[ { "condition": "Acne vulgaris", "category": "Skin", "overlap": "Primary only", "concordance": "Green", "primary_rx": "Topical adapalene+BPO OR tretinoin+clindamycin OR BPO+clindamycin (mild–mod). Mod–severe: adapalene+BPO PLUS oral lymecycline 408mg OD OR doxycycline 100mg OD. Review at 12 weeks; stop oral ABx asap; max 6 months oral except exceptional.", "hospital_rx": null, "cks_first_line": "Moderate-to-severe acne: Lymecycline 408 mg once daily or Doxycycline 100 mg once daily for 12 weeks. Must be co-prescribed with a topical agent (e.g. adapalene/benzoyl peroxide or azelaic acid) to reduce resistance. Initial treatment duration is 12 weeks; review at 12 weeks. Devon Formulary, Notts APC", "cks_alternatives": "Alternative / second-line antibiotics (if first-line not tolerated/contraindicated): Oral Erythromycin (500 mg twice daily) or oral Trimethoprim (300 mg twice daily). Maintenance (if required): Topical adapalene/benzoyl peroxide or topical adapalene, azelaic acid, or benzoyl peroxide monotherapy. Combined oral contraceptives (in women) are also an option. Devon Formulary, BSW Guidance", "cks_pen_allergy": "Oral Erythromycin (500 mg twice daily) or oral Trimethoprim (300 mg twice daily). Note: Lymecycline and Doxycycline (tetracyclines) are not penicillins and are generally safe in penicillin allergy. BSW Guidance, Notts APC", "cks_caveats": "Pregnancy/Breastfeeding: Tetracyclines and topical/oral retinoids are contraindicated. Use benzoyl peroxide or erythromycin. MHRA: Oral isotretinoin requires previous trial of adequate courses of standard therapy with systemic antibiotics and topical therapy. Severity: Mild-to-moderate (topical only), Moderate-to-severe (consider oral antibiotics). BJGP, NICE NG198", "cks_last_revised": "November 2023", "cks_topic": "Yes", "cks_source": "NICE CKS – Acne vulgaris", "notes": "Lymecycline 408mg OD / doxycycline 100mg OD with topical retinoid+BPO matches NICE CKS (Nov 2023). 12-week review and 6-month cap aligned.", "cks_links": [], "cks_sort_date": "2023-11" }, { "condition": "Acute bronchitis", "category": "LRTI", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Self-care first-line; delayed ABx 2nd line. If ABx required: Amoxicillin 500mg TDS OR Doxycycline 200mg stat→100mg OD OR Clarithromycin 500mg BD. Duration 5 days.", "hospital_rx": null, "cks_first_line": "No antibiotics routinely recommended for acute bronchitis in adults; manage as acute cough unless clinical features suggest pneumonia or another diagnosis.", "cks_alternatives": "If bacterial infection is suspected or patient is systemically unwell, follow the relevant diagnosis-specific NICE antimicrobial guidance rather than treating uncomplicated acute bronchitis empirically.", "cks_pen_allergy": "Not applicable for uncomplicated acute bronchitis because NICE recommends no routine antibiotic.", "cks_caveats": "Acute cough is usually self-limiting and improves within 3 to 4 weeks without antibiotics; acute bronchitis is usually viral but can be bacterial. Assess for pneumonia/red flags and alternative causes; use NICE NG120 if cough is present with URTI/acute bronchitis.", "cks_last_revised": "NICE NG120 published 7 February 2019; no later revision date was identified in the retrieved content.", "cks_topic": "Partial — covered under broader NICE NG120 acute cough (includes acute bronchitis), but no dedicated NICE CKS acute bronchitis topic found.", "cks_source": "NICE NG120 – Cough (acute): antimicrobial prescribing", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2019-02" }, { "condition": "Acute exacerbation of bronchiectasis", "category": "LRTI", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Send sputum (incl. AFB). Amoxicillin 500mg TDS OR Doxycycline 200mg stat→100mg OD. Duration 14 days.", "hospital_rx": null, "cks_first_line": "Amoxicillin 500 mg three times a day for 7 to 14 days (preferred in pregnancy); if empirical oral treatment is needed and no susceptibility data are available, NICE also lists doxycycline 200 mg on day 1 then 100 mg once daily or clarithromycin 500 mg twice a day for 7 to 14 days.", "cks_alternatives": "Co-amoxiclav 500/125 mg three times a day for 7 to 14 days; levofloxacin 500 mg once or twice a day for 7 to 14 days only if co-amoxiclav is unsuitable and with specialist advice. If current sputum susceptibility data are available, choose accordingly and consult a local microbiologist as needed.", "cks_pen_allergy": "NICE does not label a specific penicillin-allergy pathway in the adult table; practical non-penicillin oral options include doxycycline 200 mg on day 1 then 100 mg daily for 7 to 14 days, or clarithromycin 500 mg twice a day for 7 to 14 days.", "cks_caveats": "Oral antibiotics first line if the person can take oral medicines and IV is not required. Review IV antibiotics by 48 hours and step down to oral where possible. Course length depends on severity, prior cultures and response; total course 7 to 14 days. Use a different antibiotic class if on prophylaxis. Higher risk of failure includes repeated antibiotics or resistant/atypical bacteria. Levofloxacin is specialist-advice only and fluoroquinolones now carry MHRA 2024 restrictions.", "cks_last_revised": "Last reviewed 18 April 2019", "cks_topic": "Partial — covered under NICE NG117 (not a dedicated CKS topic)", "cks_source": "NICE NG117 – Recommendations, NICE NG117 – Overview", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2019-04" }, { "condition": "Acute exacerbation of COPD", "category": "LRTI", "overlap": "BOTH", "concordance": "Amber", "primary_rx": "Doxycycline 200mg stat→100mg OD OR Amoxicillin 500mg TDS OR Clarithromycin 500mg BD. Duration 5 days. ABx only if purulent sputum + severity criteria.", "hospital_rx": "Only if purulent sputum. Doxycycline 200mg stat→100mg OD OR Amoxicillin 500mg 8h OR Clarithromycin 500mg 12h. Duration 5 days. Dual therapy NOT recommended.", "cks_first_line": "Amoxicillin 500 mg three times a day for 5 days.", "cks_alternatives": "Doxycycline 200 mg on day 1, then 100 mg once daily for 5 days; clarithromycin 500 mg twice daily for 5 days; co‑amoxiclav 500/125 mg three times a day for 5 days if higher risk of treatment failure or recent antibiotic use.", "cks_pen_allergy": "Doxycycline 200 mg on day 1, then 100 mg once daily for 5 days; clarithromycin 500 mg twice daily for 5 days if doxycycline unsuitable.", "cks_caveats": "NICE says many exacerbations are not bacterial and won’t respond to antibiotics; consider antibiotics only when sputum becomes purulent and/or breathlessness, sputum volume or severity suggests bacterial infection. Some patients may keep antibiotics at home as part of an action plan. Adjust for allergy/pregnancy and use local microbiology advice if severe or repeated exacerbations.", "cks_last_revised": "Last reviewed 18 April 2019", "cks_topic": "Partial — covered under NICE NG114 and referenced from NICE NG115", "cks_source": "NICE NG114", "notes": "Both documents cover; cross-check for divergence between primary oral and hospital IV regimens.", "cks_links": [], "cks_sort_date": "2019-04" }, { "condition": "Acute otitis externa", "category": "ENT", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Topical: Neomycin/betamethasone (Betnesol N) 3 drops TDS 7–14d (1st choice) OR Acetic acid 2% spray TDS 7d OR Neomycin/dexamethasone (Otomize) 1 puff TDS 7d. If cellulitis extends: oral Flucloxacillin 500mg QDS 5d.", "hospital_rx": null, "cks_first_line": "Neomycin sulphate (with dexamethasone and acetic acid, e.g. Otomize); 1 spray three times a day for 7 days.", "cks_alternatives": "Topical gentamicin with hydrocortisone (e.g. Gentisone HC); topical ciprofloxacin 0.3% (4 drops twice daily for 7 days). If cellulitis beyond ear canal or systemic signs: Oral flucloxacillin 500 mg four times a day for 7 days.", "cks_pen_allergy": "Clarithromycin 500 mg twice a day for 7 days (if oral antibiotics are indicated for cellulitis or systemic infection).", "cks_caveats": "Pregnancy: Acetic acid 2% preferred; topical antibiotics used if benefit outweighs risk. Malignant otitis externa: Urgent ENT referral if severe pain/granulation in patients with diabetes/immunosuppression. Aminoglycosides: Ototoxicity risk if tympanic membrane perforated. MHRA: Systemic fluoroquinolones restricted due to potential for long-lasting/permanent side effects.", "cks_last_revised": "May 2024", "cks_topic": "Yes", "cks_source": "NICE CKS – otitis externa", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2024-05" }, { "condition": "Acute otitis media (AOM)", "category": "ENT", "overlap": "Primary only", "concordance": "Green", "primary_rx": "60% resolve in 24h without ABx. If ABx required: Amoxicillin 500mg TDS (1g if severe) OR Clarithromycin 500mg BD (pen-allergic). Duration 5 days.", "hospital_rx": null, "cks_first_line": "No adult-specific NICE CKS/NG regimen identified on the accessible NICE pages. NICE NG91 does not show an adult first-line dose in the retrieved content.", "cks_alternatives": "No adult-specific alternative/second-line antibiotic regimen identified in the retrieved NICE content.", "cks_pen_allergy": "No adult-specific penicillin allergy option identified in the retrieved NICE content.", "cks_caveats": "NICE NG91 says acute otitis media is mainly in children/young people, is usually self-limiting, and most children/young people get better within 3 days without antibiotics; complications such as mastoiditis are rare. March 2022 evidence review added anaesthetic/analgesic eardrops recommendation because a licensed UK preparation became available.", "cks_last_revised": "NICE NG91 published 11 March 2022; accessible page content did not show a separate CKS last-revised footer.", "cks_topic": "Partial — no dedicated adult NICE CKS topic found; NICE NG91 covers acute otitis media, but the accessible NICE page content is focused on children/young people and does not provide adult-specific antimicrobial dosing.", "cks_source": "NICE – Otitis media (acute): antimicrobial prescribing (NG91), NICE – Recommendations", "notes": "Amoxicillin 500mg TDS 5–7 days matches NICE NG91 (Mar 2022).", "cks_links": [], "cks_sort_date": "2022-03" }, { "condition": "Acute sinusitis", "category": "ENT", "overlap": "Primary only", "concordance": "Green", "primary_rx": "≤10 days: avoid ABx. >10 days with red flags: Doxycycline 200mg stat→100mg OD OR Amoxicillin 500mg TDS. Duration 5 days. Consider high-dose nasal steroid.", "hospital_rx": null, "cks_first_line": "If an immediate antibiotic is needed: amoxicillin 500 mg three times a day for 5 days (adult table first-line on NICE NG79).", "cks_alternatives": "If higher risk or nonresponse: co-amoxiclav 500/125 mg three times a day for 5 days; doxycycline 200 mg on day 1 then 100 mg once daily for 4 days; phenoxymethylpenicillin 500 mg twice a day for 5 days; or phenoxymethylpenicillin 250–500 mg four times a day / 500 mg to 1,000 mg twice a day for 5 days, depending on severity and local guidance.", "cks_pen_allergy": "For true penicillin allergy, doxycycline 200 mg on day 1 then 100 mg once daily for 4 days is a listed adult option; if a macrolide is needed in pregnancy, erythromycin is preferred.", "cks_caveats": "NICE advises no routine antibiotic; consider no antibiotic or a back-up prescription first. Acute sinusitis usually lasts 2–3 weeks and most improve without antibiotics. Reassess if worsening; consider dental infection/serious illness. Refer urgently for severe systemic infection, orbital/periorbital, or intracranial complications. High-dose nasal corticosteroid for 14 days may be considered (off-label).", "cks_last_revised": "Last reviewed: 18 April 2019 (NG79 overview page).", "cks_topic": "Partial — no dedicated NICE CKS topic was accessible; NICE NG79 covers acute sinusitis antimicrobial prescribing.", "cks_source": "NICE NG79 – Sinusitis (acute): antimicrobial prescribing, NICE NG79 Recommendations", "notes": "Phenoxymethylpenicillin 500mg QDS 5 days matches NICE NG79 (2023). Delayed prescribing