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[null,"Baseline assessment tool for urinary tract infection (recurrent): antimicrobial prescribing (NICE antimicrobial prescribing guideline NG112)"]
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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 (recurrent): 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 (recurrent) (NICE antimicrobial prescribing guideline NG112)."]
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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 (recurrent) (NICE antimicrobial prescribing guideline NG112)"]
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[null,null,null,null,"Number of relevant recommendations",{"$f":"COUNTIF(D8:D994,\"Yes\")","v":0}]
[null,null,null,null,"Number of recommendations met",{"$f":"COUNTIF(F8:F994,\"Yes\")","v":0}]
[null,null,null,null,"Percentage of recommendations met",{"$f":"IF(ISERROR(F4/F3),\"\",F4/F3)","v":""}]
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[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  Preventing recurrent urinary tract infections"]
[null,"Manage an acute UTI as outlined in the NICE antimicrobial prescribing guidelines on lower UTI (cystitis), acute pyelonephritis or catheter‑associated UTI. ","1.1.1"]
[null,"Be aware that recurrent UTI:\n• includes lower UTI (cystitis) and upper UTI (acute pyelonephritis) \n• may be due to relapse (with the same strain of organism) or reinfection (with a different strain or species of organism)\n• is particularly common in women.","1.1.2"]
[null,"Give advice to people with recurrent UTI about behavioural and personal hygiene measures and self‑care treatments (see the recommendations on self‑care) that may help to reduce the risk of UTI.","1.1.3"]
[null,"Referral and seeking specialist advice"]
[null,"Refer or seek specialist advice on further investigation and management for:\n• men aged 16 years and over\n• people with recurrent upper UTI\n• people with recurrent lower UTI when the underlying cause is unknown\n• pregnant women\n• children and young people under 16 years in line with the NICE guideline on urinary tract infection in under 16s\n• people with suspected cancer in line with the NICE guideline on suspected cancer: recognition and referral.","1.1.4"]
[null,"Treatment for women with recurrent UTI who are not pregnant"]
[null,"Oestrogen"]
[null,"Consider the lowest effective dose of vaginal oestrogen  (for example, estriol cream) for postmenopausal women with recurrent UTI if behavioural and personal hygiene measures alone are not effective or not appropriate. Discuss the following with the woman to ensure shared decision-making:\n• the severity and frequency of previous symptoms\n• the risk of developing complications from recurrent UTIs\n• the possible benefits of treatment, including for other related symptoms, such as vaginal dryness\n• the possible adverse effects such as breast tenderness and vaginal bleeding (which should be reported because it may require investigation)\n• the uncertainty of endometrial safety with long-term or repeated use\n• preferences of the woman for treatment with vaginal oestrogen.\nReview treatment within 12 months, or earlier if agreed with the woman.","1.1.5"]
[null,"Do not offer oral oestrogens (hormone replacement therapy) specifically to reduce the risk of recurrent UTI in postmenopausal women.","1.1.6"]
[null,"Antibiotic prophylaxis"]
[null,"For women with recurrent UTI who are not pregnant, consider a trial of antibiotic prophylaxis only if behavioural and personal hygiene measures, and vaginal oestrogen (in postmenopausal women) are not effective or not appropriate.","1.1.7"]
[null,"For women with recurrent UTI who are not pregnant, ensure that any current UTI has been adequately treated then consider single-dose antibiotic prophylaxis for use when exposed to an identifiable trigger (see the recommendations on choice of antibiotic prophylaxis). Take account of:\n• the severity and frequency of previous symptoms\n• the risk of developing complications \n• previous urine culture and susceptibility results\n• previous antibiotic use which may have led to resistant bacteria\n• the woman’s preferences for antibiotic use.","1.1.8"]
[null,"When single-dose antibiotic prophylaxis is given, give advice about:\n• how to use the antibiotic \n• possible adverse effects of antibiotics, particularly diarrhoea and nausea\n• returning for review within 6 months\n• seeking medical help if there are symptoms of an acute UTI.\n","1.1.9"]
[null,"For women with recurrent UTI who are not pregnant and have had no improvement after single-dose antibiotic prophylaxis or have no identifiable triggers, ensure that any current UTI has been adequately treated then consider a trial of daily antibiotic prophylaxis (see the recommendations on choice of antibiotic prophylaxis). Take account of:\n• any further investigations (for example, ultrasound) that may be needed to identify an underlying cause\n• the severity and frequency of previous symptoms\n• the risks of long term antibiotic use\n• the risk of developing complications \n• previous urine culture and susceptibility results\n• previous antibiotic use which may have led to resistant bacteria\n• the woman’s preferences for antibiotic use.","1.1.10"]
