Antibiotic use in the management of uncomplicated URTIs and

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Antibiotic use in the management of uncomplicated URTIs and Powered By Docstoc
					     Antibiotic use in the management of
     uncomplicated URTIs and bronchitis
 Aims of clinical audit
    To review your prescribing of antibiotics for uncomplicated upper respiratory tract infections
    (URTIs) and bronchitis.
    To compare your practice with the recommendations provided in Therapeutic Guidelines:
    Antibiotic, Version 12, 20031 and with the practice of other participating doctors.


 How to participate

1. Select patients                                          To be received at NPS not later than:
Prospectively, as patients present for consultation,        Friday 8 August 2003
identify 20 patients with a principal diagnosis of          Please note: Unfortunately, late submissions
one of the following:                                       cannot be accepted.
    common cold/rhinosinusitis
                                                            Do NOT send in the Patient Record form.
    acute or chronic bronchitis
    pharyngitis/tonsillitis
                                                            4. When you receive your results
    acute otitis media
    otitis media with effusion (glue ear), or               Once results have been analysed, you will receive
    acute sinusitis.                                        from the NPS:
                                                                your original clinical audit forms
Do NOT include patients other than those with                   feedback on your individual results
the diagnoses listed above.
                                                                the aggregate results of all participants’
Consider patient privacy policy (see attached leaflet            management practices
and poster).                                                    commentary on the aggregate results
You may use the Patient Record form to record                   review questions which allow you to reflect on
the patients you have included for your                         your prescribing practice.
future reference.                                           5. Completing the clinical audit cycle                         Guide to clinical audit
2. Collect data and review                                  Review questions will be provided with your results.
                                                            These must be completed and returned to the NPS
During or soon after the patient’s visit, complete          for 20 clinical audit points to be allocated* by the
sections A, B and C of the clinical audit form for          RACGP, and for the clinical audit to qualify as an
each of the 20 patients you have selected. See              activity for the Quality Prescribing Initiative (QPI)
notes on pages 2–3 for further information.                 of the Practice Incentives Program. You will then
                                                            be sent a certificate of completion.
Please note:
                                                            * Please note that point allocation is not guaranteed and is
    Patient information must only be collected
                                                              subject to review by the RACGP.
    and recorded by the participating doctor.
    Both full-time and part-time GPs are required
    to submit 20 completed clinical audit forms.            Further information
                                                            Contact NPS for:
3. Send in the clinical audit forms                         Therapeutic and audit enquiries
Return the 20 clinical audit forms and                      Kylie Easton-Carter or Clare Bottomley
registration form to:                                       Phone (02) 9699 4499
NPS Clinical Audit: Antibiotics
Locked Bag 4888
STRAWBERRY HILLS NSW 2012
Notes for clinical audit form
Additional information to assist you to review management

 Section A: Patient visit details
(Q1) Your patient code
Choose your own unique identifying code for the patient, e.g. sequential number or the patient’s initials (please do not use
the patient’s name).

(Q4) Was symptomatic management prescribed or recommended this visit?
Symptomatic management includes rest, fluids and medications such as decongestants or analgesics.
Symptomatic management pads are available from the NPS to assist in providing advice to patients. The free pads are
available in English, Arabic, Chinese, Greek, Italian and Vietnamese by telephoning NPS on 02 9699 4499.

 Section B: Management for principal diagnosis
(Q9)                                                                        pain with discharge of only 2 days duration, mark the bubble
The light and dark green shading in this section indicate                   in the light green shaded area.
management considered consistent with Therapeutic
                                                                            If an antibiotic was indicated, was a
Guidelines: Antibiotic, Version 12, 2003, and will be used
to review your prescribing.                                                 recommended antibiotic used?
                                                                            The antibiotics recommended by Therapeutic Guidelines:
Principal diagnosis                                                         Antibiotic are shaded in dark green. Mark if one of these
Mark the main diagnosis this visit in only one of the boxes.                was prescribed.
Continue working from left to right in only that box.
                                                                            If the antibiotic prescribed is not listed: Some clinical
Clinical features                                                           situations justify prescribing alternative antibiotics to those
                                                                            listed in the dark green shaded area. Mark ‘other antibiotic
Mark if any of the clinical features listed in the dark green
                                                                            prescribed’ and record the reason for selecting the antibiotic
shaded area for that diagnosis were seen in this patient;
                                                                            prescribed (e.g. drug allergy or adverse reaction to first-line
Therapeutic Guidelines: Antibiotic recommends antibiotics
                                                                            drugs, treatment failure in this patient using first-line drugs
be considered for patients with these features.
                                                                            or pregnancy or lactation).
If these clinical features do not apply: Mark the bubble in                 Duration of antibiotic therapy
the light green shaded area, ‘clinical features other than those            The duration of antibiotic therapy recommended in
below’. For example, if a patient with acute sinusitis has facial           Therapeutic Guidelines: Antibiotic is shaded in dark green.