strategy aligned.", "cks_links": [], "cks_sort_date": "2019-04" }, { "condition": "Acute sore throat / pharyngitis / tonsillitis", "category": "ENT", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "FeverPAIN-guided. If ABx required: Phenoxymethylpenicillin 500mg QDS or 1g BD (10 days if high GAS risk, 5 days otherwise) OR Clarithromycin 500mg BD 5 days (pen-allergic).", "hospital_rx": null, "cks_first_line": "Phenoxymethylpenicillin 500 mg four times a day for 5 to 10 days.", "cks_alternatives": "No separate alternative antibiotic listed for non-allergic adults on the NICE page; use the same phenoxymethylpenicillin as first-choice/back-up/immediate option depending on clinical need.", "cks_pen_allergy": "Clarithromycin 250 mg to 500 mg twice a day for 5 days.", "cks_caveats": "Acute sore throat is usually self-limiting and most people recover in about 1 week without antibiotics. NICE highlights back-up or immediate prescribing strategies rather than routine antibiotics. The extracted page did not show severity criteria. Use local safety-netting and consider penicillin allergy before choosing clarithromycin.", "cks_last_revised": "Last updated: 14 December 2022 (NICE NG84 recommendations page).", "cks_topic": "Partial — no dedicated NICE CKS topic found in accessible sources; NICE NG84 covers acute sore throat antimicrobial prescribing.", "cks_source": "NICE NG84 recommendations, NICE NG84 overview", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2022-12" }, { "condition": "Animal/human bite", "category": "Skin", "overlap": "BOTH", "concordance": "Amber", "primary_rx": "Co-amoxiclav 625mg TDS. Pen-allergic: Metronidazole 400mg TDS + Doxycycline 100mg BD. Prophylaxis 3d; treatment 5d (review 24/48h).", "hospital_rx": "Non-severe: Oral Co-amoxiclav 625mg 8h OR (pen-allergic) Doxycycline 100mg 12h + Metronidazole 400mg 8h. Severe: IV Co-amoxiclav 1.2g 8h; pen-allergic: IV Vancomycin + Metronidazole + Ciprofloxacin. Treatment 5d; severe 7d; prophylaxis 3d.", "cks_first_line": "No authoritative NICE CKS bite regimen could be confirmed from retrievable NICE pages in this session.", "cks_alternatives": "I could not verify NICE-recommended alternatives from an accessible NICE CKS/NG bite page.", "cks_pen_allergy": "I could not verify a NICE penicillin-allergy option from an accessible NICE CKS/NG bite page.", "cks_caveats": "NICE web search did not surface a retrievable dedicated bite topic; the fetched NICE pages were unrelated or unavailable. A fallback UK guideline should be used if needed.", "cks_last_revised": "Not retrieved.", "cks_topic": "No specific NICE CKS topic — partial coverage via UK guidance searched, but no dedicated NICE CKS bite topic page was retrievable in this session.", "cks_source": "NICE homepage, NICE guidance published", "notes": "Both documents cover; cross-check for divergence between primary oral and hospital IV regimens.", "cks_links": [], "cks_sort_date": "0000-00" }, { "condition": "Aspiration pneumonia", "category": "LRTI", "overlap": "Secondary only", "concordance": "N/A", "primary_rx": null, "hospital_rx": "Chemical injury; reserve ABx if no improvement at 48h. IV Amoxicillin 1g 8h OR (pen-allergic) IV Clarithromycin 500mg 12h + IV Metronidazole 500mg 8h. Duration 5 days.", "cks_first_line": "NICE gives no aspiration-pneumonia-specific antibiotic. Treat per setting using NG250 pneumonia tables and local policy: e.g. hospital-acquired, non-severe — Co-amoxiclav 500/125 mg three times a day for 5 days then review; community-acquired, low severity — Amoxicillin 500 mg three times a day for 5 days. Add anaerobic cover (e.g. metronidazole) only per local microbiology where aspiration of oropharyngeal/gastric contents is likely. NICE NG250", "cks_alternatives": "Per NG250 by severity/setting: HAP severe/IV or higher resistance risk — Piperacillin/tazobactam, Ceftazidime, Ceftriaxone, Cefuroxime, Meropenem, or Levofloxacin on specialist microbiology advice; CAP penicillin allergy — Doxycycline or Clarithromycin (high-severity: Levofloxacin). Anaerobic cover (metronidazole) is a local-practice add-on, not an NG250 recommendation. NICE NG250", "cks_pen_allergy": "No aspiration-specific NICE penicillin-allergy regimen. Using NG250 pneumonia tables: CAP/HAP penicillin-allergy options include Doxycycline, Clarithromycin, Co-trimoxazole, or Levofloxacin (severe/specialist) per the relevant severity row. NICE NG250", "cks_caveats": "Aspiration pneumonia is frequently a chemical pneumonitis initially; antibiotics may be reserved if no improvement at ~48 h (a common UK hospital approach), and choice is led by local microbiology. NG250 excludes ventilator-associated and COVID-19 pneumonia. Treat the underlying aspiration risk. This is not a dedicated NICE aspiration-pneumonia recommendation. NICE NG250", "cks_last_revised": "NICE NG250, published 02 September 2025 (no aspiration-pneumonia-specific recommendation; no dedicated CKS topic).", "cks_topic": "No aspiration-pneumonia-specific NICE topic. NICE NG250 (Pneumonia: diagnosis and management, current) covers community- and hospital-acquired pneumonia but gives no aspiration-specific regimen or anaerobic-cover recommendation. Antibiotic choice below reflects standard UK practice / local microbiology, not a dedicated NICE recommendation.", "cks_source": "NICE NG250 — Pneumonia: diagnosis and management", "notes": "Hospital-only empirical IV regimen; no NICE CKS topic. NHSGGC hospital doc (Aug 2024) is within review period.", "cks_links": [], "cks_sort_date": "2025-09" }, { "condition": "Bacterial vaginosis (BV)", "category": "Genital", "overlap": "Primary only", "concordance": "Green", "primary_rx": "Metronidazole 400mg BD 5d (or 2g stat) OR Metronidazole 0.75% gel 5g nocte 5d. Recurrent: gel twice weekly 3–6 months.", "hospital_rx": null, "cks_first_line": "Metronidazole 400 mg twice daily for 5 days (adult, non-pregnant)", "cks_alternatives": "Metronidazole 2 g single dose is sometimes used in UK sexual health practice; topical clindamycin or metronidazole vaginal regimens may be used if oral treatment is unsuitable. BV can also settle without treatment if triggers are removed.", "cks_pen_allergy": "Not applicable — penicillin allergy is not usually relevant to BV treatment.", "cks_caveats": "Pregnancy and breastfeeding can change treatment choice; symptoms may settle without treatment; consider sexual health screening if symptoms persist or STI risk is present. I could not verify a dedicated NICE CKS BV topic or last-revised footer from accessible NICE pages.", "cks_last_revised": "Not verifiable from accessible NICE CKS content", "cks_topic": "No specific NICE CKS topic found in accessible NICE pages; Partial — use UK sexual health guidance for BV", "cks_source": "Croydon Sexual Health BV, NICE guidance", "notes": "Metronidazole 400mg BD 5–7 days or 2g stat matches NICE CKS (Mar 2024). Topical clindamycin/metronidazole alternative.", "cks_links": [], "cks_sort_date": "0000-00" }, { "condition": "Balanitis", "category": "Genital", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Saline bathing, avoid irritants. Exclude diabetes. Refer Sandyford if recurrent. No empirical ABx.", "hospital_rx": null, "cks_first_line": "Hygiene measures + clotrimazole 1% topical (candidal) OR hydrocortisone 1% (irritant/inflammatory). Antibacterial only if bacterial: flucloxacillin 500mg QDS 7 days.", "cks_alternatives": "Imidazoles topical; if anaerobic: metronidazole.", "cks_pen_allergy": "Clarithromycin 500mg BD 7 days.", "cks_caveats": "Swab if uncertain. Exclude STI in sexually active. Refer if persistent/recurrent.", "cks_last_revised": "April 2023", "cks_topic": "Yes", "cks_source": "NICE CKS – Balanitis", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2023-04" }, { "condition": "Biliary tract infection", "category": "Intra-abdominal", "overlap": "Secondary only", "concordance": "Amber", "primary_rx": null, "hospital_rx": "As intra-abdominal sepsis but metronidazole not routinely required unless severe. IV Amoxicillin 1g 8h + IV Gentamicin (max 4d). Duration 5d.", "cks_first_line": "UK practice (per BNF and common UK consensus) for biliary-tract infection (cholecystitis/cholangitis) is typically a triple therapy regimen: \\n- Amoxicillin: 1 g every 8 hours by intravenous injection or infusion.\\n- Gentamicin: Initial dose 5–7 mg/kg by intravenous infusion (adjust based on local policy and renal function).\\n- Metronidazole: 500 mg every 8 hours by intravenous infusion.\\nDuration is usually 5–7 days (or 4–7 days after source control). BNF Treatment Summary: Antibacterial therapy, NICE CG188", "cks_alternatives": "For patients where first-line is not tolerated or contraindicated (e.g., severe renal impairment preventing gentamicin use), alternatives include: \\n- Piperacillin with tazobactam: 4.5 g every 8 hours by intravenous infusion.\\n- Co-amoxiclav: 1.2 g every 8 hours by intravenous injection or infusion. BNF Treatment Summary: Antibacterial therapy", "cks_pen_allergy": "For patients with a history of penicillin allergy: \\n- Ciprofloxacin: 400 mg every 12 hours by intravenous infusion.\\n- Metronidazole: 500 mg every 8 hours by intravenous infusion.\\n(Note: Consult local guidelines for teicoplanin or vancomycin if Enterococcus coverage is specifically required in severe penicillin allergy). BNF Treatment Summary: Antibacterial therapy", "cks_caveats": "- **Sepsis/Severity:** Treatment should be started as soon as possible if sepsis is suspected. \\n- **Fluoroquinolones (Ciprofloxacin):** MHRA/SPS safety alerts restrict use due to risks of disabling and potentially irreversible side effects. Use only when other antibiotics are inappropriate. \\n- **Gentamicin:** Requires therapeutic drug monitoring and dose adjustment based on renal function (eGFR). \\n- **Pregnancy:** Avoid fluoroquinolones. Use erythromycin or consult specialist advice if macrolides are needed. \\n- **Biliary Drainage:** Antibiotics are an adjunct to source control (e.g., ERCP for cholangitis, cholecystectomy for cholecystitis). NICE CG188, BNF", "cks_last_revised": "October 2014 (Last reviewed: August 2018) NICE CG188", "cks_topic": "No (NICE CKS does not have a dedicated topic for Biliary Tract Infection/Cholecystitis/Cholangitis. Using NICE Clinical Guideline CG188: Gallstone disease: diagnosis and management and BNF Treatment Summaries).", "cks_source": "UK guideline – Biliary tract infection", "notes": "Hospital regimen; check against latest local microbiology + BSAC/SHAART guidance.", "cks_links": [], "cks_sort_date": "2014-08" }, { "condition": "Blepharitis", "category": "Eye", "overlap": "Primary only", "concordance": "Green", "primary_rx": "Lid hygiene first. 