[null,"When a trial of daily antibiotic prophylaxis is given, give advice about:\n• the risk of resistance with long-term antibiotics, which means they may be less effective in the future\n• possible adverse effects of long-term antibiotics \n• returning for review within 6 months\n• seeking medical help if there are symptoms of an acute UTI.","1.1.11"]
[null,"Treatment for men and pregnant women with recurrent UTI"]
[null,"For men and pregnant women with recurrent UTI, ensure that any current UTI has been adequately treated then consider a trial of daily antibiotic prophylaxis (see the recommendations on choice of antibiotic prophylaxis) if behavioural and personal hygiene measures alone are not effective or not appropriate, with specialist advice. Take account of:\n• any further investigations (for example, ultrasound) that may be needed to identify an underlying cause\n• the severity and frequency of previous symptoms\n• the risks of long term antibiotic use\n• the risk of developing complications \n• previous urine culture and susceptibility results\n• previous antibiotic use which may have led to resistant bacteria\n• the person’s preferences for antibiotic use.","1.1.12"]
[null,"When a trial of daily antibiotic prophylaxis is given, give advice as in recommendation 1.1.11.","1.1.13"]
[null,"Treatment for children and young people under 16 years with recurrent UTI"]
[null,"For children and young people under 16 years with recurrent UTI, ensure that any current UTI has been adequately treated then consider a trial of daily antibiotic prophylaxis (see the recommendations on choice of antibiotic prophylaxis) if behavioural and personal hygiene measures alone are not effective or not appropriate, with specialist advice. Take account of:\n• underlying causes following specialist assessment and investigations\n• the uncertain evidence of benefit of antibiotic prophylaxis for reducing the risk of recurrent UTI and the rate of deterioration of renal scars \n• the severity and frequency of previous symptoms\n• the risks of long term antibiotic use\n• the risk of developing complications \n• previous urine culture and susceptibility results\n• previous antibiotic use which may have led to resistant bacteria \n• preferences for antibiotic use.","1.1.14"]
[null,"When a trial of daily antibiotic prophylaxis is given, give advice as in recommendation 1.1.11.","1.1.15"]
[null,"Reassessment"]
[null,"Review antibiotic prophylaxis for recurrent UTI at least every 6 months, with the review to include:\n• assessing the success of prophylaxis\n• discussion of continuing, stopping or changing prophylaxis (taking into account the person’s preferences for antibiotic use and the risk of antimicrobial resistance)\n• a reminder about behavioural and personal hygiene measures and self-care treatments (see the recommendations on self care)\nIf antibiotic prophylaxis is stopped, ensure that people have rapid access to treatment if they have an acute UTI.","1.1.16"]
[null,"1.2  Self-care"]
[null,"Be aware that:\n• some women with recurrent UTI may wish to try D-mannose  if they are not pregnant\n• some women with recurrent UTI may wish to try cranberry products if they are not pregnant (evidence of benefit is uncertain and there is no evidence of benefit for older women)\n• some children and young people under 16 years with recurrent UTI may wish to try cranberry products with the advice of a paediatric specialist (evidence of benefit is uncertain).","1.2.1"]
[null,"Advise people taking cranberry products or D-mannose about the sugar content of these products, which should be considered as part of the person’s daily sugar intake.","1.2.2"]
[null,"Be aware that evidence is inconclusive about whether probiotics (lactobacillus) reduce the risk of UTI in people with recurrent UTI.","1.2.3"]
[null,"1.3  Choice of antibiotic prophylaxis "]
[null,"When prescribing antibiotic prophylaxis for recurrent UTI, take account of local antimicrobial resistance data and:\n• follow the recommendations in table 1 for people aged 16 years and over\n• follow the recommendations in table 2 for children and young people under 16 years. ","1.3.1"]

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[null,"Table 1. Adults and young people aged 16 years and over"]
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[null,"Antibiotic prophylaxis1,2 ","Dosage3"]
[null,"First choice"]
[null,"Trimethoprim4 ","200 mg single dose when exposed to a trigger or"]
[null,null,"100 mg at night"]
[null,"Nitrofurantoin – if eGFR ≥45 ml/minute5","100 mg single dose when exposed to a trigger or"]
[null,null,"50 to 100 mg at night"]
[null,"Second choice "]
[null,"Amoxicillin6","500 mg single dose when exposed to a trigger or"]
[null,null,"250 mg at night"]
[null,"Cefalexin","500 mg single dose when exposed to a trigger or"]
[null,null,"125 mg at night"]
[null,"1See BNF for appropriate use and dosing in specific populations, for example, hepatic impairment, renal impairment, pregnancy and breast feeding."]
