexamine hippurate
Hiprex
nitrofurantion
Macrodantin, Ralodantin
trimethoprim
Alprim, Triprim
trimethoprim+sulfamethoxazole
Bactrim DS, Cosig Forte, Resprim, Resprim Forte, Septrin,
Septrin Forte
5
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Patient consent
Please:
display the enclosed poster (Quality assurance and
your privacy) in your practice
ask patients who present to the practice to read
and sign a copy of the enclosed Patient information
and consent form, or
send the enclosed Patient information and consent
form to patients whose records you wish to use
retrospectively, asking them to sign and return it
to the practice
DO NOT send the Patient information and consent
form to NPS.
Privacy
By participating you agree to aggregation of your
de-identified patient data and use of your personal
data. Individual results of your clinical audit are kept
confidential by NPS.
What will happen to
Your patient data:
your de-identified patient data forms are returned
to you
your individual results are provided to you only
your data are aggregated with that of other
participants and the de-identified aggregate results:
are provided to all participants
may be used in NPS evaluation and reports
are provided to the RACGP and ACRRM.
The RACGP has advised that program information
may be shared with researchers and interested general
practitioners for the purpose of continuing education
coordination at the discretion of the QA&CPD Program.
Your personal details:
are provided to the RACGP QA&CPD Program
and/or ACRRM Professional Development Program
for point allocation (if applicable)
are recorded for the purpose of the PIP and
NPS evaluation
can be obtained from NPS by request in writing.
Individual clinical audit results will not be available
after potentially identifying data are removed from
NPS records at the close of the clinical audit cycle.
Please note: you are responsible for advising NPS
of any changes of address during the audit cycle.
Further information
Therapeutic enquiries
Kim Barry at NPS: phone (02) 8217 8700
Audit and QPI enquiries
Cris Abbu at NPS: phone (02) 8217 8700
References
1. Britt H, et al. General practice activity in Australia 2003–04. Canberra: Australian
Institute of Health and Welfare (General Practice Series No 16); 2004. Report No.:
AIHW Cat. No. GEP 16.
5. PRODIGY Guidance-Urinary tract infection children (last revised April 2002);
accessed 14 January <http://www.prodigy.nhs.uk/guidance.asp?gt=UTI%20%20children>.
2. Therapeutic Guidelines: Antibiotic, 12th ed. Melbourne: Therapeutic Guidelines
Limited; 2003.
6. Jepson RG, et al. Cranberries for preventing urinary tract infections. Cochrane
Database Syst Rev 2004;(2):CD001321.
3. PRODIGY Guidance-Urinary tract infection (lower)-women (last revised January
2004); accessed 12 January
<http://www.prodigy.nhs.uk/guidance.asp?gt=uti%20(lower)%20-%20women>.
7. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd;
2005.
4. PRODIGY Guidance-Urinary tract infection (lower)-men (last revised September
2004); accessed 31 March
<http://www.prodigy.nhs.uk/guidance.asp?gt=uti%20(lower)%20-%20men>.
8. Stockley's Drug Interactions, 6th ed. London: Royal Pharmaceutical Society of Great
Britain; 2002.
The information contained in this material is derived from a critical analysis of a wide range of authoritative evidence.
Any treatment decisions based on this information should be made in the context of the clinical circumstances of each patient.
NPSA0299
National Prescribing Service Limited ACN 082 034 393
An independent, Australian organisation for Quality Use of Medicines,
funded by the Australian Government Department of Health and Ageing
Level 7 / 418A Elizabeth Street Surry Hills NSW 2010
Phone: 02 8217 8700 l Fax: 02 9211 7578 l email: [email protected] l web: www.nps.org.au
OKA4013 antibiotics audit form
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Clinical audit: Antibiotic
use in urinary tract infection
Please see the Guide to clinical audit booklet for supporting information to assist you to complete this form.
NPS office use only
Use a black biro to mark a cross (X) in the appropriate box
beside your response.
If you make a mistake, use white correction fluid.
Management
Patient details
10. Symptomatic and other management recommended for
this presentation
(mark all that apply)
1. Your patient code:
2. Age range:
0–5 years
6–14 years
Only indicate
weight for patients
aged 0–14 years
3. Sex:
male
female
15–65 years
> 65 years
kg
premenarcheal
pregnant
postmenopausal
4. Provisional/confirmed diagnosis (mark one only)
asymptomatic bacteriuria
acute cystitis/lower UTI
acute pyelonephritis
cranberry juice or cranberry tablets
ibuprofen
increased fluid intake
intra-vaginal oestrogen
paracetamol
urine-alkalinising agents (e.g. Citralite, Citravescent, Sodibic, Ural)
none
other ________________________________________________________________________________________________________________________________________
not known
11. Antibiotics/antibacterials prescribed for this presentation
Please turn over to complete Q11
5. History of presentation (See Guide page 2)
only episode within a 12 month period
within 2 weeks of previous infection (relapse)
2nd presentation within a 12 month period
≥ 3 presentations within a 12 month period
6. History of anatomical or functional abnormality
yes
no
not known
12. Will/have you prescribed prophylactic antibiotic/antibacterial
treatment subsequent to this presentation?
