Avoid prescribing antibiotics in patients with low grade fever, viral respiratory infections such as viral pharyngitis/rhinosinusitis/bronchitis, skin and soft tissue infections such as subcutaneous abscesses, recommends the ICMR in the latest edition of its “Treatment guidelines for antimicrobial use in common syndromes 2022”.¹ The other conditions where ICMR advises against antibiotics are asymptomatic bacteriuria and pyuria including in catheterized patients and microbial colonization and culture contamination.

The guidelines advocate a clinical diagnosis of infection rather than “blindly” depending on laboratory tests for instance white cell counts, culture reports or imaging or presence of fever for selection of an appropriate antibiotic tailored to the clinical situation. The non-infectious causes must be ruled out.

Empirical use of antibiotics is generally restricted to critically ill patients such as severe sepsis, septic shock, pneumonias - community-acquired and ventilator-associated, necrotizing fasciitis and febrile neutropenia. However, relevant samples for culture and sensitivity must be obtained first. Review the patient within 48 hours of initiating antibiotics and accordingly. De-escalate combination therapy to a single drug or modify according to culture reports. Switch from broad spectrum antibiotics to narrow spectrum antibiotics and from intravenous to oral antibiotics, wherever possible.

Antibiotics should be prescribed for a certain period, which should be prespecified. For this, ICMR recommends consulting practice guidelines and recommendations to decide on the optimum duration of therapy. Prescribe antibiotics for 5 days for CAP and SSTIs, 8 days for hospital-acquired pneumonia, 3-5 days for cystitis, as per the guidelines. A single dose of antibiotics is approved for surgical prophylaxis.

Reference

1. Treatment guidelines for antimicrobial use in common syndromes 2022. Available at: https://amrtg.icmr.org.in/dashboard.html