 Section C: Consistency with Therapeutic Guidelines: Antibiotic
(Q10) Use the shading in the table to compare your responses to Therapeutic Guidelines:
      Antibiotic recommendations.
To be consistent with the guidelines, responses marked in Q9 must EITHER be wholly within the light green OR the dark
green shaded areas. For example:

Management considered consistent with Therapeutic Guidelines: Antibiotic
    Chronic bronchitis           clinical features other than those below              no antibiotic required                 not applicable

                                 infective exacerbations with both:                    amoxycillin, or                        5 days (amoxycillin)
                                 • increased cough and dyspnoea, and                   doxycycline#                           6 days (doxycycline#)
                                 • increased sputum volume and purulence
                                                                                       other antibiotic prescribed            other
                                                                                   reason selected ________________________


Management NOT considered consistent with Therapeutic Guidelines: Antibiotic
Responses marked across the light green and dark green shaded areas or across both shaded and non-shaded areas are
NOT considered consistent with the guidelines. For example:
    Chronic bronchitis           clinical features other than those below              no antibiotic required                 not applicable

                                 infective exacerbations with both:                    amoxycillin, or                        5 days (amoxycillin)
                                 • increased cough and dyspnoea, and                   doxycycline#                           6 days (doxycycline#)
                                 • increased sputum volume and purulence
                                                                                       other antibiotic prescribed            other
                                                                                   reason selected ________________________