[null,"2Choose antibiotics according to recent culture and susceptibility results where possible, with rotational use based on local policies. Select a different antibiotic for prophylaxis if treating an acute UTI."]
[null,"3Doses given are by mouth using immediate release medicines, unless otherwise stated."]
[null,"4Teratogenic risk in first trimester of pregnancy (folate antagonist; BNF, August 2018). Manufacturers advise contraindicated in pregnancy (trimethoprim summary of product characteristics)."]
[null,"5Avoid at term in pregnancy; may produce neonatal haemolysis (BNF, August 2018)."]
[null,"6Amoxicillin is not licensed for preventing UTIs, so use for this indication 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,"Abbreviation: eGFR, estimated glomerular filtration rate. "]
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[null,"Table 2. Children and young people under 16 years"]
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[null,"Antibiotic prophylaxis1,2","Dosage3"]
[null,"Children under 3 months"]
[null,"Refer to paediatric specialist"]
[null,"Children aged 3 months and over (specialist advice only)"]
[null,"First choice"]
[null,"Trimethoprim4","3 to 5 months, 2 mg/kg at night (maximum 100 mg per dose) or 12.5 mg at night"]
[null,null,"6 months to 5 years, 2 mg/kg at night (maximum 100 mg per dose) or 25 mg at night"]
[null,null,"6 to 11 years, 2 mg/kg at night (maximum 100 mg per dose) or 50 mg at night"]
[null,null,"12 to 15 years, 100 mg at night"]
[null,"Nitrofurantoin – if eGFR ≥45 ml/minute5","3 months to 11 years, 1 mg/kg at night "]
[null,null,"12 to 15 years, 50 to 100 mg at night "]
[null,"Second choice "]
[null,"Cefalexin","3 months to 15 years, 12.5 mg/kg at night (maximum 125 mg per dose)"]
[null,"Amoxicillin6","3 to 11 months, 62.5 mg at night"]
[null,null,"1 to 4 years, 125 mg at night"]
[null,null,"5 to 15 years, 250 mg at night"]
[null,"1See BNF for children (BNFC) for appropriate use and dosing in specific populations, for example hepatic and renal impairment. "]
[null,"2Choose antibiotics according to recent culture and susceptibility results where possible, with rotational use based on local policies. Select a different antibiotic for prophylaxis if treating an acute UTI. If 2 or more antibiotics are appropriate, choose the antibiotic with the lowest acquisition cost."]
[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. Doses given are by mouth using immediate release medicines, unless otherwise stated."]
[null,"4Teratogenic risk in first trimester of pregnancy (folate antagonist; BNFC, August 2018). Manufacturers advise contraindicated in pregnancy (trimethoprim summary of product characteristics)."]
[null,"5Avoid at term in pregnancy; may produce neonatal haemolysis (BNFC, August 2018)."]
[null,"6Amoxicillin is not licensed for preventing UTIs, so use for this indication 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,"Abbreviation: eGFR, estimated glomerular filtration rate."]