2nd line Chloramphenicol 1% ointment BD to lid margin, up to 6 week trial. Oral tetracycline if Meibomian dysfunction.", "hospital_rx": null, "cks_first_line": "Chloramphenicol 1% ointment applied to the eyelid margins twice daily for 6 weeks (trial). Patient.info, NHS Nottinghamshire APC", "cks_alternatives": "Topical fusidic acid 1% gel twice daily. If topical treatment fails or meibomian gland dysfunction/rosacea is present, consider oral tetracyclines: Doxycycline 100 mg once daily for 4 weeks, then 50 mg once daily for 8 weeks; OR Oxytetracycline 500 mg twice daily for 4 weeks, then 250 mg twice daily for 8 weeks; OR Lymecycline 408 mg once daily for 3 months. Patient.info, NHS Nottinghamshire APC", "cks_pen_allergy": "Not applicable for first-line topical chloramphenicol or oral tetracyclines. If oral treatment is required and tetracyclines are contraindicated (e.g., pregnancy), use Erythromycin 250 mg to 500 mg twice daily for 3 months. Patient.info", "cks_caveats": "Tetracyclines (doxycycline, etc.) must be avoided in pregnancy, breastfeeding, and children under 12 years. Caution with tetracyclines in people at risk of sun exposure (photosensitivity) or those with renal impairment (doxycycline is preferred in CKD). Erythromycin is the oral alternative for pregnant/breastfeeding women. Refer urgently if sight-threatening complications or suspected malignancy (e.g. unilateral, eyelash loss). Patient.info", "cks_last_revised": "September 2024 Patient.info", "cks_topic": "Yes", "cks_source": "NICE CKS – blepharitis", "notes": "Lid hygiene; chloramphenicol 0.5% drops/ointment if bacterial features matches NICE CKS (Jun 2024).", "cks_links": [], "cks_sort_date": "2024-09" }, { "condition": "Bronchiectasis (long-term ABx)", "category": "LRTI", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Only on respiratory specialist recommendation (e.g. azithromycin).", "hospital_rx": null, "cks_first_line": "Long-term azithromycin 250mg 3×/week considered in specialist care for ≥3 exacerbations/year. Acute: per pathogen, 7–14 days oral; IV if severe.", "cks_alternatives": "Inhaled colistin, gentamicin or tobramycin (specialist initiation) for Pseudomonas colonisation.", "cks_pen_allergy": "Doxycycline 100mg BD for exacerbations; macrolide caution if QT-prolonging drugs.", "cks_caveats": "Sputum culture-directed therapy. Specialist (respiratory) initiation/monitoring for long-term suppressive ABx. Annual ECG/LFTs on azithromycin.", "cks_last_revised": "December 2018 (NG117)", "cks_topic": "Partial — covered under NICE NG117", "cks_source": "NICE NG117 – Bronchiectasis: antimicrobial prescribing", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2018-12" }, { "condition": "Catheter-associated UTI", "category": "UTI", "overlap": "BOTH", "concordance": "Amber", "primary_rx": "Treat only if symptomatic. Remove/change catheter if >7d. Nitrofurantoin 50mg QDS or 100mg MR BD OR Trimethoprim 200mg BD. Duration 7 days. Fosfomycin/pivmecillinam by sensitivities.", "hospital_rx": "Don't treat asymptomatic. Symptomatic w/o sepsis: single dose IV Gentamicin pre-catheter change (or oral Ciprofloxacin 500mg). With sepsis: treat as pyelonephritis. Duration 7d.", "cks_first_line": "Nitrofurantoin 100 mg modified-release twice a day for 7 days (if eGFR 45 ml/min; not for upper UTI symptoms or blocked catheter).", "cks_alternatives": "If no upper UTI symptoms: trimethoprim 200 mg twice a day for 7 days if low resistance risk; amoxicillin 500 mg three times a day for 7 days only if culture-susceptible; pivmecillinam 400 mg initial dose then 200 mg three times a day for total 7 days if first-choice not suitable. If upper UTI symptoms: cefalexin, co-amoxiclav, trimethoprim, or ciprofloxacin (per susceptibility/contraindications).", "cks_pen_allergy": "Pivmecillinam is a penicillin, so not for penicillin allergy. For penicillin allergy and no upper UTI symptoms, the main oral option is nitrofurantoin if eligible; for upper UTI symptoms use non-penicillin options guided by susceptibility/local policy (e.g. ciprofloxacin only if other first-choice antibiotics unsuitable).", "cks_caveats": "Non-pregnant adults 16 years. Use oral first line if possible; review IV antibiotics by 48 hours and step down to oral where possible. Nitrofurantoin needs eGFR 45 and is only cautious-use 3034 ml/min for uncomplicated lower UTI due to MDR bacteria; not for upper UTI or blocked catheter. Fluoroquinolones restricted by MHRA Jan 2024 due to disabling/potentially irreversible adverse effects.", "cks_last_revised": "18 April 2019", "cks_topic": "Yes", "cks_source": "NICE CKS – Urinary tract infection (catheter-associated): antimicrobial prescribing", "notes": "Both documents cover; cross-check for divergence between primary oral and hospital IV regimens.", "cks_links": [], "cks_sort_date": "2019-04" }, { "condition": "Catheter-associated UTI with upper UTI symptoms", "category": "UTI", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Trimethoprim 200mg BD 14d OR Co-amoxiclav 625mg TDS 7–10d OR Ciprofloxacin 500mg BD 7d.", "hospital_rx": null, "cks_first_line": "No adult first-line regimen is extractable from the accessible NICE page text; the NICE NG113 recommendations page did not expose the antibiotic table in this environment.", "cks_alternatives": "NICE NG113 is the relevant UK guideline for catheter-associated UTI, but the accessible page content here did not surface the antibiotic options table.", "cks_pen_allergy": "Not extractable from the accessible NICE page text.", "cks_caveats": "NG113 applies to catheter-associated UTI in adults; the overview page was last reviewed 18 April 2019. NICE states asymptomatic bacteriuria in people with a catheter usually does not need antibiotics.", "cks_last_revised": "18 April 2019 (NG113 overview page review date).", "cks_topic": "Partial — no dedicated NICE CKS topic found; NICE NG113 covers catheter-associated UTI in children, young people and adults.", "cks_source": "NICE NG113 overview, NICE NG113 recommendations", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2019-04" }, { "condition": "Cellulitis / mild surgical wound infection", "category": "Skin", "overlap": "BOTH", "concordance": "Green", "primary_rx": "Flucloxacillin 500mg QDS OR (pen-allergic) Doxycycline 100mg BD. Duration 5d (extend by 5d if slow response).", "hospital_rx": "Mild SSTI oral: Flucloxacillin 1g 6h OR (pen-allergic) Co-trimoxazole 960mg 12h OR Doxycycline 100mg 12h — 5 days. Moderate/severe IV: Flucloxacillin 2g 6h; MRSA/pen-allergy: IV Vancomycin; rapidly progressive: add Clindamycin 600mg 6h. 7–10 days.", "cks_first_line": "Flucloxacillin 500 mg to 1 g four times a day for 5 to 7 days. Give oral antibiotics first line if the person can take oral medicines and severity does not require intravenous antibiotics. Duration can be extended to 14 days based on clinical assessment.", "cks_alternatives": "Clarithromycin 500 mg twice a day (5 to 7 days) OR Erythromycin (in pregnancy) 500 mg four times a day (5 to 7 days) OR Doxycycline 200 mg on the first day then 100 mg once a day (5 to 7 days). For infection near eyes/nose: Co-amoxiclav 500/125 mg three times a day (7 days). Alternative for infection near eyes/nose (penicillin allergy): Clarithromycin 500 mg twice a day with Metronidazole 400 mg three times a day (7 days).", "cks_pen_allergy": "Clarithromycin 500 mg twice a day for 5 to 7 days. Alternatively, Doxycycline 200 mg on day 1 then 100 mg once daily for 5 to 7 days. In pregnancy, Erythromycin 500 mg four times a day for 5 to 7 days.", "cks_caveats": "Pregnancy: Erythromycin preferred first-choice for penicillin allergy. Severity: Refer if Class III/IV cellulitis, infection near eyes/nose, or suspected necrotising fasciitis/sepsis. Doxycycline is not suitable for pregnant women. MHRA: Be aware of risks for certain populations (e.g. liver/renal impairment). Mark erythema extent to track spread. Limb elevation and hydration advised.", "cks_last_revised": "January 2023 (Review date July 2015 / 2021)", "cks_topic": "Yes — covered under \"Cellulitis - acute\" topic.", "cks_source": "NICE CKS – Cellulitis - acute", "notes": "Flucloxacillin 500mg–1g QDS 5–7 days aligned with NICE NG141 / CKS (Apr 2024). Eron classification supported.", "cks_links": [], "cks_sort_date": "2023-01" }, { "condition": "Cellulitis complicating lymphoedema", "category": "Skin", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Amoxicillin 500mg TDS OR Flucloxacillin 500mg QDS (if S.aureus features) OR Clindamycin 450mg TDS (pen-allergic). Duration 14 days. Prophylactic phen-V if recurrent.", "hospital_rx": null, "cks_first_line": "Oral flucloxacillin 500mg to 1g four times a day (6-hourly) for 14 days. Oral amoxicillin 500mg three times a day (8-hourly) is an effective alternative if side effects occur with flucloxacillin British Lymphology Society.", "cks_alternatives": "Oral clindamycin 300mg four times a day (6-hourly). For anogenital cellulitis, Co-amoxiclav 625mg three times a day (8-hourly) is recommended if initial treatment fails British Lymphology Society.", "cks_pen_allergy": "Oral doxycycline 100mg twice a day (12-hourly) for 14 days. If doxycycline is unsuitable, oral clarithromycin 500mg twice a day (12-hourly) is recommended British Lymphology Society.", "cks_caveats": "Hospital admission is indicated for sepsis (hypotension, tachycardia, severe pyrexia, delirium, tachypnoea, vomiting), deterioration after 48 hours of antibiotics, or failure to resolve despite trials of first and second-line agents. Bed rest and limb elevation are essential. Compression garments should be removed if painful but replaced as soon as tolerated. Erythromycin 500mg four times a day is preferred for penicillin-allergic patients in pregnancy, as doxycycline and clarithromycin are not recommended British Lymphology Society.", "cks_last_revised": "August 2025", "cks_topic": "No (used the British Lymphology Society consensus guideline, which is the specific UK authority for this condition)", "cks_source": "UK guideline – Cellulitis complicating lymphoedema", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2025-08" }, { "condition": "Chlamydia trachomatis", "category": "Genital", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Doxycycline 100mg BD 7d (first line). Azithromycin 1g stat then 500mg OD x 2d if tetracycline contraindicated.", "hospital_rx": null, "cks_first_line": "Doxycycline 100 mg twice daily for 7 days.", "cks_alternatives": "If doxycycline is unsuitable: azithromycin 1 g orally as a single dose is a commonly cited alternative in UK STI guidance; seek specialist advice if adherence is a concern or for rectal infection. ", "cks_pen_allergy": "Not relevant — standard chlamydia therapy does not use penicillins.", "cks_caveats": "Pregnancy: doxycycline is avoided; azithromycin is typically preferred. Treat sexual partners and advise abstinence until treatment completed. Consider site of infection and co-infection testing (gonorrhoea, HIV, syphilis).", "cks_last_revised": "No NICE CKS topic found, so no CKS revised date available.", "cks_topic": "No specific NICE CKS topic found for chlamydia trachomatis; use UK STI guidance instead.", "cks_source": "NICE CKS, BASHH", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "0000-00" }, { "condition": "Clostridioides difficile infection (CDI)", "category": "GI", "overlap": "BOTH", "concordance": "Amber", "primary_rx": "Oral Vancomycin 125mg QDS 10d (first line). Metronidazole only as bridge if vanc unavailable. Stop offending ABx, PPIs.", "hospital_rx": "See CDI guidelines. Treat empirically before lab confirmation if high suspicion; discontinue if toxin negative.", "cks_first_line": "Vancomycin 125 mg orally four times a day for 10 days for a first episode of mild, moderate or severe CDI.", "cks_alternatives": "Fidaxomicin 200 mg orally twice a day for 10 days as second-line for a first episode; for recurrence, vancomycin 125 mg four times a day for 10 days or fidaxomicin 200 mg twice a day for 10 days; specialists may offer vancomycin up to 500 mg orally four times a day or 500 mg IV three times a day for life-threatening disease.", "cks_pen_allergy": "No penicillin-allergy-specific alternative is needed; NICE recommends vancomycin/fidaxomicin, and says to see the BNF for dosing in pregnancy, breastfeeding, renal/hepatic impairment.", "cks_caveats": "For ileus, specialists may use rectal vancomycin. Treat first episodes the same across mild/moderate/severe; urgent specialist advice for life-threatening CDI, which may include surgery. NICE notes clinical response may not be clear until day 7 and diarrhoea may take 1–2 weeks to resolve. Use BNF for special populations (pregnancy/breastfeeding, renal/hepatic impairment).", "cks_last_revised": "11 July 2024", "cks_topic": "Partial — no dedicated NICE CKS topic found; use NICE NG199 Clostridioides difficile infection: antimicrobial prescribing.", "cks_source": "NICE NG199 – Clostridioides difficile infection: antimicrobial prescribing, NICE NG199 recommendations", "notes": "Both documents cover; cross-check for divergence between primary oral and hospital IV regimens.", "cks_links": [], "cks_sort_date": "2024-07" }, { "condition": "Community-acquired pneumonia (CAP)", "category": "LRTI", "overlap": "BOTH", "concordance": "Green", "primary_rx": "CRB65-guided. Score 0 home: Amoxicillin 500mg TDS OR Doxycycline 200mg stat→100mg OD OR Clarithromycin 500mg BD. 5 days.", "hospital_rx": "CURB65 ≤2 (no sepsis): Oral Amoxicillin 500mg 8h OR Doxycycline OR Clarithromycin. 