(See Guide page 3)
yes
no
not known
Patient counselling
urine dipstick (nitrate, leucocyte esterase and blood)
13. Was the patient educated about potential adverse effects and
drug interactions with antibiotic/antibacterial treatment?
yes
no
catheter specimen of urine
midstream urine (MSU)
suprapubic aspiration of urine
14. Were instructions given to the patient on dose, frequency and
duration of treatment?
yes
no
7. Investigations for this presentation (mark all that apply)
Obtained (mark all that apply)
before starting antibiotic treatment
after antibiotic course completed
other (please specify) _______________________________________
none
8. Were investigation(s) ordered (other than urine culture)?
yes (please specify) ________________________________________
no
not known
9. Were results of urine culture available to guide
antibiotic selection?
yes
no
not known
15. Was the patient provided with or recommended to obtain a
Consumer Medicine Information leaflet?
yes
no
Guidelines
16. Use the summary chart of recommended antibiotic treatment in
urinary tract infection (see Guide page 4) to compare your
responses to Therapeutic Guidelines: Antibiotic, Version 12, 2003
(Please indicate which statement applies for this patient).
Prescribing of antibiotic treatment for this patient IS consistent with
Therapeutic Guidelines: Antibiotic, Version 12, 2003 recommendations
Prescribing of antibiotic treatment for this patient IS NOT consistent with
Therapeutic Guidelines: Antibiotic, Version 12, 2003 recommendations
Please turn over to
complete form
OKA4013 antibiotics audit form
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Page 2
11. Antibiotics/antibacterials prescribed at this presentation
None
OR
Clearly mark name, dose (mg), route, frequency and duration for the antibiotic prescribed at this visit.
If the patient is a child, indicate the dose in mg for each kg of weight.
Antibiotic/antibacterial prescribed and dose (brand names) Route
amoxycillin
oral
(Alphamox, Amohexal, Amoxil, Bgramin, Cilamox, Ibiamox, Fisamox,
Maxamox, Moxacin)
IV/IM
Frequency
Duration
single dose
8-hourly
once daily
12-hourly
6-hourly
other _____________________
not applicable
7 days
3 days
10 days
5 days
14 days
other _____________________
oral
single dose
8-hourly
once daily
12-hourly
6-hourly
other _____________________
not applicable
7 days
3 days
10 days
5 days
14 days
other _____________________
oral
single dose
8-hourly
once daily
12-hourly
6-hourly
other _____________________
not applicable
7 days
3 days
10 days
5 days
14 days
other _____________________
IV/IM
single dose
8-hourly
once daily
12-hourly
6-hourly
other _____________________
not applicable
7 days
3 days
10 days
5 days
14 days
other _____________________
IV/IM
single dose
8-hourly
once daily
12-hourly
6-hourly
other _____________________
not applicable
7 days
3 days
10 days
5 days
14 days
other _____________________
oral
single dose
8-hourly
once daily
12-hourly
6-hourly
other _____________________
not applicable
7 days
3 days
10 days
5 days
14 days
other _____________________
oral
single dose
8-hourly
once daily
12-hourly
6-hourly
other _____________________
not applicable
7 days
3 days
10 days
5 days
14 days
other _____________________
IV/IM
single dose
8-hourly
once daily
12-hourly
6-hourly
other _____________________
not applicable
7 days
3 days
10 days
5 days
14 days
other _____________________
oral
single dose
8-hourly
once daily
12-hourly
6-hourly
other _____________________
not applicable
7 days
3 days
10 days
5 days
14 days
other _____________________
oral
single dose
8-hourly
once daily
12-hourly
6-hourly
other _____________________
not applicable
7 days
3 days
10 days
5 days
14 days
other _____________________
oral
single dose
8-hourly
once daily
12-hourly
6-hourly
other _____________________
not applicable
7 days
3 days
10 days
5 days
14 days
other _____________________
oral
single dose
8-hourly
once daily
12-hourly
6-hourly
other _____________________
not applicable
7 days
3 days
10 days
5 days
14 days
other _____________________
trimethoprim+sulfamethoxazole
oral
(Bactrim, Cosig Forte, Resprim, Septrin)
