Prescribing Advice for Antibiotic Prophylaxis

Allergy and Hypersensitivity

• Amoxicillin: Rarely causes anaphylaxis, but patients with a penicillin allergy are at a higher risk of hypersensitivity and should not be prescribed this drug.
• Broad-spectrum antibiotics: Amoxicillin and clindamycin use is associated with a risk of Clostridium difficile infection (CDI), which can be severe and even fatal, particularly in vulnerable populations (e.g., elderly patients, those with gastrointestinal diseases, or those on proton pump inhibitors).

Antimicrobial Resistance

• The emergence of resistant bacterial strains is a global concern. Although the impact of single-dose prophylaxis on community resistance is unclear, individual risks of resistance acquisition exist.
• NICE emphasises avoiding overuse of antibiotics without clear evidence of benefit to limit community resistance.

Practical Guidance

For Planned Invasive Procedures

1. Prescriptions:

   • Provide the prescription during the appointment before the procedure, unless antibiotics are supplied in-house.
   • Note "prophylaxis" on the prescription and document alternative regimens if advised by a cardiology expert.
   • For sequential treatments in a short time frame, use the same antibiotic unless contraindicated.

2. Administration and Patient Instructions:

   • Antibiotics should be taken 60 minutes before the procedure.
   • Preferably administer the antibiotic in the practice; if the patient takes it elsewhere, confirm the procedure will proceed as planned.
   • Discuss potential adverse events (e.g., hypersensitivity, anaphylaxis, colitis) and advise seeking urgent care for severe diarrhoea.

3. Adjustments for Recent Antibiotic Use:

   • If a patient has recently been treated with antibiotics within six weeks, prescribe from a different class to reduce resistance risk. Consult specialists as needed for alternatives.

Regimens

• Adult dosing recommendations are based on the 2006 British Society for Antimicrobial Chemotherapy guidelines.
• Paediatric dosing follows the 2015 ESC guidelines.

By following these protocols, clinicians can balance patient safety, effective prophylaxis, and the need to mitigate broader public health risks such as antimicrobial resistance.