Bacterial infections review tool

It is good practice to review patients who have been prescribed a course of antibiotic treatment. This provides an opportunity to identify patients who are not improving or whose symptoms are worsening, enabling timely reassessment and escalation of care if required. Alternatively, patients whose symptoms have resolved can be advised to stop taking the antibiotic, in line with antimicrobial stewardship principles that recommend the shortest, effective course to reduce the risk of antibiotic resistance and adverse effects.

Ideally, the review should take place at 3 days (if practicable). The review can be carried out in person or by phone, with the choice based on clinical judgement. For cases of severe infection, the review should preferably be carried out in person and can take place earlier than 3 days if there are particular concerns about the patient.

This tool has been developed in collaboration with the Scottish Antimicrobial Prescribing Group’s Dental Stewardship Steering Group to support the review of patients prescribed antibiotic treatment.

Review the diagnosis and the effectiveness of previous local measures. Points to consider include:
- Is the patient systemically unwell?
- Are they able to eat and drink?
- Is the swelling resolved/ resolving significantly?
- Is pain controlled?
Assess the patient for any red flag signs and symptoms* of severe or rapidly progressing spreading infection.
- If the patient has no red flag signs and/or symptoms*, their pain is resolving, they are eating and drinking normally and there are no ongoing signs of infection, advise the patient to stop taking the antibiotic. Record this in the clinical notes.
  - Provide safety netting advice on what to do if symptoms recur or deteriorate.
  - Advise the patient to return any unused antibiotics to a pharmacy.
- If the patient no red flag signs and/or symptoms* but still has ongoing signs of infection, advise them to complete the full course of antibiotic treatment. Record this in the clinical notes. Second-line antibiotics should only be considered if symptoms have not significantly resolved or are worsening after the initial 5 days of antibiotic treatment. In this case, either refer the patient or consider speaking to a specialist before prescribing second-line antibiotics.
- If the patient has red flag signs and/or symptoms* of severe or rapidly progressing spreading infection, transfer them to hospital as an emergency.
  - For any patient with airway compromise, for example in cases of Ludwig’s angina or sepsis (see Sepsis), call 999 for an ambulance and provide any necessary medical emergency care.

*Red flag signs and symptoms of severe or rapidly progressing spreading infection include significant trismus, floor-of-mouth swelling, difficulty breathing, difficulty swallowing, rapidly spreading cellulitis or involvement of deep or high-risk fascial spaces.