[Indicate dose of trimethoprim only]
IV/IM
single dose
8-hourly
once daily
12-hourly
6-hourly
other _____________________
not applicable
7 days
3 days
10 days
5 days
14 days
other _____________________
single dose
8-hourly
once daily
12-hourly
6-hourly
other _____________________
not applicable
7 days
3 days
10 days
5 days
14 days
other _____________________
DOSE
mg or mg/kg
amoxycillin+clavulanate
(Augmentin, Ausclav, Clamoxy, Clavulin, Curam, Muric)
[Indicate dose of amoxycillin only]
DOSE
mg or mg/kg
ampicillin
(Alphacin, Ampicyn, Aspen, Austrapen, Ibimicyn)
DOSE
cefotaxime
DOSE
IV/IM
mg or mg/kg
mg or mg/kg
ceftriaxone
(Rocephin)
DOSE
mg or mg/kg
cephalexin
(Cilex, Ialex, Ibilex, Keflex, Sporahexal)
DOSE
mg or mg/kg
ciprofloxacin
(C-Flox, Ciprol, Ciproxin, Profloxin, Proquin)
DOSE
IV/IM
mg or mg/kg
gentamicin
DOSE
mg or mg/kg
hexamine hippurate
(Hiprex)
DOSE
mg or mg/kg
nitrofurantoin
(Macrodantin, Ralodantin)
DOSE
mg or mg/kg
norfloxacin
(Insensye, Norflohexal, Noroxin, Nufloxib, Roxin)
DOSE
mg or mg/kg
trimethoprim
(Alprim, Triprim)
DOSE
DOSE
mg or mg/kg
mg or mg/kg
other antibiotic prescribed
oral
(please specify) __________________________________________________
DOSE
mg or mg/kg
Reason for selection
drug allergy
adverse reaction to first-line drug(s)
treatment failure using first-line drug(s)
pregnancy or lactation
other
IV/IM
Please turn over and
continue with Q12.
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Clinical audit
enrolment form
Clinical audit
Antibiotic use in urinary tract infection
Aims of this clinical audit
What this audit involves
Completing this clinical audit cycle offers
you the opportunity to:
review your prescribing of antibiotics for
uncomplicated urinary tract infection
As patients present for consultation or from a search
of your medical records, identify 20 patients who have
been diagnosed with either:
compare your practice with the recommendations
provided in Therapeutic Guidelines: Antibiotic,
Version 12, 2003 and with the practice of other
participating doctors.
Continuing professional
development points and PIP
NPS has applied for professional development points
in the 2005–2007 triennium of the RACGP Quality
Assurance and Continuing Professional Development
Program (QA&CPD) and the ACRRM Professional
Development Program.
This is the second clinical audit offered by NPS which
qualifies for the Quality Prescribing Initiative (QPI)
of the Practice Incentives Program (PIP) for May
2005 to April 2006.
asymptomatic bacteriuria
acute cystitis (lower urinary tract infection)
acute pyelonephritis.
Complete a clinical audit form for each patient.
Participation in this clinical audit requires agreement
to aggregation of de-identified patient data.
Completing the clinical audit cycle
Review individual and aggregate results
and commentary.
Record patients’ progress.
Identify where improvement in patient
management has occurred.
This Clinical Audit activity has been approved by the RACGP QA&CPD Program.
TOTAL POINTS for Steps 1–5: 30 (Category 1)
IMPORTANT
To enrol
Fill out the form on the reverse then return to NPS
to recieve your free audit pack.
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Clinical audit
enrolment form
Antibiotic use in urinary tract infection
To enrol
Submission date for your audit
Fill out the form below then return to NPS.
Enrolments must be received at NPS by
Friday 12 August 2005.
Completed clinical audit forms must be submitted
to NPS by Friday 9 September, 2005. Unfortunately,
late submissions cannot be accepted.
For more information:
Kim Barry
Chris Abbu
}
Phone: 02 8217 8700
Fax:
02 9211 7579
Email: [email protected]
Your details:
Please use BLOCK LETTERS
Doctor’s first name
Family name
Phone number
(
)
Fax number
(
)
Postal address
Suburb/town
State
Postcode
After you have enrolled, your free audit pack will be posted to you. To see a sample audit form before enrolling,
visit our website at www.nps.org.au/healthpro. Enrolments must be received at NPS by Friday 12 August, 2005.
Fax this completed form to (02) 9211 7579
OR
Post to: NPS, PO Box 1147,
STRAWBERRY HILLS NSW 2012
NPSF0298