                                                                   2
Summary of antibiotic treatment in uncomplicated URTIs and bronchitis1
 Are antibiotics required for this condition?                                                          Treatment options
 Common cold/rhinosinusitis                                  Symptomatic treatment only
 Acute bronchitis                                            Symptomatic treatment only
 Chronic bronchitis                                                            Antibiotic of first choice (if decision to treat with antibiotics)
    Exacerbations may be due to non-infective
    causes as well as bacterial infections.                  Patients without penicillin hypersensitivity   Patients with penicillin hypersensitivity*    Duration
    Antibiotics have only been shown to be effective
                                                                                                                        #
    when all 3 cardinal symptoms of acute bacterial          amoxycillin                                    doxycycline                                  amoxycillin:
    exacerbations are present: increased dyspnoea,           adult: 500 mg orally, 8-hourly                 adult: 200 mg orally, for the first dose,       5 days
    increased sputum volume and purulence.                                                                         then 100 mg daily for a further
                                                             doxycycline#                                                                                doxycycline:
    Antibiotics other than those listed have not been                                                              five days
                                                             adult: 200 mg orally, for the first dose,                                                      6 days
    shown to be superior and are not recommended.
                                                             then 100 mg daily for a further five days
 Pharyngitis/tonsillitis                                     penicillin V                                   roxithromycin                                10 days
    Antibiotics are not needed for most patients             (phenoxymethylpenicillin)                      adult: 300 mg orally, daily
    with sore throat in general practice.2                   adult: 500 mg orally, 12-hourly                child: 4 mg/kg (up to 150 mg)
    A Cochrane review concluded that 85%                     child: 10 mg/kg (up to 500 mg)                        orally, 12-hourly
    of placebo treated patients were symptom                        orally, 12-hourly
    free at one week.2
    Use antibiotics for • tonsillitis displaying the four
    features suggestive of Strep. infection§
    • presumptive Strep. in some Aboriginal and
    other communities at risk of rheumatic fever
    • existing rheumatic heart disease
    • scarlet fever • quinsy.
 Acute otitis media (AOM)                                    amoxycillin 8-hourly                           cefuroxime¥                                  5 days
    Antibiotics not routinely needed.                        adult: 500 mg orally, 8-hourly                 adult: 500 mg orally, 12-hourly
    A Cochrane review concluded that 66%                     child: 15 mg/kg (up to 500 mg)                 child: 10 mg/kg (up to 500 mg)
    of children were pain-free 24 hours after                       orally, 8-hourly                               orally, 12-hourly (no paediatric
    the start of treatment whether they received             or                                                    preparation available)
    placebo or antibiotic.3                                                                                 cefaclor¥
                                                             amoxycillin 12-hourly
 Children without systemic features                          adult: 1000 mg orally, 12-hourly               adult: 375 mg orally, 12-hourly
 (vomiting and fever)                                        child: 30 mg/kg (up to 1000 mg)                child: 10 mg/kg (up to 250 mg)
    In children between 6 months and 2 years,                       orally, 12-hourly                              orally, 8-hourly
    consider delaying antibiotics for 24 hours.
    If antibiotics are withheld, follow-up by
    telephone or visit is essential.                         If poor response to antibiotic
    In children 2 years, consider delaying antibiotics       of first choice:
    for 48 hours. Reassess if symptoms persist.              amoxycillin+clavulanate for 5–7 days
 Children with systemic features (vomiting and fever)        adult: 875+125 mg orally, 8-hourly**
    If fever and vomiting are marked when the                child: 22.5+3.2 mg/kg (up to
    patient first presents antibiotic therapy may                    875+125 mg) orally, 8-hourly**
    be indicated.
 Otitis media with effusion (OME, glue ear)                  amoxycillin 8-hourly                           cefaclor¥                                    10 –30 days
    The aetiology of OME is uncertain and bacterial          adult: 500 mg orally, 8-hourly                 adult: 375 mg orally, 12-hourly
    infection is only one of many factors which              child: 15 mg/kg (up to 500 mg)                 child: 10 mg/kg (up to 250 mg)
    contribute to this condition.                                   orally, 8-hourly                               orally, 8-hourly
    Those with a more chronic course or with no              or
    preceding history of AOM may benefit from
    antibiotics.                                             amoxycillin 12-hourly
                                                             adult: 1000 mg orally, 12-hourly
                                                             child: 30 mg/kg (up to 1000 mg)
                                                                    orally, 12-hourly
 Acute sinusitis                                             amoxycillin                                    cefuroxime¥                                  5–7 days
    Antibiotics not routinely needed.                        adult: 500 mg orally, 8-hourly                 adult: 500 mg orally, 12-hourly
    Sinusitis improves in approximately 70%                  child: 15 mg/kg (up to 500 mg)                 child: 10 mg/kg (up to 500 mg)
    of patients not treated with antibiotics.4                      orally, 8-hourly                               orally, 12-hourly (no paediatric
    Consider antibiotics for severe sinusitis                                                                      preparation available)
    with at east 3 of the following:                                                                        cefaclor¥
                                                             If poor response to antibiotic
    • mucopurulent discharge > 7–10 days                                                                    adult: 375 mg orally, 12-hourly
    • poor response to decongestants                         of first choice:
    • facial pain                                            amoxycillin+clavulanate for 7–14 days.         child: 10 mg/kg (up to 250 mg)
    • tenderness over the sinuses                            adult: 875+125 mg orally, 8-hourly**                  orally, 8-hourly
    • tenderness on percussion of maxillary                  child: 22.5+3.2 mg/kg (up to                   doxycycline#
      molar and premolar teeth.                                     875+125 mg) orally, 8-hourly**          adult: 200 mg orally, initially
                                                                                                                   then 100 mg daily
                                                                                                            child > 8 years: 4 mg/kg (up to
                                                                                                                    200 mg) orally, initially, then
                                                                                                                    2 mg/kg (up to 100 mg) daily


* Hypersensitivity occurs in up to 10% of people receiving penicillins;              ** Note: not included in relevant product information. The usual dosage
  anaphylaxis occurs in 0.01%.1 Intolerance due to common adverse                       frequency is 12-hourly. The 8-hourly regimen is used for increased activity.
  effects such as diarrhoea and nausea may not be due to hypersensitivity.           ¥ Between 3 and 6% of patients who are hypersensitive to penicillin exhibit
# Not in children ≤ 8 years old or in pregnancy/lactation.                              cross-reactivity with cephalosporins. Cephalosporins are contraindicated if
§ The four features suggestive of Strep. infection are: fever > 38oC,                   there is a history of an immediate hypersensitivity reaction to penicillin
  tender cervical lymphadenopathy, tonsillar exudate and no cough.                      antibiotics. In these patients specialist advice should be sought.1