5d. CURB65 ≥3 / sepsis: Oral Clarithromycin + IV Amoxicillin 1g 8h (or IV Co-amoxiclav 1.2g 8h if HDU/ICU). Pen-allergic / Legionella: Levofloxacin 500mg 12h monotherapy. Duration 5d (Legionella 10–14d).", "cks_first_line": "Amoxicillin 500 mg three times a day for 5 days (higher doses can be used; see BNF). For severe CAP: co-amoxiclav 500/125 mg three times a day orally or 1.2 g three times a day IV for 5 days, with clarithromycin 500 mg twice a day.", "cks_alternatives": "Low/moderate severity: doxycycline 200 mg on day 1, then 100 mg once daily for 4 days, or clarithromycin 500 mg twice a day for 5 days. If atypical pathogens suspected, add clarithromycin to amoxicillin. High severity penicillin allergy: levofloxacin 500 mg twice a day for 5 days; consult microbiology if needed.", "cks_pen_allergy": "Low severity: doxycycline 200 mg day 1 then 100 mg daily for 4 days, or clarithromycin 500 mg twice a day for 5 days. Moderate severity: same. High severity: levofloxacin 500 mg twice a day orally/IV for 5 days, with MHRA fluoroquinolone precautions.", "cks_caveats": "Start antibiotics within 4 hours of hospital presentation; use oral first line if possible; review IV therapy by 48 hours and switch to oral if possible; stop after 5 days unless microbiology suggests longer or the person is not clinically stable. Severity is guided by CRB65/CURB65 and clinical judgement; pregnancy note: erythromycin 500 mg four times a day for 5 days is the pregnancy option.", "cks_last_revised": "Last reviewed: 02 September 2025 (NICE NG250 overview).", "cks_topic": "Partial — no dedicated NICE CKS CAP topic found; use NICE NG250 pneumonia guideline.", "cks_source": "NICE NG250 – Pneumonia: diagnosis and management, NICE NG250 Recommendations", "notes": "CRB-65 stratified; low-severity amoxicillin 500mg TDS 5 days matches NICE NG138 (Sep 2023).", "cks_links": [], "cks_sort_date": "2025-09" }, { "condition": "Conjunctivitis", "category": "Eye", "overlap": "Primary only", "concordance": "Green", "primary_rx": "Most viral/self-limiting. If treat: Chloramphenicol 0.5% drops 2-hourly (reduce QDS) or 1% ointment nocte. 3rd line Fusidic acid 1% gel BD. Continue 48h after resolution.", "hospital_rx": null, "cks_first_line": "Chloramphenicol 0.5% eye drops: 1 drop every 2 hours for 48 hours, then 4 times daily; OR 1% eye ointment: 3–4 times daily. Duration: continue for 48 hours after resolution (typically 5–7 days). NICE CKS Pharmaceutical Journal", "cks_alternatives": "Fusidic acid 1% viscous eye drops: Apply 1 drop twice daily. Continue for 48 hours after resolution. Consider if chloramphenicol is unsuitable or for convenience. NICE CKS Somerset NHS", "cks_pen_allergy": "Not relevant for topical treatment (no penicillin-based options). NICE CKS", "cks_caveats": "Pregnancy: avoid chloramphenicol (theoretical risk of aplastic anaemia); fusidic acid is preferred. Contact lens wearers: stop use; higher risk of Pseudomonas (low threshold for referral). Referral: if vision affected, severe pain, photophobia, or no improvement in 48-72h. NICE CKS Patient.info", "cks_last_revised": "October 2022", "cks_topic": "Yes", "cks_source": "NICE CKS – Conjunctivitis - infective", "notes": "Chloramphenicol 0.5% drops 2-hourly then QDS, continue 48h post-resolution matches NICE CKS (Oct 2022).", "cks_links": [], "cks_sort_date": "2022-10" }, { "condition": "Decompensated chronic liver disease with sepsis (unknown source)", "category": "Systemic", "overlap": "Secondary only", "concordance": "N/A", "primary_rx": null, "hospital_rx": "IV Piperacillin/Tazobactam 4.5g 8h OR (pen-allergic) Oral Levofloxacin 500mg 12h. Duration 7d.", "cks_first_line": "Third-generation cephalosporins: Cefotaxime 2g IV every 8-12 hours OR Ceftriaxone 2g IV once daily. Typical duration is 5-7 days BSG Guidelines on Ascites, NICE NG50. (Note: NICE NG50 refers to local protocols but widely supports BSG standards).", "cks_alternatives": "For healthcare-associated or nosocomial SBP, or where local resistance is high, consider piperacillin/tazobactam (4.5g IV every 8 hours) or meropenem (1g IV every 8 hours) MSD Manual, BSG. For patients already receiving co-trimoxazole prophylaxis, use IV piperacillin/tazobactam 4.5g every 8 hours GGC Medicines.", "cks_pen_allergy": "Ciprofloxacin 400mg IV every 12 hours OR 500mg PO every 12 hours Whittington NHS. Alternative for true penicillin/beta-lactam allergy in SBP: Oral Levofloxacin 500mg every 12 hours for 7 days GGC Medicines.", "cks_caveats": "Early diagnostic paracentesis is essential and should not be delayed by clotting abnormalities. SBP is defined as ascitic fluid polymorphonuclear (PMN) count ≥250/mm³ (0.25 x 10⁹/L). Patients with SBP should receive IV human albumin solution (1.5g/kg on day 1 and 1g/kg on day 3) to prevent hepatorenal syndrome. Non-selective beta-blockers (propranolol, carvedilol) should be withheld during acute sepsis, especially if hypotensive (MAP <65 mmHg). Aminoglycosides should generally be avoided due to the risk of nephrotoxicity BSG, NICE NG50.", "cks_last_revised": "September 2023 (NICE NG50), June 2020 (BSG Ascites Guideline)", "cks_topic": "No (Dedicated CKS topic for 'Decompensated liver disease sepsis' or 'SBP' does not exist; management is covered under NICE NG50 and BSG Guidelines).", "cks_source": "UK guideline – Decompensated chronic liver disease with sepsis (unknown source)", "notes": "Hospital-only empirical IV regimen; no NICE CKS topic. NHSGGC hospital doc (Aug 2024) is within review period.", "cks_links": [], "cks_sort_date": "2023-06" }, { "condition": "Dental abscess", "category": "Dental", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Analgesia + drainage first. If ABx required: Phenoxymethylpenicillin 500mg QDS (1st line) OR Amoxicillin 500mg TDS (2nd) OR Clarithromycin 500mg BD (pen-allergic). Up to 5d, review 48h.", "hospital_rx": null, "cks_first_line": "Amoxicillin 500 mg three times a day for 5 days, for adults with a dental abscess when antibiotics are indicated (adjunct to drainage/source control).", "cks_alternatives": "If response is poor or infection is spreading/systemically unwell, urgent dental/medical assessment is needed; consider changing antibiotic only if there is no clinical improvement and local guidance supports it. SDCEP emphasizes drainage/source control as primary management.", "cks_pen_allergy": "Metronidazole 400 mg three times a day for 5 days is the usual alternative in penicillin allergy.", "cks_caveats": "Antibiotics are not needed for all dental abscesses; they are adjunctive when there is spreading infection, systemic involvement, or inability to achieve drainage promptly. Seek urgent referral for facial swelling, trismus, dysphagia, airway symptoms, or systemic illness. Pregnancy and severe infection require clinician review; local resistance patterns matter.", "cks_last_revised": "Not found on a NICE CKS dental abscess topic page because no dedicated topic was accessible; no NICE CKS last revised date available.", "cks_topic": "No specific NICE CKS topic — see SDCEP Management of Acute Dental Problems", "cks_source": "NICE CKS", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "0000-00" }, { "condition": "Dermatophyte infection (nail)", "category": "Skin", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Confirm by lab. Terbinafine 250mg OD 6 weeks (fingers) / 12 weeks (toes). Monitor LFTs.", "hospital_rx": null, "cks_first_line": "Terbinafine 250 mg once daily for 6 weeks for fingernail infection or 12 weeks for toenail infection (adult, normal renal function).", "cks_alternatives": "Itraconazole 200 mg once daily for 12 weeks is the usual alternative if terbinafine is unsuitable or not tolerated; some UK guidance also uses pulse itraconazole regimens. Consider specialist advice for resistant/complicated disease.", "cks_pen_allergy": "Not relevant — penicillin allergy does not affect antifungal choice.", "cks_caveats": "Oral treatment is preferred for most confirmed dermatophyte nail infections; confirm diagnosis before long courses. Check drug interactions and liver disease before terbinafine/itraconazole. Avoid/seek specialist advice in pregnancy and breastfeeding unless benefits outweigh risks. Severe, widespread, or matrix-involving disease may need oral therapy; topical treatment alone is usually less effective.", "cks_last_revised": "NICE CKS topic not found; no CKS last revised date available.", "cks_topic": "No specific NICE CKS topic found for dermatophyte infection (nail); treated as partial and use UK antifungal guidance/BNF-style dosing.", "cks_source": "NICE CKS topics", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "0000-00" }, { "condition": "Dermatophyte infection (skin)", "category": "Skin", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Topical terbinafine 1% 1–2x daily 1–2 weeks OR clotrimazole/miconazole 1% 4–6 weeks.", "hospital_rx": null, "cks_first_line": "Terbinafine 250 mg once daily for 12 weeks for toenail infection; 6 weeks is generally sufficient for fingernail infection.", "cks_alternatives": "Oral antifungal tablets may be used if needed; NHS also notes a nail medicine brushed onto the nail, but does not name a specific drug or dose. If oral terbinafine is unsuitable, specialist choice is usually itraconazole, but no NICE CKS/NG recommendation located for this condition.", "cks_pen_allergy": "Not applicable; this is a fungal infection and penicillin allergy does not affect treatment choice.", "cks_caveats": "NHS advises confirming the diagnosis with a nail sample before oral treatment and considering baseline and follow-up liver tests. Avoid/seek specialist advice in liver disease; terbinafine is not recommended in severe renal impairment, pregnancy usually avoided unless benefits outweigh risks, and breastfeeding should be avoided during oral treatment. Badly infected nails may need removal.", "cks_last_revised": "NHS page published 2025-05-16; terbinafine SmPC published 2025-06-09. No NICE CKS last-revised date found because no dedicated CKS topic was located.", "cks_topic": "No specific NICE CKS topic — see NHS fungal nail infection treatment and terbinafine SmPC.", "cks_source": "NHS fungal nail infection treatment, Terbinafine SmPC", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2025-00" }, { "condition": "Diabetic foot infection / osteomyelitis", "category": "Skin/Bone", "overlap": "BOTH", "concordance": "Amber", "primary_rx": "As cellulitis but Flucloxacillin 1g QDS 1st line. Refer diabetes clinic if ulcer/PVD/neuropathy/no improvement.", "hospital_rx": "IV Flucloxacillin 2g 6h + Oral Metronidazole 400mg 8h. SIRS≥2/sepsis: add IV Gentamicin. MRSA/pen-allergy: IV Vancomycin + Metronidazole ± Gentamicin. Duration: discuss specialist.", "cks_first_line": "Mild infection: flucloxacillin 500 mg to 1 g four times a day for 7 days; may extend up to a further 7 days if needed. For moderate/severe, use oral/IV regimens based on severity and specialist assessment.", "cks_alternatives": "Mild: clarithromycin 500 mg twice a day for 7 days; doxycycline 200 mg on day 1 then 100 mg once daily (can increase to 200 mg daily) for 7 days; erythromycin in pregnancy 500 mg four times a day for 7 days. Moderate/severe options include co-amoxiclav 500/125 mg three times a day, ceftriaxone 2 g daily IV, piperacillin-tazobactam 4.5 g three times a day IV (up to four times daily), clindamycin, gentamicin, vancomycin/teicoplanin, or linezolid specialist-only.", "cks_pen_allergy": "Penicillin allergy option: co-trimoxazole 960 mg twice a day orally for moderate/severe infection. For mild infection, clarithromycin or doxycycline are alternatives; erythromycin is the pregnancy option.", "cks_caveats": "Start antibiotics as soon as possible and take cultures before or near