2.
Do not take a swab or use antibiotics for the management of a leg ulcer without clinical infection.
Lower leg ulcers, most commonly venous ulcers are often treated with oral antibiotics, even in the absence of evidence of clinical infection. There is no evidence to support this use, except if screening for carriage of multi-resistant organisms. Also a swab for microscopy and culture, in the absence of signs of infection is not recommended. Unnecessary antibiotics and swabbing will add to healthcare costs, antimicrobial resistance and patient allergy.
Supporting evidence
- O’Meara S, Al-Kurdi D, Olugun Y, Antibiotics and antiseptics for Venus ulcers. Cochrane Database Systematic Review 2014; CD003557.
- Hansson C, Hoborn J, Moller A, Swanbeck G. The microbial flora in venous leg ulcers without clinical signs of infection. Repeated culture using a validated standardised microbiological technique. Acta Dermato Venereologica 1995;75:24.
How this list was made
An initial list of 10 low value interventions was compiled by the Lead Fellow of the Australasian Society for Infectious Diseases (ASID) Inc following an online discussion in ASID's discussion forum, Ozbug. The Royal Australasian College of Physicians (RACP) then facilitated a consultation of all ASID members via a survey distributed through the society’s e-newsletter. In the survey, members were asked to rank the 10 suggested interventions and suggest additional items for consideration. A subsequent shortlist of items was created by selecting the top 7 interventions as ranked by the members from the initial list.
The shortlist was sent to ASID’s special interest groups and selected members who had agreed to assist, who were asked to recommend the items to comprise the ‘top 5’. This final list was endorsed by ASID Council on 31 July 2015. The Top 5 was then circulated again to the ASID members for final comments before being signed off by ASID’s Executive Committee.
- 1 Do not use antibiotics in asymptomatic bacteriuria.
- 2 Do not take a swab or use antibiotics for the management of a leg ulcer without clinical infection.
- 3 Avoid prescribing antibiotics for upper respiratory tract infection.
- 4 Do not investigate or treat for faecal pathogens in the absence of diarrhoea or other gastro-intestinal symptoms.
- 5 In a patient with fatigue, avoid performing multiple serological investigations, without a clinical indication or relevant epidemiology.