                                                                               3
               Generic and brand names for selected antibiotics
                 Generic                 Brand name                                                        Generic              Brand name
                 amoxycillin             Alphamox , Amohexal , Amoxil ,
                                                      ®         ®         ®
                                                                                                           cefaclor             Ceclor®, Ceclor CD®, Cefkor®, Cefkor CD®,




                                                                                         Cephalosporins
                                         Amoxil Forte®, Bgramin®, Cilamox®,                                                     Keflor®, Keflor CD®
                                         Maxamox®, Moxacin®
                                                                                                           cefuroxime           Zinnat®
                 amoxycillin+            Augmentin®, Augmentin Duo®, Augmentin
                                                                                                           cephalexin           Cilex®, Ibilex®, Keflex®, Sporahexal®
                 clavulanate             Duo Forte®, Augmentin Duo 400®, Ausclav®,
                                         Ausclav Duo®, Ausclav Duo Forte®, Ausclav
 Penicillins




                                         Duo 400®, Clamoxyl®, Clamoxyl Duo®,
                                         Clamoxyl Duo Forte®, Clamoxyl Duo 400®,
                                                                                                           doxycycline          Doryx®, Doxsig®, Doxy-50®, Doxy-100®,




                                                                                         Tetracyclines
                                         Clavulin®, Clavulin Duo®, Clavulin Duo 400®,
                                                                                                                                Doxyhexal®, Doxylin®, Vibramycin®,
                                         Clavulin Duo Forte®
                                                                                                                                Vibra-tabs®
                 penicillin V            Abbocillin-V®, Cilicaine V®, Cilicaine VK®,
                 (phenoxymethyl-         Cilopen VK®, LPV®, Penhexal®, Penhexal VK®
                                                                                                           tetracycline         Achromycin®, Tetrex®
                 penicillin)
                 procaine penicillin     Cilicaine®                                                        trimethoprim and     Bactrim®, Bactrim DS®, Cosig Forte®,
                                                                                                           sulfamethoxazole     Resprim®, Resprim Forte®, Septrin®,
                 azithromycin            Zithromax®
                                                                                                           (co-trimoxazole)     Septrin Forte®, Trimoxazole – BC 800/160®
 Macrolides




                 clarithromycin          Klacid®
                 erythromycin            E.E.S®, E-Mycin®, Eryc®, Erythrocin®


                 roxithromycin           Biaxsig®, Rulide®, Rulide D®



Professional development
This clinical audit qualifies as an activity for the Quality Prescribing Initiative of the Practice Incentives Program.
The NPS has applied for 20 clinical audit points in the 2002–2004 Triennium of the Royal Australian College of General
Practitioners (RACGP) Quality Assurance & Continuing Professional Development (QA&CPD) Program, but point allocation
is not guaranteed and is subject to review by the RACGP.

Confidentiality
Patient information must only be collected and recorded by the participating doctor. Individual results of your clinical audit and
responses to review questions are kept confidential by NPS.
What will happen to:
Your patient data:                                                                      Your personal details:
               Your de-identified patient data forms are                                    are provided to the RACGP QA&CPD program for allocation
               returned to you.                                                            of QA&CPD points (if applicable)

               Your individual results are provided to you only.                                          are recorded for the purpose of the Practice Incentives
                                                                                                          Program and NPS evaluation.
               Your data are aggregated with that of other
               participants and the de-identified aggregate results:                     Individual clinical audit results will not be available after potentially
                                                                                        identifying data are removed from NPS records at the close of the
                  are provided to all participants                                      clinical audit cycle, i.e. after submission of the review questions in
                  may be used in NPS evaluation and reports                             step 4.
                  are provided to the RACGP QA&CPD program.                             Please note: You are responsible for advising the NPS of any changes
                  The RACGP has advised that program information                        of address during the audit cycle. You can obtain a record of your
                  may be shared with researchers and interested general                 personal details from the NPS by request in writing.
                  practitioners for the purpose of continuing education
                  coordination at the discretion of the QA&CPD Program.                   Important: Please sign the confidentiality agreement
                                                                                          on the enclosed Registration form

References
1. Writing Group for Therapeutic Guidelines: Antibiotic. Therapeutic                    3. Glasziou PP, Del Mar CB, Sanders SL. Antibiotics for acute otitis media
   Guidelines: Antibiotic, Version 12. Melbourne: Therapeutic Guidelines                   in children (Cochrane Review). In: The Cochrane Library, Issue 1, 2003.
   Limited; 2003.                                                                          Oxford: Update software.
2. Del Mar CB, Glasziou PP, Spinks AB. Antibiotics for sore throat                      4. de Ferranti SD, Ioannidis JPA, Lau J, Anninger WV, Barza M. Are
   (Cochrane Review). In: The Cochrane Library, Issue 1, 2003. Oxford:                     amoxycillin and folate inhibitors as effective as other antibiotics for
   Update software.                                                                        acute sinusitis? A meta-analysis. BMJ 1998;317:632–637.