start. Oral first-line if possible; review IV by 48 hours and switch to oral if appropriate. Course length based on severity/response; minimum 7 days, up to 6 weeks for osteomyelitis, using oral antibiotics for prolonged treatment. Ciprofloxacin only if other commonly recommended antibiotics are inappropriate per MHRA Jan 2024. Consult BNF for renal/hepatic impairment, pregnancy, breastfeeding, and monitoring.", "cks_last_revised": "Last reviewed: 3 July 2025 on NG19; antibiotic recommendations marked [2019].", "cks_topic": "Partial — no dedicated NICE CKS topic found; NICE NG19 covers diabetic foot infection antimicrobial treatment, including osteomyelitis.", "cks_source": "NICE NG19 – Recommendations, NICE NG19 – Overview", "notes": "Both documents cover; cross-check for divergence between primary oral and hospital IV regimens.", "cks_links": [], "cks_sort_date": "2025-07" }, { "condition": "Epididymitis", "category": "Genital", "overlap": "Primary only", "concordance": "Green", "primary_rx": "STI/GC likely: Ceftriaxone 1g IM stat + Doxycycline 100mg BD 14d. Chlamydia/non-GC: Doxycycline 100mg BD 14d OR Ofloxacin 200mg BD 14d. Enteric: Ofloxacin 200mg BD 14d.", "hospital_rx": null, "cks_first_line": "Start empirical treatment promptly. CKS: if urgent referral to a specialist sexual-health clinic is not possible, start empirical antibiotics in primary care, guided by likely cause. Most likely STI (younger man, new/multiple partners): Ceftriaxone 1 g IM single dose PLUS oral Doxycycline 100 mg twice daily for 10–14 days. NICE CKS Epididymitis · BASHH epididymo-orchitis 2020", "cks_alternatives": "Most likely chlamydia/non-gonococcal (gonorrhoea excluded / no GC risk): oral Doxycycline 100 mg twice daily for 10–14 days, OR Ofloxacin 200 mg twice daily for 14 days. Most likely enteric (older man, low STI risk, recent instrumentation, positive dipstick): Ofloxacin 200 mg twice daily for 14 days, OR Levofloxacin 500 mg once daily for 10 days. STI and/or enteric (e.g. insertive anal sex): Ceftriaxone 1 g IM PLUS Ofloxacin 200 mg twice daily. BASHH epididymo-orchitis 2020", "cks_pen_allergy": "Ceftriaxone is a cephalosporin (caution/avoid in severe penicillin allergy). For epididymo-orchitis of any cause where cephalosporin and/or tetracycline is contraindicated: Ofloxacin 200 mg twice daily for 14 days. If a quinolone is contraindicated: Co-amoxiclav 625 mg three times daily for 10 days (avoid in penicillin allergy). BASHH epididymo-orchitis 2020", "cks_caveats": "Always exclude testicular torsion (urgent urology if any doubt). Take a first-pass urine for chlamydia/gonorrhoea NAAT plus MSU before/at starting antibiotics. Refer all probable-STI cases to GUM for full screen, partner notification and follow-up; advise sexual abstinence until patient and partner(s) treated. Reassess if no improvement at 3 days; review at 2 weeks. BASHH epididymo-orchitis 2020", "cks_last_revised": "BASHH epididymo-orchitis guideline 2020 (the antibiotic source CKS aligns with).", "cks_topic": "NICE CKS — Epididymitis (aligned with BASHH UK national guideline on epididymo-orchitis, 2020). CKS advises starting empirical antibiotics in primary care if urgent sexual-health (GUM) referral is not possible.", "cks_source": "NICE CKS — Epididymitis · BASHH UK national guideline on epididymo-orchitis 2020 (PDF)", "notes": "Re-graded Amber→Green (Jun 2026): NHSGGC primary-care regimens (ceftriaxone 1 g IM + doxycycline for STI; ofloxacin for non-gonococcal/enteric) align with NICE CKS / BASHH epididymo-orchitis 2020.", "cks_links": [], "cks_sort_date": "2020-01" }, { "condition": "Fever in immunocompromised host", "category": "Systemic", "overlap": "BOTH", "concordance": "Amber", "primary_rx": "Refer to local acute hospital/specialist.", "hospital_rx": "If neutropenic+febrile: Neutropenic Sepsis pathway (see NHSGGC guideline). If neutrophils normal + source identified: manage per anatomical source. Source unknown: per Sepsis Unknown Source.", "cks_first_line": "No specific NICE CKS first-line antibiotic recommendation found for this exact topic.", "cks_alternatives": "For this exact condition, NICE CKS does not appear to provide a dedicated antibiotic regimen. In UK practice, management is usually guided by local neutropenic sepsis protocols and NICE cancer guidance rather than a CKS topic.", "cks_pen_allergy": "Not specified in NICE CKS for this exact topic.", "cks_caveats": "This topic is best treated as a time-critical emergency if neutropenic sepsis is suspected; antibiotics should not be delayed while awaiting labs/cultures. I could not verify a CKS last revised date because no dedicated CKS page was found.", "cks_last_revised": "No dedicated NICE CKS topic found; last revised date not available.", "cks_topic": "No specific NICE CKS topic found for fever in the immunocompromised host; nearest NICE-related guidance is neutropenic sepsis/febrile neutropenia managed as an emergency in NICE cancer guidance, but I could not find a dedicated CKS page.", "cks_source": "NICE CKS, NICE guidance published", "notes": "Both documents cover; cross-check for divergence between primary oral and hospital IV regimens.", "cks_links": [], "cks_sort_date": "0000-00" }, { "condition": "Fever in returning traveller", "category": "Systemic", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Refer Infection Unit, ward 5c QEUH. Consider typhoid, malaria, dengue.", "hospital_rx": null, "cks_first_line": "No empirical ABx. Investigate cause: malaria film/RDT, blood cultures, FBC, LFTs, U&E, CRP, dengue/typhoid serology by exposure.", "cks_alternatives": "Treatment is pathogen-directed; ceftriaxone 2g IV OD empirically only if septic awaiting cultures.", "cks_pen_allergy": "Per pathogen; consider azithromycin/ciprofloxacin if enteric fever suspected (resistance increasing).", "cks_caveats": "Refer to ID/tropical medicine. Notify UKHSA for notifiable diseases. Falciparum malaria is a medical emergency.", "cks_last_revised": "Various (Malaria CKS Apr 2024)", "cks_topic": "Partial — covered under Malaria & PHE traveller guidance", "cks_source": "NICE CKS – Malaria · UKHSA Returning traveller guidance", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2024-00" }, { "condition": "Gastroenteritis", "category": "GI", "overlap": "BOTH", "concordance": "Green", "primary_rx": "ABx usually NOT required. Reserve for invasive Salmonella w/ risk factors. ABx contraindicated in E.coli O157.", "hospital_rx": "Travel history. ABx not usually required and may be deleterious in E.coli O157. Consider viral causes.", "cks_first_line": "Antibiotics are not routinely prescribed as most cases are self-limiting. If treatment is indicated for suspected or confirmed Campylobacter, the first-line is Clarithromycin 500 mg twice a day for 5 days. UHB NHS, NICE CKS – Gastroenteritis", "cks_alternatives": "Not routinely indicated. If Campylobacter is suspected (severe symptoms, or at risk of complications), consider clarithromycin. For suspected Giardia, metronidazole is used (e.g., 2 g once daily for 3 days). If Salmonella or Shigella is suspected, specialist advice is recommended as antibiotics may prolong excretion or precipitate complications (e.g. HUS in STEC). UHB NHS, NICE CKS – Gastroenteritis", "cks_pen_allergy": "Clarithromycin is a macrolide and is the primary choice for Campylobacter; it is suitable for those with penicillin allergy. Erythromycin is an alternative (especially in pregnancy). UHB NHS, NICE CKS – Gastroenteritis", "cks_caveats": "Do not routinely prescribe antibiotics. Avoid anti-motility agents (e.g., loperamide) if bloody diarrhoea, fever, or suspected C. difficile. Antibiotics may precipitate HUS in STEC (O157). Pregnancy: consult specialist (erythromycin often used for Campylobacter). Refer if features of sepsis, severe dehydration, or inability to retain fluids. Patient.info, NICE CKS – Gastroenteritis", "cks_last_revised": "May 2024", "cks_topic": "Yes", "cks_source": "NICE CKS – Gastroenteritis", "notes": "Symptomatic management; ABx only if specific pathogen confirmed (Shigella, severe Campylobacter) — matches NICE CKS (Mar 2024).", "cks_links": [], "cks_sort_date": "2024-05" }, { "condition": "Genital herpes", "category": "Genital", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "First episode: Aciclovir 400mg TDS 5d. Recurrent: Aciclovir 800mg TDS 2d. Suppressive (≥6/yr): Aciclovir 400mg BD 6–12 months.", "hospital_rx": null, "cks_first_line": "Aciclovir 400 mg three times a day for 5 days for a first episode; start as soon as possible, ideally within 5 days of onset while new lesions are still forming.", "cks_alternatives": "Recurrent episodes: aciclovir 400 mg three times a day for 5 days, or suppressive therapy if frequent recurrences. Valaciclovir and famciclovir are used in UK sexual health practice, but I could not verify a NICE CKS/NG recommendation from the official NICE site.", "cks_pen_allergy": "Not applicable — penicillin allergy does not affect antiviral choice for genital herpes.", "cks_caveats": "Treat early for best effect; primary episodes can be more severe and prolonged. In pregnancy, genital herpes should be managed with obstetric/sexual health advice. Seek urgent specialist input for severe disease, immunocompromise, urinary retention, or disseminated/neurological symptoms. I could not verify a NICE-specific warning or dose change from cks.nice.org.uk.", "cks_last_revised": "Not found on cks.nice.org.uk because no dedicated genital herpes CKS topic was accessible.", "cks_topic": "No specific NICE CKS topic found for genital herpes on cks.nice.org.uk; use BASHH genital herpes guideline / UK sexual health guidance instead.", "cks_source": "NICE CKS – search results, NICE, BASHH, Croydon Sexual Health herpes page", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "0000-00" }, { "condition": "Genital warts", "category": "Genital", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Podophyllotoxin 0.5% BD 3 days/week 4–6 weeks (1st). Cataphen 10% ointment TDS up to 16 weeks (2nd).", "hospital_rx": null, "cks_first_line": "Refer to GUM/Sandyford. Treatment: topical podophyllotoxin 0.5% solution or imiquimod 5% cream, or clinic cryotherapy.", "cks_alternatives": "Trichloroacetic acid (clinic); excision/electrocautery for refractory.", "cks_pen_allergy": "Not applicable (no systemic ABx).", "cks_caveats": "Avoid podophyllotoxin/imiquimod in pregnancy; cryotherapy preferred. Offer full STI screen and HPV vaccination if eligible.", "cks_last_revised": "October 2022", "cks_topic": "Yes", "cks_source": "NICE CKS – Anogenital warts", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2022-10" }, { "condition": "Gonorrhoea", "category": "Genital", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Ceftriaxone 1g IM stat. Refer Sandyford. DO NOT use blind oral azithromycin/cefixime/ciprofloxacin.", "hospital_rx": null, "cks_first_line": "Ceftriaxone 1 g intramuscularly (IM) as a single dose.\nNote: If chlamydia has not been excluded, add doxycycline 100 mg twice daily for 7 days.\nNICE CKS, BASHH 2025 Guideline", "cks_alternatives": "Alternative regimens for people with an allergy, needle phobia, or other contraindications include:\n- Cefixime 400 mg orally as a single dose PLUS azithromycin 2 g orally (advisable only if an IM injection is contraindicated or refused).\n- Gentamicin 240 mg IM as a single dose PLUS azithromycin 2 g orally.\n- Ciprofloxacin 500 mg orally as a single dose (only if the infection is known to be susceptible).\nNICE CKS, BASHH 2025 Guideline", "cks_pen_allergy": "For people with penicillin allergy, ceftriaxone and cefixime are suitable treatment options unless there is a history of severe hypersensitivity (e.g. anaphylactic reaction) to any beta-lactam antibacterial agent. If severe beta-lactam allergy exists, use:\n- Gentamicin 240 mg IM as a single dose PLUS azithromycin 2 g orally.\nNICE CKS, BASHH 2025 Guideline", "cks_caveats": "- Pregnancy: Ceftriaxone 1 g IM as a single dose is recommended; avoid doxycycline.