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          <h1 class="page-heading">Antimicrobial Guidelines</h1>
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          <p>The <a href="/wps/wcm/connect/public+content/sa+health+internet/about+us/about+sa+health/reporting+and+advisory+groups/south+australian+medicines+committees/south+australian+expert+advisory+group+on+antimicrobial+resistance+saagar" >South Australian expert Advisory Group on Antimicrobial Resistance (SAAGAR)</a> has developed evidence-based, peer-reviewed guidelines relating to best practice standards in antimicrobial usage. By optimising use of antimicrobials, adverse events including the development of antimicrobial resistance can be minimised.</p>

<p>These guidelines are designed to be used in conjunction with <em><a href="https://tgldcdp.tg.org.au/topicTeaser?guidelinePage=Antibiotic&amp;etgAccess=true" >Therapeutic Guidelines: Antibiotic Version 16</a></em> developed by Therapeutic Guidelines Limited (TGL), an independent not-for-profit organisation.</p>

<p>Further guidelines will be added to this site as they become available.</p>
<h2>Antimicrobial alerts regarding national shortage</h2>

<p>See the following for more information related to antimicrobial shortages:</p>
<ul>
  <li><a href="https://apps.tga.gov.au/Prod/msi/search?shortagetype=All" >Therapeutic Goods Administration (TGA) Medicine Shortages Information Initiative web page</a></li>
</ul>
<h2>SAAGAR&nbsp;position statements</h2>
<ul>
  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/potential+shortage+of+hydroxychloroquine+-+antimicrobial+alert" >Hydroxychloroquine and COVID-19 (PDF 278KB)</a></li>
  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/appropriate+use+of+fluoroquinolones" >Appropriate use of fluoroquinolones (PDF 350KB)</a><br /></li>
  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/inappropriate+topical+application+of+antimicrobials+saagar+position+statement" >Inappropriate topical application of antimicrobials (PDF 380KB)</a></li>
  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/multi-drug+resistant+uti+fact+sheet" >Multi-drug resistant UTI (PDF 189KB)</a>.</li>
</ul>
<h2>Guidelines from the National COVID-19 Clinical Evidence Taskforce</h2>
<p>A <a href="https://covid19evidence.net.au/about-the-taskforce/" >national COVID-19 Clinical Evidence Taskforce</a> has been established to undertake continuous evidence surveillance and synthesis to provide <a href="https://covid19evidence.net.au/#living-guidelines" >national, evidence-based guidelines</a> for the clinical care of patients with COVID-19. These 'living' guidelines are continually updated weekly. Please note that antimicrobials included in the guideline or evidence summaries may not be on the <a href="http://sahealth.sa.gov.au/safc" >SA hospital formulary</a> - prescribers should check the formulary status before prescribing in SA public hospitals.</p>
<h2>Surgical antibiotic prophylaxis guidelines</h2>

<p>Surgical antibiotic prophylaxis is an accepted part of surgical practice to prevent infections at the surgical site and optimise post-operative recovery. The statewide <a href="/wps/wcm/connect/public+content/sa+health+internet/resources/policies/surgical+antimicrobial+prophylaxis+clinical+guideline" >Surgical Antibiotic Prophylaxis Clinical Guideline (PDF 1.40MB)</a> has been developed by SAAGAR to assist clinicians with recommendations on appropriate antibiotic dosage and administration, risks and contraindications and post-operative care for a range of surgical procedures.</p>

<h2>Guideline appendices</h2>

<p>The recommended antimicrobial prophylaxis regimens for specific surgical procedures, along with alternatives for patients with a high risk of penicillin/cephalosporin allergy, are available in the <a href="/wps/wcm/connect/public+content/sa+health+internet/resources/policies/surgical+antimicrobial+prophylaxis+clinical+guideline" >Surgical Antibiotic Prophylaxis Clinical Guideline (PDF 1.40MB)</a> appendices 1 to 17.</p>
<ul>
  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/appendix+1+breast+procedures+endocrine+procedures+abdominal+procedures" >Appendix 1: Breast procedures / Endocrine procedures / Abdominal procedures (including Splenectomy, Herniorrhaphy, insertion of infusaport and clean excision procedures) (PDF 292KB)</a></li>
  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/appendix+2+cardiac+surgery+adult" >Appendix 2: Cardiac Surgery (Adult) (PDF 104KB)</a></li>

  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/appendix+3+cviu+cardiology+procedures" >Appendix 3: CVIU / Cardiology Procedures (PDF 75KB)</a></li>