                                              National Prescribing Service Limited ACN 082 034 393
                                       An independent, Australian organisation for Quality Use of Medicines
                                                   Level 1 / 31 Buckingham Street, Surry Hills NSW 2010
                               Phone: 02 9699 4499 l Fax: 02 9699 5155 l email: info@nps.org.au l web: http://www.nps.org.au
                                                                                                                                                                        05/03
     Clinical audit: Antibiotic use
in the management of uncomplicated
         URTIs and bronchitis
 Please see the Guide to clinical audit booklet for additional
       information to assist you to complete this form.




                  Mark the appropriate response(s) for this patient.
                 Completely fill in bubbles with black biro (as shown
                   here). Do not use pencil. Make no stray marks.




                   If you make a mistake use white correction fluid
                 or cross through the bubble clearly (as shown here),
                           and mark your selected response.




                                  Please open for your
                                    clinical audit form.
                                                                                                                                                                                                                                  NPS office use only




    Section A               Patient visit details




                                                                             LY
                                                                                                                                    4. Was symptomatic management prescribed or recommended this visit?
1. Your patient code:                                                                                                                        no                           yes                       not applicable




                                                                            N
2. Age:                              birth – < 2 years           2 – 17 years                                                       5. Was an antibiotic(s) prescribed this visit?
                                     18 – 64 years               65 – 80 years           > 80 years                                          no Go to Section B                      yes Go to Q6
3. Mark ONE principal diagnosis for this visit:

          Common cold, rhinosinusitis



                                                                         E O
                                                                 Acute otitis media
                                                                                                                                    6. Record the antibiotic(s) prescribed this visit in BLOCK letters:




                                                                        L
          Acute bronchitis                                        Otitis media with effusion (OME, glue ear)
                                                                                                                                    7. When did you instruct for the prescription to be filled?



                                                                       P
          Chronic bronchitis                                     Acute sinusitis
                                                                                                                                             script to be filled immediately                         script to be filled later if required
          Pharyngitis/tonsillitis




                                                                      M
                                                                                                                                    8. Does the patient have a drug allergy/adverse reaction:
     Does the patient have co-morbidities relevant to this diagnosis?
                                                                                                                                             penicillin allergy/adverse reaction                    nil history of antibiotic allergy/adverse reaction




                                                                     A
          no                                               _______________________________________________________
                                     yes – please specify ________________________________________________________
                                                                                                                                             other antibiotic allergy/adverse reaction              not known




    Section B Management for principal diagnosis                    S
9. Mark ONE principal diagnosis for this patient, then work from left to right in that box only and mark appropriate responses.
   The principal diagnosis marked should be the same as that marked in Q3.
                                                                                                                                    Go to Section B




     • Light green shading indicates no antibiotic treatment required, according to Therapeutic Guidelines: Antibiotic, Version 12, 2003.
     • Dark green shading indicates clinical features where antibiotic therapy should be considered, and the antibiotics recommended by Therapeutic Guidelines: Antibiotic.
       Some clinical situations justify prescribing alternative choices, if ’other antibiotic prescribed’ is marked, specify the reason for the selected antibiotic.

    Principal diagnosis                   Mark whether the patient has clinical features where Therapeutic Guidelines:                               If an antibiotic was indicated, was a                   Was the duration of antibiotic
    (mark one only)                       Antibiotic recommends antibiotic therapy (dark green shaded areas)                                         recommended antibiotic used?                            therapy according to guidelines?