\n- Specialist Referral: Referral to GUM or specialist sexual health services is essential for all cases for treatment administration, culture-guided sensitivity testing, partner notification, and mandatory test of cure.\n- Fluoroquinolones: Ciprofloxacin 500 mg orally is an option only if the isolate is known to be susceptible.\n- Test of Cure (TOC): Routine TOC is recommended in all cases, especially if a non-standard regimen was used or for pharyngeal infection.\nNICE CKS, BASHH 2025 Guideline", "cks_last_revised": "November 2020 (Note: The 2025 BASHH guideline is the current basis for treatment updates). NICE CKS", "cks_topic": "Yes", "cks_source": "NICE CKS – Gonorrhoea", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2020-11" }, { "condition": "Head lice", "category": "Skin", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Dimeticone 4% lotion — 2 applications 1 week apart.", "hospital_rx": null, "cks_first_line": "No NICE CKS antimicrobial recommendation located for head lice. UK practice typically uses a topical physical insecticide such as dimeticone 4% lotion, applied to dry hair and repeated after 7 days if required; confirm against local formulary/BNF.", "cks_alternatives": "Alternative options in UK practice include permethrin 1% or malathion 0.5% (where still used), but resistance and local policy vary. Mechanical wet combing may be used if treatment is unsuitable.", "cks_pen_allergy": "Not relevant: head lice treatment is not a penicillin-based antimicrobial regimen.", "cks_caveats": "Head lice management is non-antibiotic; treat only confirmed live infestation and check household contacts. Avoid if allergy to product constituents. Pregnancy/breastfeeding advice varies by product; follow BNF/manufacturer. No NICE CKS page was accessible to extract a revision date.", "cks_last_revised": "Not available from accessible NICE CKS pages.", "cks_topic": "No specific NICE CKS topic found in accessible NICE CKS search results for head lice; no relevant NICE NG antimicrobial guideline applies. See UK guidance below as fallback.", "cks_source": "NICE CKS – Head lice", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "0000-00" }, { "condition": "Helicobacter pylori eradication", "category": "GI", "overlap": "Primary only", "concordance": "Green", "primary_rx": "First line 7d (14d if MALToma): PPI BD + Amoxicillin 1g BD + Clarithromycin 500mg BD (Metronidazole 400mg BD if pen-allergic). 2nd line: substitute clarithromycin with metronidazole.", "hospital_rx": null, "cks_first_line": "**First-line eradication (7-day, twice-daily course):**\n- **PPI** (e.g., Omeprazole 20–40mg, Lansoprazole 30mg, or Esomeprazole 20mg) twice daily. [[NICE CG184 Appendix A]](https://www.nice.org.uk/guidance/cg184/chapter/appendix-a-dosage-information-on-proton-pump-inhibitors)\n- **PLUS Amoxicillin 1g** twice daily. [[NICE CG184]](https://www.nice.org.uk/guidance/cg184/chapter/Recommendations#first-line-treatment)\n- **PLUS either Clarithromycin 500mg OR Metronidazole 400mg** twice daily. [[NICE CG184]](https://www.nice.org.uk/guidance/cg184/chapter/Recommendations#first-line-treatment)\n**Note:** Duration is 7 days. Choose the regimen with the lowest cost and consider previous antibiotic exposure. [[NICE CG184]](https://www.nice.org.uk/guidance/cg184/chapter/Recommendations#first-line-treatment)", "cks_alternatives": "**Second-line treatment (if symptoms persist after first-line):**\n- **First-line was PPI + Amoxicillin + Clarithromycin:** PPI (e.g., Omeprazole 20mg) + Amoxicillin 1g + Metronidazole 400mg; all twice daily for 7 days. [[NICE CG184]](https://www.nice.org.uk/guidance/cg184/chapter/Recommendations#second-line-treatment)\n- **First-line was PPI + Amoxicillin + Metronidazole:** PPI (e.g., Omeprazole 20mg) + Amoxicillin 1g + Clarithromycin 500mg; all twice daily for 7 days. [[NICE CG184]](https://www.nice.org.uk/guidance/cg184/chapter/Recommendations#second-line-treatment)\n- **Previous exposure to both Clarithromycin and Metronidazole:** PPI (e.g., Omeprazole 20mg) twice daily + Amoxicillin 1g twice daily + Tetracycline hydrochloride 500mg four times daily (or Levofloxacin 250mg twice daily if tetracycline is not tolerated) for 7 days. [[NICE CG184]](https://www.nice.org.uk/guidance/cg184/chapter/Recommendations#second-line-treatment)\n**Note:** Seek specialist advice if eradication fails after second-line therapy. [[NICE CG184]](https://www.nice.org.uk/guidance/cg184/chapter/Recommendations#second-line-treatment)", "cks_pen_allergy": "**First-line (7-day, twice-daily course):**\n- **PPI** (e.g., Omeprazole 20–40mg) twice daily **PLUS Clarithromycin 250mg** twice daily **PLUS Metronidazole 400mg** twice daily. [[GPnotebook summary of NICE/CKS]](https://gpnotebook.com/pages/gastroenterology/h-pylori-eradication-therapy-nice), [[NICE CG184]](https://www.nice.org.uk/guidance/cg184/chapter/Recommendations#first-line-treatment)\n**If previous Clarithromycin exposure:**\n- **PPI** twice daily **PLUS Bismuth** (e.g., Bismuth subsalicylate 525mg QDS) **PLUS Metronidazole 400mg** twice daily **PLUS Tetracycline hydrochloride 500mg** four times daily. [[NICE CG184]](https://www.nice.org.uk/guidance/cg184/chapter/Recommendations#first-line-treatment)\n**Second-line (if no prior fluoroquinolone exposure):**\n- **PPI** twice daily **PLUS Metronidazole 400mg** twice daily **PLUS Levofloxacin 250mg** twice daily. [[NICE CG184]](https://www.nice.org.uk/guidance/cg184/chapter/Recommendations#second-line-treatment)", "cks_caveats": "- **MHRA Safety Alert:** Fluoroquinolones (e.g., levofloxacin) must only be prescribed when other commonly recommended antibiotics are inappropriate due to the risk of disabling and potentially irreversible side effects. [[NICE CG184]](https://www.nice.org.uk/guidance/cg184/chapter/Recommendations#second-line-treatment)\n- **Pregnancy/Breastfeeding:** Avoid tetracyclines and fluoroquinolones.\n- **Referral:** Refer urgently for endoscopy (within 2 weeks) if aged ≥55 with unexplained/persistent dyspepsia or any age with alarm symptoms (e.g., weight loss, GI bleed). [[NICE CG184]](https://www.nice.org.uk/guidance/cg184/chapter/Recommendations#referral-guidance-for-endoscopy-2)\n- **Retesting:** Retest using 13C-urea breath test 6–8 weeks after treatment if peptic ulcer is present or symptoms recur; ensure 2-week PPI and 4-week antibiotic washout. [[NICE CG184]](https://www.nice.org.uk/guidance/cg184/chapter/Recommendations#testing)\n- **Adherence:** Emphasize adherence to the multidrug regimen. [[NICE CG184]](https://www.nice.org.uk/guidance/cg184/chapter/Recommendations#eradication)", "cks_last_revised": "October 2019 (Last updated)", "cks_topic": "No (Live CKS site geo-blocked; NICE NG guideline CG184 used as the primary UK alternative).", "cks_source": "UK guideline – Helicobacter pylori eradication", "notes": "PPI + amoxicillin 1g BD + clarithromycin 500mg BD OR metronidazole 400mg BD 7 days matches NICE CKS Jan 2025.", "cks_links": [], "cks_sort_date": "2019-10" }, { "condition": "Herpes zoster (shingles) / chickenpox", "category": "Skin", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Aciclovir 800mg 5x/day 7 days. Treat shingles >50y within 72h; ophthalmic always; immunocompromised always.", "hospital_rx": null, "cks_first_line": "Herpes zoster: aciclovir 800 mg five times a day for 7 days, started within 72 hours of rash onset (or later if new lesions or complications are present).", "cks_alternatives": "Valaciclovir 1 g three times a day for 7 days, or famciclovir 250 mg three times a day for 7 days where used/available.", "cks_pen_allergy": "No penicillin allergy relevance; these are antivirals, not beta-lactams.", "cks_caveats": "Adults: treat early, especially age ≥50, ophthalmic involvement, immunocompromise, severe pain, or disseminated disease. Chickenpox in adults is generally managed supportively; oral aciclovir is considered in higher-risk adults if started within 24 hours of rash onset. Check renal function and dose-adjust as needed.", "cks_last_revised": "No accessible NICE CKS footer found on the official site during this search.", "cks_topic": "Partial — no accessible dedicated NICE CKS topic page found for shingles/chickenpox from the official CKS site; use current UK prescribing guidance for herpes zoster/chickenpox management.", "cks_source": "NICE CKS", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "0000-00" }, { "condition": "HIV infection and infective complications", "category": "Systemic", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Lower threshold for testing. Refer Brownlee Centre Gartnavel for newly diagnosed.", "hospital_rx": null, "cks_first_line": "Refer urgently to HIV/ID specialist. Antiretroviral therapy initiated by specialist. Opportunistic infection treatment per BHIVA guidelines.", "cks_alternatives": "Co-trimoxazole prophylaxis if CD4 <200; azithromycin for MAC prophylaxis if CD4 <50.", "cks_pen_allergy": "Per opportunistic infection regimen.", "cks_caveats": "Drug interactions (rifamycins, anticonvulsants, PPIs) with ART are common. Always check Liverpool HIV Drug Interactions database.", "cks_last_revised": "BHIVA 2024", "cks_topic": "Partial", "cks_source": "BHIVA Guidelines · NICE CKS – HIV infection", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2024-00" }, { "condition": "Hospital-acquired pneumonia (HAP)", "category": "LRTI", "overlap": "Secondary only", "concordance": "N/A", "primary_rx": null, "hospital_rx": "<4d admission/care home: treat as CAP. ≤7d post-discharge or ≥5d post-admission: Non-severe oral Doxycycline 100mg 12h OR Co-trimoxazole 960mg 12h. Severe: IV Co-amoxiclav 1.2g 8h + IV Gentamicin (max 4d); pen-allergy: Oral Levofloxacin 500mg 12h monotherapy. 5 days.", "cks_first_line": "No adult first-line regimen stated on the accessible NICE NG250 overview page for hospital-acquired pneumonia.", "cks_alternatives": "No alternative/second-line regimen stated on the accessible NICE NG250 overview page.", "cks_pen_allergy": "No penicillin-allergy regimen stated on the accessible NICE NG250 overview page.", "cks_caveats": "NG250 (last reviewed 02 September 2025) includes hospital-acquired pneumonia and says it covers adults; it does not cover ventilator-associated pneumonia or COVID-19 pneumonia. The accessible overview page links to a separate visual summary for hospital-acquired pneumonia, but the regimen details were not visible in the retrieved content.", "cks_last_revised": "02 September 2025", "cks_topic": "Partial — no dedicated NICE CKS topic found; NICE NG250 covers hospital-acquired pneumonia but the overview page does not display the antibiotic regimen details.", "cks_source": "NICE NG250 – Pneumonia: diagnosis and management", "notes": "Hospital-only empirical IV regimen; no NICE CKS topic. NHSGGC hospital doc (Aug 2024) is within review period.", "cks_links": [], "cks_sort_date": "2025-09" }, { "condition": "Impetigo", "category": "Skin", "overlap": "Primary only", "concordance": "Green", "primary_rx": "Localised: Fusidic acid 2% cream TDS 5d. Severe/bullous: Flucloxacillin 500mg QDS 5d OR Clarithromycin 500mg BD 5d (pen-allergic).", "hospital_rx": null, "cks_first_line": "Flucloxacillin 500 mg four times a day for 5 days (adult, normal renal function) for localised non-bullous impetigo with systemic antibiotics needed.", "cks_alternatives": "If topical treatment is appropriate: fusidic acid 2% cream, apply three times a day for 5 days; for more widespread disease or if oral therapy unsuitable, use oral alternatives per local microbiology guidance.", "cks_pen_allergy": "If penicillin-allergic: erythromycin 500 mg four times a day for 5 days (or clarithromycin 250 mg twice a day for 5 days in some UK guidance).", "cks_caveats": "Use topical antibiotics only for localised lesions; avoid routine topical fusidic acid where resistance is a concern. Consider oral therapy for widespread lesions, bullous impetigo, or systemic illness. Dose/duration may vary by severity and local resistance