  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/appendix+4+prevention+of+endocarditis+or+infection+of+prosthetic+implants+or+grafts" >Appendix 4: Prevention of Endocarditis (PDF 83KB)</a></li>

  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/appendix+5+endoscopic+gastrointestinal+procedures" >Appendix 5: Endoscopic Gastrointestinal Procedures (PDF 99KB)</a></li>

  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/appendix+6+gastrointestinal+surgery" >Appendix 6: Gastrointestinal Surgery (PDF 217KB)</a></li>
  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/appendix+7+head+and+neck+surgery" >Appendix 7: Head and Neck Surgery (PDF 213KB)</a></li>

  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/appendix+8+maxillofacial+surgery" >Appendix 8: Maxillofacial Surgery (PDF 205KB)</a></li>

  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/appendix+9+neurosurgery" >Appendix 9: Neurosurgery Procedures (PDF 200KB)</a></li>

  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/appendix+10+obstetrics+and+gynaecology+surgery" >Appendix 10: Obstetrics and Gynaecology Surgery (PDF 78KB)</a></li>

  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/appendix+11+ophthalmology" >Appendix 11: Ophthalmology (PDF 83KB)</a></li>

  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/appendix+12+orthopaedic+surgery+joint+replacement" >Appendix 12: Orthopaedic Surgery – Joint Replacement (PDF 80KB)</a></li>

  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/appendix+13+orthopaedic+surgery+non-joint+replacement" >Appendix 13: Orthopaedic Surgery – Non Joint Replacement (PDF 118KB)</a></li>

  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/appendix+14+plastic+and+reconstructive+surgery" >Appendix 14: Plastic and Reconstructive Surgery (PDF 74KB)</a></li>

  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/appendix+15+thoracic+surgery" >Appendix 15: Thoracic Surgery  (PDF 215KB)</a></li>

  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/appendix+16+urology" >Appendix 16: Urology (PDF 88KB)</a></li>

  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/appendix+17+vascular+surgery" >Appendix 17: Vascular Surgery (PDF 74KB)</a></li>
</ul>

<h2>Prescribing guidelines</h2>

<p><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/policies/aminoglycosides+recommendations+for+use+dosing+and+monitoring+clinical+guideline" >Aminoglycosides: recommendations for use, dosing and monitoring (PDF 152KB)</a> - prescribing guideline for the safe and effective use of aminoglycoside antibiotics.</p>

<p><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/policies/antimicrobial+prescribing+clinical+guideline" >Antimicrobial prescribing clinical guideline (PDF 356KB)</a> – provides general principles when prescribing antimicrobials for patients with, or risk of, infection.</p>

<p><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/policies/community+acquired+pneumonia+%28adults%29+management+clinical+guideline" >Community acquired pneumonia (adults) management clinical guideline (PDF 275KB)</a> – provides advice to assist prescribers to identify and initiate empirical antimicrobial therapy for suspected community acquired pneumonia (CAP) in adult patients.</p>

<p><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/policies/diabetic+foot+infections+antibiotic+management+clinical+guideline" >Diabetic foot infections antibiotic management clinical guideline (PDF 1.16MB)</a> - provides advice on the appropriate empiric antimicrobial treatment based on the assessment of the severity of foot infections and the likely pathogens involved.</p>
<p><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/policies/empirical+treatment+of+bacterial+urinary+tract+infections+%28adults%29+clinical+guideline" >Empirical treatment of bacterial urinary tract infection (UTI) clinical guideline (PDF 301KB)</a> – provides advice on the initial empirical antimicrobial therapy for urinary tract infections in adult patients. For treatment of <a href="/wps/wcm/connect/public+content/sa+health+internet/resources/policies/urinary+tract+infection+in+pregnancy+-+sa+perinatal+practice+guidelines" >UTI's in pregnancy</a>, visit the S.A Health Perinatal&nbsp;Practice Guideline page. For <a href="/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+programs+and+practice+guidelines/children+and+youth/paediatric+clinical+practice+guidelines" >Urinary Tract Infection (UTI) in children</a> visit the Paediatric&nbsp;Clinical Practice Guidelines page.&nbsp;</p>

<p><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/policies/febrile+neutropenia+management+%28adults%29+clinical+guideline" >Febrile neutropenia management (adults) clinical guideline (PDF 313KB)</a> – provides advice on the best practice in the initial management of febrile neutropenia in adult patients. The <a href="/wps/wcm/connect/public+content/sa+health+internet/resources/febrile+neutropenia+emergency+letter" >febrile neutropenia emergency letter (PDF 176KB)</a> provides instruction for prompt assessment and treatment of patients at risk.</p>
<p><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/policies/hospital-acquired+pneumonia+and+ventilator-associated+pneumonia+adults+clinical+guideline" >Hospital-acquired Pneumonia and Ventilator-associated Pneumonia (Adults) Clinical Guideline (PDF 733KB)</a> - guide the management of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP.)</p>