        Common cold, rhinosinusitis       Nil (no clinical features specified by Guidelines to require antibiotics)                                          no antibiotic required                                   not applicable

When responses have been marked, go to section C                                    SAMPLE ONLY                                                            other antibiotic prescribed
                                                                                                                                                      reason selected _________________________________
                                                                                                                                                                       _________________________________
                                                                                                                                                                                                                     other


        Acute bronchitis                  Nil (no clinical features specified by Guidelines to require antibiotics)                                          no antibiotic required                                   not applicable
                                                                                                                                                           other antibiotic prescribed                               other
When responses have been marked, go to section C
                                                                                    SAMPLE ONLY                                                                        _________________________________
                                                                                                                                                      reason selected _________________________________

        Chronic bronchitis                      clinical features other than those below                                                                    no antibiotic required                                   not applicable

                                                infective exacerbations with both:          • increased cough and dyspnoea, and                             amoxycillin, or                                          5 days (amoxycillin)
                                                                                            • increased sputum volume and purulence                         doxycycline#                                             6 days (doxycycline#)
                                                                                                                                                           other antibiotic prescribed                               other
When responses have been marked, go to section C
                                                                                    SAMPLE ONLY                                                                        _________________________________
                                                                                                                                                      reason selected _________________________________

        Pharyngitis/tonsillitis                 clinical features other than one below                                                                      no antibiotic required                                   not applicable
                                                                          o
                                                tonsillitis with fever >38 C, tender cervical lymphadenopathy, tonsillar exudate and no cough              penicillin V (phenoxymethylpenicillin)                    10 days
                                                presumptive Strep. in some Aboriginal and other communities at risk                                   If penicillin allergic:
                                                existing rheumatic heart disease                                                                           roxithromycin
                                                scarlet fever
                                                quinsy
                                                                                                                                                           other antibiotic prescribed                               other
When responses have been marked, go to section C
                                                                                    SAMPLE ONLY                                                                        _________________________________
                                                                                                                                                      reason selected _________________________________

        Acute otitis media (AOM)                clinical features other than one below                                                                      no antibiotic required                                   not applicable

                                           Children without systemic features (vomiting and fever)                                                         amoxycillin                                               5 days
                                                between 6 months and 2 years of age – persistent pain and fever after 24 hours                        If penicillin allergic:
                                                of symptomatic treatment without antibiotics                                                               cefuroxime , or
                                                over 2 years of age – persistent pain and fever after 48 hours of symptomatic treatment                    cefaclor
                                                without antibiotics
                                           Children with systemic features (vomiting and fever)
                                                vomiting and fever marked on presentation

When responses have been marked, go to section C
                                                                                    SAMPLE ONLY                                                            other antibiotic prescribed
                                                                                                                                                      reason selected _________________________________
                                                                                                                                                                       _________________________________
                                                                                                                                                                                                                     other


        Otitis media with effusion              clinical features other than one below                                                                      no antibiotic required                                   not applicable
        (OME, glue ear)
                                                Chronic OME                                                                                                 amoxycillin                                              10 – 30 days
                                                OME with no preceding history of AOM                                                                  If penicillin allergic:
                                                                                                                                                            cefaclor
                                                                                                                                                           other antibiotic prescribed                               other
When responses have been marked, go to section C
                                                                                    SAMPLE ONLY                                                                        _________________________________
                                                                                                                                                      reason selected _________________________________

        Acute sinusitis                         clinical features other than those below                                                                    no antibiotic required                                   not applicable

                                                severe sinusitis with at least 3 of the following:                                                          amoxycillin                                              5 – 7 days
                                                • mucopurulent discharge > 7 – 10 days • tenderness over the sinuses                                  If penicillin allergic:
                                                • facial pain                                • tenderness on percussion of maxillary molar                  cefuroxime , or
                                                • poor response to decongestants               and premolar teeth                                           cefaclor , or
                                                                                                                                                            doxycycline#
#
    not in children ≤ 8 years old or in pregnancy/lactation       excluding a history of immediate hypersensitivity reaction to penicillin                 other antibiotic prescribed                               other
                                                                                                                                                                       _________________________________
                                                                                                                                                      reason selected _________________________________

                           Please complete section C below

    Section C Consistency with Therapeutic Guidelines: Antibiotic
10. Use the shading to compare your responses to the Therapeutic Guidelines: Antibiotic recommendations.
       Are the responses marked in Q9 EITHER wholly within the light green OR the dark green shaded areas? (See example on p.2 of Guide to clinical audit booklet.)
            no – prescribing is not consistent with Therapeutic Guidelines: Antibiotic recommendations           yes – prescribing is consistent with Therapeutic Guidelines: Antibiotic recommendations

				
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