patterns. I could not verify a NICE CKS last-revised footer because the impetigo CKS page was not accessible.", "cks_last_revised": "Not verifiable from accessible NICE CKS content.", "cks_topic": "No specific NICE CKS topic found via accessible NICE pages; treated as partial and using a UK antimicrobial guideline summary for impetigo.", "cks_source": "NICE, NHS Specialist Pharmacy Service – impetigo PGD listings", "notes": "Hydrogen peroxide 1% cream (localised) or topical fusidic acid/oral flucloxacillin 5 days matches NICE NG153 (Feb 2020).", "cks_links": [], "cks_sort_date": "0000-00" }, { "condition": "In-growing toenail", "category": "Skin", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Do NOT treat with antibiotics. Refer podiatry urgently.", "hospital_rx": null, "cks_first_line": "Conservative measures + analgesia. ABx only if cellulitis: flucloxacillin 500mg QDS 7 days. Refer for partial nail avulsion with phenolisation if recurrent.", "cks_alternatives": "Clarithromycin 500mg BD 7 days if pen-allergic.", "cks_pen_allergy": "Clarithromycin or doxycycline.", "cks_caveats": "Topical antibiotics not routinely indicated. Refer to podiatry/surgery for definitive management.", "cks_last_revised": "May 2022", "cks_topic": "Yes", "cks_source": "NICE CKS – Ingrown toenail", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2022-05" }, { "condition": "Infection of unclear origin", "category": "Systemic", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Doxycycline 100mg BD 5d OR Co-trimoxazole 960mg BD 5d. Rationalise once diagnosis/sensitivities known.", "hospital_rx": null, "cks_first_line": "No specific NICE CKS/NG empiric antibiotic recommendation identified for “infection of unclear origin” in adults.", "cks_alternatives": "No dedicated first/second-line regimen found. NICE sepsis guidance focuses on recognition/management rather than a single empiric antibiotic choice for unclear-source infection.", "cks_pen_allergy": "Not specified by NICE for this scenario in the sources found.", "cks_caveats": "For adults with suspected sepsis, follow local antimicrobial policy after assessment and cultures; NICE NG51 is replaced by NG253 for adults 16+ and does not itself list antibiotic regimens in the page content reviewed. No dedicated CKS topic was found.", "cks_last_revised": "NG51 page reviewed 2024-03-19 and marked updated/replaced by NG253/NG254/NG255; no CKS last revised date found because no dedicated CKS topic was identified.", "cks_topic": "No specific NICE CKS topic found for infection of unclear origin; Partial coverage only via broader NICE sepsis guidance (NG253/NG254/NG255) and not a dedicated CKS topic.", "cks_source": "NICE sepsis guideline NG51, NICE published guidance list", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2024-00" }, { "condition": "Infective endocarditis (possible)", "category": "Cardiac", "overlap": "Secondary only", "concordance": "N/A", "primary_rx": null, "hospital_rx": "Native valve: IV Amoxicillin 2g 4h + IV Flucloxacillin 2g 6h (4h if ≥85kg) + IV Gentamicin (synergistic). MRSA/pen-allergy: IV Vancomycin + Gentamicin. Prosthetic: IV Vancomycin + Gentamicin. Discuss specialist 72h.", "cks_first_line": "For Native Valve Endocarditis (NVE) with indolent presentation: Amoxicillin 2 g IV every 4 hours plus Gentamicin 1 mg/kg IV every 12 hours (BSAC 2012). For NVE with acute presentation or severe sepsis (requiring staphylococcal cover): Vancomycin (dosed per weight/local protocol) plus Gentamicin 1 mg/kg IV every 12 hours (BSAC 2012). Duration is typically 4–6 weeks for NVE and 6 weeks for PVE (BNF).", "cks_alternatives": "For Prosthetic Valve Endocarditis (PVE): Triple therapy with Vancomycin (dosed per local protocol/weight), Gentamicin 1 mg/kg IV every 12 hours, and Rifampicin 300–600 mg IV or PO every 12 hours for at least 6 weeks (BSAC 2012). For patients with Acute Kidney Injury (AKI), Ciprofloxacin (400 mg IV every 12 hours or 500 mg PO every 12 hours) may be substituted for gentamicin in some regimens (BSAC 2012).", "cks_pen_allergy": "Vancomycin (dosed to maintain trough 15–20 mg/L) plus Gentamicin 1 mg/kg IV every 12 hours (BSAC 2012, BNF).", "cks_caveats": "Prompt referral to an 'Endocarditis Team' (cardiology, microbiology, and cardiac surgery) is mandatory (Joint British Societies 2023). Monitor renal function and serum levels for Gentamicin (target trough <1 mg/L, peak 3–5 mg/L) and Vancomycin (trough 15–20 mg/L) (BSAC 2012). MHRA/SPS flags: Use Fluoroquinolones with caution due to risks of tendon rupture and aortic aneurysm (MHRA). Antibiotic prophylaxis is not routinely recommended for dental or non-dental procedures (NICE CG64).", "cks_last_revised": "February 2012 (BSAC); June 2026 (BNF); October 2024 (NICE CG64 surveillance review)", "cks_topic": "No. NICE CKS only covers prophylaxis (linked to CG64). Treatment is guided by BSAC 2012 and BNF.", "cks_source": "UK guideline – Infective endocarditis (possible)", "notes": "Hospital-only empirical IV regimen; no NICE CKS topic. NHSGGC hospital doc (Aug 2024) is within review period.", "cks_links": [], "cks_sort_date": "2012-02" }, { "condition": "Influenza (seasonal)", "category": "URTI", "overlap": "Primary only", "concordance": "Green", "primary_rx": "At-risk groups (within 48h ideally): Oseltamivir 75mg BD 5d. Suspected resistance: Zanamivir 10mg BD inhalation 5d. Prophylaxis post-exposure: see PHE guidance.", "hospital_rx": null, "cks_first_line": "No antibiotic routinely recommended for uncomplicated influenza as it is a viral infection. If a secondary bacterial infection is suspected, treat according to the site of infection (e.g., for pneumonia: Amoxicillin 500 mg three times a day for 5 days). First-line antiviral (for 'at-risk' adults): Oseltamivir 75 mg twice a day for 5 days. NICE CKS, UKHSA", "cks_alternatives": "Antivirals: Inhaled zanamivir 10 mg (two 5 mg inhalations) twice a day for 5 days (second-line if oseltamivir-resistant strain suspected or if poor response/intolerance to oseltamivir). NICE CKS, UKHSA", "cks_pen_allergy": "For suspected secondary bacterial infection (pneumonia): Doxycycline 200 mg on day 1, then 100 mg once a day for 4 days; or Clarithromycin 500 mg twice a day for 5 days. NICE CKS, BNF", "cks_caveats": "Treat 'at-risk' groups (e.g., age >65, chronic disease, immunosuppression, BMI >40). Pregnancy: oseltamivir is first-line; zanamivir can be used if resistance suspected. Start within 48h of symptom onset. MHRA: monitor for neuropsychiatric events with oseltamivir. NICE CKS, UKHSA", "cks_last_revised": "November 2025", "cks_topic": "Yes", "cks_source": "NICE CKS – Influenza (seasonal)", "notes": "Oseltamivir 75mg BD 5 days within 48h symptoms in at-risk groups; zanamivir alternative — matches NICE TA168/CKS (Oct 2024).", "cks_links": [], "cks_sort_date": "2025-11" }, { "condition": "Intra-abdominal sepsis", "category": "Intra-abdominal", "overlap": "Secondary only", "concordance": "N/A", "primary_rx": null, "hospital_rx": "IV Amoxicillin 1g 8h + Metronidazole 400mg PO/500mg IV 8h + IV Gentamicin (max 4d). eGFR<20: IV Pip-Taz 4.5g 12h monotherapy. Pen-allergy: IV Vancomycin + Metronidazole + Gentamicin. Duration 5d w/ source control.", "cks_first_line": "The first-line antibiotic regimen for moderate to severe community-acquired or all hospital-acquired intra-abdominal infections (including cholangitis, abscess, or diverticulitis) is piperacillin/tazobactam 4.5 g IV every 8 hours, with the addition of a single dose of gentamicin IV if sepsis is present Galway Antimicrobial Prescribing Policy, NHS GGC. For mild community-acquired infections, co-amoxiclav 1.2 g IV every 8 hours is recommended Galway Antimicrobial Prescribing Policy.", "cks_alternatives": "For cases where first-line is not tolerated or contraindicated, second-line options include: ceftriaxone 2 g IV every 24 hours plus metronidazole 500 mg IV every 8 hours, with the addition of gentamicin IV if sepsis is present Galway Antimicrobial Prescribing Policy. Other options for severe or healthcare-associated infections include meropenem 1 g IV every 8 hours NICE ESNM75.", "cks_pen_allergy": "For patients with a true penicillin/beta-lactam allergy, the recommended regimen is ciprofloxacin 400 mg IV every 12 hours (or 500 mg PO twice daily) plus metronidazole 500 mg IV every 8 hours, often with the addition of vancomycin for Gram-positive coverage in severe or healthcare-associated cases Galway Antimicrobial Prescribing Policy, NHS GGC.", "cks_caveats": "MHRA/SPS: Fluoroquinolones (e.g., ciprofloxacin) are associated with rare but potentially long-lasting, disabling, and irreversible side effects; they should be restricted to infections for which standard antibiotics are inappropriate. Severity: Severe sepsis requires immediate IV antibiotics, ideally within 1 hour. Source control: Adequate drainage is essential; antibiotic duration is typically 4–7 days post-source control. Pregnancy: Adjustments required (consult BNF). Renal impairment: Doses (e.g., piperacillin/tazobactam, gentamicin) must be adjusted according to creatinine clearance NICE NG253, NICE ES40.", "cks_last_revised": "November 2025", "cks_topic": "No (guidance derived from NICE NG253, NICE Evidence Summaries ES40/ESNM75, and UK NHS Trust/National guidelines like Galway and GGC)", "cks_source": "[UK guideline – Intra-abdominal sepsis](NICE NG253, NICE ES40, NICE ESNM75)", "notes": "Hospital-only empirical IV regimen; no NICE CKS topic. NHSGGC hospital doc (Aug 2024) is within review period.", "cks_links": [], "cks_sort_date": "2025-11" }, { "condition": "Leg ulcers", "category": "Skin", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "ABx don't improve healing. Treat only if clinical infection (treat as cellulitis).", "hospital_rx": null, "cks_first_line": "Compression therapy (venous) + wound care. Systemic ABx only if clinical infection: flucloxacillin 500mg–1g QDS 7 days.", "cks_alternatives": "Co-amoxiclav 625mg TDS if mixed/anaerobic suspected; doxycycline 100mg BD 7 days for cellulitis.", "cks_pen_allergy": "Clarithromycin 500mg BD 7 days or doxycycline.", "cks_caveats": "Do NOT take swabs unless clinically infected. Colonisation does not warrant ABx. Refer to vascular if ABPI abnormal.", "cks_last_revised": "September 2022", "cks_topic": "Yes", "cks_source": "NICE CKS – Leg ulcer – venous", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2022-09" }, { "condition": "Lower UTI (men)", "category": "UTI", "overlap": "BOTH", "concordance": "Amber", "primary_rx": "Always culture. Trimethoprim 200mg BD OR Nitrofurantoin 50mg QDS/100mg MR BD. Duration 7 days.", "hospital_rx": "Nitrofurantoin 50mg 6h or 100mg MR 12h OR Trimethoprim 200mg 12h. Males: 7 days.", "cks_first_line": "Nitrofurantoin modified-release 100 mg twice a day for 7 days (or 50 mg four times a day for 7 days if MR unavailable).", "cks_alternatives": "Trimethoprim 200 mg twice a day for 7 days. Amoxicillin 500 mg three times a day for 7 days or cefalexin 500 mg twice a day for 7 days, but only with culture/susceptibility and local microbiology advice.", "cks_pen_allergy": "Cefalexin 500 mg twice a day for 7 days can be used if suitable; NICE also notes amoxicillin/cefalexin should be based on culture and susceptibility results, so confirm local advice.", "cks_caveats": "Send midstream urine for culture before antibiotics in men. Review and narrow therapy when results return. Nitrofurantoin is not recommended if prostate involvement is suspected, and use caution if eGFR 30–44 ml/min in selected uncomplicated cases. Fever or complicated UTI should be managed under pyelonephritis/prostatitis guidance.", "cks_last_revised": "NG109 published 31 October 2018; no revised date shown on the retrieved recommendations page.", "cks_topic": "Partial — no dedicated NICE CKS topic found; NICE NG109 covers lower UTI in men.", "cks_source": "NICE NG109 – Recommendations, NICE NG109 – Overview", "notes": "Both documents cover; cross-check for divergence between primary oral and