<p><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/policies/iv+to+oral+switch+clinica+guideline+for+adults+patients+-+can+antibiotics+s.t.o.p." >Intravenous to oral switch clinical guideline for adult patients – can antibiotics S.T.O.P. (PDF 175KB)</a> – provides recommendations for the appropriate and timely switching of intravenous antimicrobials to an oral equivalent.</p><p><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/policies/vaccination+and+antimicrobial+prophylaxis+for+adult+asplenic+%28splenectomy%29+and+hyposplenic+patients+clinical+guideline"  style="font-size: 1.125rem; background-color: rgb(255, 255, 255);">Splenectomy Vaccination and Antimicrobial Prophylaxis (Adult Asplenic and Hyposplenic Patients) Clinical guideline (PDF 817KB)</a><span style="font-size: 1.125rem;"> and The </span>SA<span style="font-size: 1.125rem;"> Health </span><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/post-splenectomy+treatment+consumer+information"  style="font-size: 1.125rem; background-color: rgb(255, 255, 255);">Post-splenectomy treatment consumer information (PDF 322KB)</a><span style="font-size: 1.125rem;"> – provides recommendations for the care of patients in order to protect them from overwhelming </span>post-splenectomy<span style="font-size: 1.125rem;"> infections (</span>OPSI<span style="font-size: 1.125rem;">).</span><br /></p>

<p><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/policies/staphylococcus+aureus+bacteraemia+sab+management+clinical+guideline" >Staphylococcus aureus bacteraemia (SAB) management (adult) clinical guideline (PDF 363KB)</a> - to assist decision making around antimicrobial prescribing, investigations and duration of therapy.</p>

<p><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/policies/vancomycin+dosing+and+monitoring+in+adults+clinical+guideline" >Vancomycin dosing and monitoring clinical practice guideline (PDF 379KB)</a> - provides statewide directive on the safe and effective use of vancomycin in adults.</p><p><strong>Sepsis:</strong> SA&nbsp;Health's web page <a href="/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+programs+and+practice+guidelines/infection+and+injury+management/sepsis+for+health+professionals" >Sepsis for Health Professionals</a> has important information&nbsp;regarding the recognition of the signs of Sepsis. Further resources on the management of Sepsis can be found at <a href="https://clinicalexcellence.qld.gov.au/priority-areas/safety-and-quality/sepsis/sepsis-resources/adult-sepsis-pathways" >Queensland Health.&nbsp;</a></p><p><br /></p>

<h2>Paediatric&nbsp;guidelines</h2>
<p>The AMS committee at Women's and Children's Hospital have developed a number of prescribing guidelines and resources for paediatric patients. For access to these resources please contact <a href="mailto:HealthAntibio@sa.gov.au" >SA&nbsp;Health's Antimicrobial Programs team.</a></p>
<p>[Note SA Health employees can access these resources through the Women's and Children's Hospital Intranet site].</p>
<h2>Antibiotic allergies</h2>
<p>For information regarding antibiotic allergies; including choosing the appropriate antibiotic for a patient with a history of antibiotic allergy plus how an antibiotic allergy should be recorded&nbsp;in patient notes visit the <a href="/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+programs+and+practice+guidelines/medicines+and+drugs/antibiotic+allergies/antibiotic+allergies" >Antibiotic Allergies </a>page.</p>
<h2>Fact sheets</h2><ul>
  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/understanding+and+interpreting+pkpd+targets+for+antimicrobial" >Understanding and interpreting pharmacokinetic (PK) and pharmacodynamic (PD) targets for antimicrobial 

 (PDF 82KB)</a></li>
  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/dosing+of+antimicrobials+for+obese+patients" >Dosing of antimicrobials for obese patients

(PDF 132KB)</a></li>
  <li><a href="/wps/wcm/connect/public+content/sa+health+internet/resources/its+about+time+antibiotic+duration" >It's about time: Antibiotic Duration (PDF 253KB)</a></li>
</ul>


<h2>Further information</h2>
<p>For further information on antimicrobial guidelines contact <a href="mailto:HealthAntibio@sa.gov.au" >HealthAntibio@sa.gov.au</a></p>

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