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What should prescribers do?

What should prescribers do?

Prescribers (people who write prescriptions for medicines) have an important role in making sure that antimicrobials are used safely and wisely. They should follow guidelines about this and should prescribe an antimicrobial at a dose that will work and for the shortest time possible.

Question to ask about prescribers

  • Who are prescribers and what do they do?

  • Who might write me a prescription for an antimicrobial? How will they make sure I'm getting the right treatment?

What prescribers should think about before prescribing an antimicrobial

When considering whether or not to prescribe an antimicrobial, health professionals should think about how this decision might affect how well the medicine works against infection in the future (antimicrobial resistance).

They should check the patient's symptoms and record these in the patient's notes. If the infection isn't severe, health professionals should think about asking the microbiology laboratory to find out what the infection is before prescribing an antimicrobial. But they should only do this if it is safe to delay treatment. If an infection won't go away or keeps coming back, health professionals may also ask the microbiology laboratory to find out what the infection is. But they should go ahead and prescribe an antimicrobial and when the laboratory results come back they should check that the antimicrobial is right for treating the infection.

Tests to find out if an antimicrobial is needed

For patients in hospital, health professionals should take a sample for the microbiology laboratory before they prescribe an antimicrobial for a suspected infection. They should review the prescription when the laboratory results come back and change it if the results show this is needed.

In some cases, health professionals may consider using a test to find out whether an antimicrobial is needed for a chest infection. See other NICE guidance for details of our guidance on pneumonia.

Discussions before prescribing an antimicrobial

Health professionals should take the time to talk to patients and/or their family members or carers about:

  • what the infection is likely to be and what it might be caused by

  • why an antimicrobial may not be the best option

  • other options for treatment

  • the benefits and risks of prescribing an antimicrobial straightaway, including the risk of allergy and severe allergic reactions

  • what they should do if their condition gets worse

  • whether they need any written information about their medicine.

When an antimicrobial is not needed

Antimicrobials should not be prescribed for infections that are likely to get better on their own without treatment.

If prescribing an antimicrobial is not the best course of action, health professionals should talk to patients and/or their family members or carers about other options, such as:

  • buying over‑the‑counter medicines at the local pharmacy

  • prescribing an antimicrobial later if they don't get any better

  • other treatments that might help, such as draining (removing pus from) the infection (for some types of infection only).

Questions to ask when an antimicrobial is not needed

  • Why have you decided not to give me a prescription for an antimicrobial? What do I do if I go home and my condition gets worse?

  • What can I do to help myself get better?

  • Do all infections need to be treated with antibiotics?

  • Can you tell the difference between a bacterial and viral infection, and if so how?

  • What is a back‑up prescription and why have you given this to me?

  • Can I get a prescription for an antimicrobial from another doctor?

  • Why have you decided to stop my repeat prescriptions for antimicrobials?

When an antimicrobial is an option

If an antimicrobial is an option for treatment, health professionals should note in the patient's records the reasons for prescribing or not prescribing an antimicrobial, and the plan for the patient's care. If they decide to prescribe an antimicrobial, they should take the following things into account when deciding which to prescribe:

  • how the antimicrobial might interact with other medicines the patient is taking, and with food and drink

  • any other illnesses the patient has (for example, kidney disease), which may mean the dose of antimicrobial needs to be changed

  • any allergies to medicines the patient may have

  • the risk that prescribing the antimicrobial may encourage the growth of bacteria, which are linked to infections in hospitals (for example, infections caused by a bacteria known as Clostridium difficile).

If a health professional prescribes an antimicrobial that is not in line with local guidelines, they should note the reason for this in the patient's record.

Questions to ask when an antimicrobial is an option

  • Why have you decided to give me a prescription for an antimicrobial?

  • Is there a choice of antimicrobial I could take? How do I know I'm getting the right one?

  • What should I do if my condition does not improve with the antimicrobial or it gets worse?

  • What do I do if I have a bad reaction to the antimicrobial? Is there anything in particular I should look out for?

  • Do I need to complete the course of antibiotics or should I stop taking them when I feel better?

When an antimicrobial is needed to prevent an infection

People who are taking antimicrobials to prevent an infection rather than to treat an infection should not have repeat prescriptions for more than 6 months. This should help to reduce antimicrobial resistance and allergic reactions.

Intravenous antimicrobials

For some infections, for example severe infections, patients need to have an antimicrobial by syringe or drip directly into their bloodstream (an intravenous antimicrobial).

After 48 to 72 hours health professionals should check whether the antimicrobial is still needed and if it is whether it can now be taken by mouth (for example, in tablet form).

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