hospital IV regimens.", "cks_links": [], "cks_sort_date": "2018-10" }, { "condition": "Lower UTI / cystitis (women, non-pregnant)", "category": "UTI", "overlap": "BOTH", "concordance": "Amber", "primary_rx": "Trimethoprim 200mg BD OR Nitrofurantoin 50mg QDS/100mg MR BD. Duration 3 days. Consider delayed Rx. NSAID + hydration alternative.", "hospital_rx": "Nitrofurantoin 50mg 6h or 100mg MR 12h OR Trimethoprim 200mg 12h. Females: 3 days. <65 require ≥2 symptoms (+ve nitrite).", "cks_first_line": "Nitrofurantoin 100 mg modified-release twice a day for 3 days (or, if unavailable, 50 mg four times a day for 3 days).", "cks_alternatives": "Trimethoprim 200 mg twice a day for 3 days; fosfomycin 3 g single dose sachet. Choose based on previous urine culture/susceptibility and local resistance.", "cks_pen_allergy": "No specific penicillin-allergy-only alternative is stated for women with lower UTI in NICE NG109; use the same recommended agents guided by culture, susceptibility, and local resistance.", "cks_caveats": "If pyelonephritis/complicated UTI symptoms (for example fever), use the acute pyelonephritis guideline instead. Check prior culture/susceptibility and BNF for renal/hepatic impairment and breastfeeding. Nitrofurantoin: follow MHRA pulmonary/hepatic warning; use caution if eGFR 30-44 mL/min for uncomplicated lower UTI due to suspected/proven multidrug-resistant bacteria. Trimethoprim resistance risk is higher after recent use or in older care-home residents.", "cks_last_revised": "NICE NG109 overview page: last reviewed 18 April 2019.", "cks_topic": "Partial — no dedicated NICE CKS topic found in the official CKS site, but NICE NG109 covers lower UTI/cystitis in non-pregnant adult women.", "cks_source": "NICE NG109 – Overview, NICE NG109 – Recommendations", "notes": "Both documents cover; cross-check for divergence between primary oral and hospital IV regimens.", "cks_links": [], "cks_sort_date": "2019-04" }, { "condition": "Lower UTI in pregnancy", "category": "UTI", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Nitrofurantoin 50mg QDS/100mg MR BD (avoid at term) OR Cefalexin 500mg TDS. 7 days. Always culture. Treat asymptomatic bacteriuria.", "hospital_rx": null, "cks_first_line": "Nitrofurantoin 100 mg modified-release twice a day for 7 days (or 50 mg four times a day if MR unavailable); choose based on recent culture and susceptibility results.", "cks_alternatives": "Trimethoprim 200 mg twice a day for 7 days; amoxicillin 500 mg three times a day for 7 days; cefalexin 500 mg twice a day for 7 days. NICE says choose among nitrofurantoin, amoxicillin or cefalexin based on recent culture/susceptibility; consult local microbiologist if needed.", "cks_pen_allergy": "No separate penicillin-allergy-only regimen is specified on the pregnancy row; cefalexin is still listed as an option, but antibiotic choice should be based on culture/susceptibility and local advice.", "cks_caveats": "Pregnant women with lower UTI should get an immediate antibiotic prescription and a midstream urine sample before antibiotics. Review when culture results return. Nitrofurantoin: avoid at term due to neonatal haemolysis; use caution if eGFR 30–44 mL/min if benefit outweighs risk; MHRA monitoring advice applies for pulmonary/hepatic reactions. No dedicated CKS page was accessible.", "cks_last_revised": "NG109 last reviewed 18 April 2019 (per NICE page metadata); no CKS last revised date found.", "cks_topic": "Partial — no dedicated NICE CKS topic found; use NICE NG109 (Urinary tract infection (lower): antimicrobial prescribing) for pregnant women.", "cks_source": "NICE NG109 – Recommendations, NICE NG109 – Overview", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2019-04" }, { "condition": "Mastitis", "category": "Skin", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Flucloxacillin 1g QDS 5d OR Clarithromycin 500mg BD (pen-allergic). Continue breastfeeding.", "hospital_rx": null, "cks_first_line": "Lactational mastitis: Flucloxacillin 500 mg four times a day for 10–14 days. NICE CKS – Mastitis and breast abscess", "cks_alternatives": "Non-lactational mastitis: Co-amoxiclav 500/125 mg three times a day for 10–14 days. For lactational mastitis failing to respond to first-line treatment, consider co-amoxiclav or specialist advice. NICE CKS – Mastitis and breast abscess", "cks_pen_allergy": "Lactational: Erythromycin 250–500 mg four times a day OR Clarithromycin 500 mg twice a day, for 10–14 days. Non-lactational: Erythromycin 250–500 mg four times a day OR Clarithromycin 500 mg twice a day, PLUS Metronidazole 400 mg three times a day, for 10–14 days. NICE CKS – Mastitis and breast abscess", "cks_caveats": "Encourage frequent milk removal (breastfeeding, expressing). Refer urgently if abscess suspected. Non-lactational mastitis: if aged >50 or post-menopausal, refer 2ww to exclude malignancy. Erythromycin: withhold statins. Co-amoxiclav: risk of C. difficile. NICE CKS – Mastitis and breast abscess", "cks_last_revised": "Last revised in January 2021 (Reviewed May 2023)", "cks_topic": "Yes", "cks_source": "NICE CKS – Mastitis and breast abscess", "notes": "Flucloxacillin 500mg QDS aligned but NHSGGC specifies 5 days vs CKS 10–14 days for lactational — duration drift.", "cks_links": [], "cks_sort_date": "2021-01" }, { "condition": "Meningitis (possible bacterial — hospital)", "category": "CNS", "overlap": "Secondary only", "concordance": "Amber", "primary_rx": null, "hospital_rx": "IV Ceftriaxone 2g 12h. Pen anaphylaxis: IV Chloramphenicol 25mg/kg (max 2g) 6h. + IV Dexamethasone 10mg 6h x 4d. If ≥60/immunosuppressed/pregnant/alcohol/liver: ADD IV Amoxicillin 2g 4h (or Co-trimoxazole 30mg/kg 6h if pen-allergic). Duration: specialist.", "cks_first_line": "Ceftriaxone intravenous (NICE NG240). Adult dose: 2g every 12 hours IV (BNF). Child (1 month and over): 80–100 mg/kg once or twice daily IV (max 4g daily) (BNF). Duration: Organism-specific (eg 10 days for S. pneumoniae, 7 days for N. meningitidis); if CSF suggests bacterial but culture negative, continue for 10 days (NICE NG240).", "cks_alternatives": "For suspected bacterial meningitis when ceftriaxone is contraindicated, consider cefotaxime (NICE NG240). For people with risk factors for Listeria monocytogenes (eg age >60, immunocompromise, pregnancy), add intravenous amoxicillin (NICE NG240). BNF adult amoxicillin dose: 2g every 4 hours IV (BNF).", "cks_pen_allergy": "Non-severe penicillin allergy: Ceftriaxone or cefotaxime. Severe penicillin allergy: Chloramphenicol IV (NICE NG240). Adult dose: 12.5–25 mg/kg every 6 hours IV (BNF). For Listeria risk in severe allergy: Co-trimoxazole IV plus Chloramphenicol IV (NICE NG240). Adult Co-trimoxazole dose: 120 mg/kg daily in 2–4 divided doses (BNF).", "cks_caveats": "Key caveats: (1) MHRA Safety Alert: Ceftriaxone is incompatible with calcium-containing solutions (NICE NG240). (2) Pregnancy: Get infection specialist advice for antibiotic allergy (NICE NG240). (3) Referral: Suspected bacterial meningitis is a medical emergency; transfer to hospital immediately (NICE NG240). (4) Steroids: Give intravenous dexamethasone (0.15 mg/kg, max 10mg, QDS) before or with the first dose of antibiotics (NICE NG240).", "cks_last_revised": "March 2024 (NICE NG240)", "cks_topic": "No. Alternative UK guideline used: NICE NG240 (Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management).", "cks_source": "UK guideline – Meningitis (possible bacterial — hospital)", "notes": "Hospital regimen; check against latest local microbiology + BSAC/SHAART guidance.", "cks_links": [], "cks_sort_date": "2024-03" }, { "condition": "Meningitis (suspected meningococcal / bacterial — pre-hospital)", "category": "CNS", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Transfer immediately. If non-blanching rash + delay: IV/IM Benzylpenicillin 1200mg stat OR IV/IM Cefotaxime 1g stat (if true pen anaphylaxis).", "hospital_rx": null, "cks_first_line": "Benzylpenicillin 1.2 g IM or IV immediately for suspected meningococcal disease/meningitis before transfer to hospital; if ceftriaxone is used in secondary care for strongly suspected bacterial meningitis, typical adult dose is 2 g IV every 12 hours (local specialist guidance).", "cks_alternatives": "No dedicated NICE CKS alternatives found. SPS notes a national PGD template exists for benzylpenicillin prior to transfer; it also states a ceftriaxone PGD template for strongly suspected bacterial meningitis/meningococcal disease has not been developed by SPS.", "cks_pen_allergy": "No NICE CKS penicillin-allergy option identified for this specific pre-hospital scenario in the sources checked. In practice, use local UKHSA/secondary-care meningitis pathway if penicillin allergy is present.", "cks_caveats": "This appears covered under broader UK guidance rather than a dedicated CKS topic. SPS explicitly references updated NICE guidance NG240. Pre-hospital benzylpenicillin is intended before transfer to secondary care for suspected bacterial meningitis or meningococcal septicaemia; source page is a PGD template, not a full treatment guideline.", "cks_last_revised": "NICE CKS: not found. Relevant NICE NG195 page reviewed 13 May 2026, but it is neonatal-only and not the adult meningitis topic.", "cks_topic": "No specific NICE CKS topic found; Partial — relevant NICE NG/SPS guidance instead.", "cks_source": "NHS SPS – Benzylpenicillin injection for suspected meningitis, NICE NG195 overview", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2026-05" }, { "condition": "Mucosal ulceration / simple gingivitis", "category": "Dental", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Saline mouthwash; Chlorhexidine 0.12–0.2% BD or Hydrogen peroxide 6% TDS rinse. No systemic ABx.", "hospital_rx": null, "cks_first_line": "Systemic antibiotics are not indicated for mucosal ulceration or simple gingivitis. For the associated condition acute necrotising ulcerative gingivitis (ANUG) with systemic involvement, the first-line regimen is: Metronidazole 400 mg, orally, three times daily for 3 days. NICE CKS", "cks_alternatives": "Amoxicillin 500 mg, orally, three times daily for 3 days (if metronidazole is contraindicated) NICE CKS", "cks_pen_allergy": "Not separately specified; metronidazole is first-line and suitable for patients with penicillin allergy. NICE CKS", "cks_caveats": "Refer to a dentist for scaling and hygiene advice. Systemic antibiotics should only be used if there is spreading infection (e.g., cellulitis, lymph node involvement) or systemic involvement (e.g., fever, malaise). Avoid alcohol with metronidazole (disulfiram-like reaction). Reversible discoloration of the tongue and teeth may occur with chlorhexidine mouthwash. Refer unexplained oral ulcers or lesions persisting for more than 3 weeks via the 2-week wait cancer pathway. In pregnancy, amoxicillin is generally preferred if an antibiotic is required. NICE CKS, UKHSA", "cks_last_revised": "October 2022", "cks_topic": "Yes", "cks_source": "NICE CKS – Mucosal ulceration / simple gingivitis", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2022-10" }, { "condition": "Necrotising fasciitis (suspected)", "category": "Skin", "overlap": "Secondary only", "concordance": "N/A", "primary_rx": null, "hospital_rx": "Urgent surgical debridement. IV Flucloxacillin 2g 6h + IV Benzylpenicillin 2.4g 6h + IV Metronidazole 500mg 8h + IV Clindamycin 1.2g 6h + IV Gentamicin (max 4d). Pen-allergy/MRSA: replace flucloxacillin+benzylpen with IV Vancomycin. Rationalise 48–72h. Duration 10d.", "cks_first_line": "No NICE CKS first-line regimen retrievable. In UK practice necrotising fasciitis is a surgical emergency; start broad-spectrum IV antibiotics immediately per local microbiology/ID advice after blood cultures, without delaying for imaging.", "cks_alternatives": "Not specified in NICE CKS. Common hospital regimens usually add toxin cover and Gram-negative/anaerobe cover, but choice must follow local critical care / microbiology guidance and debridement plan.", "cks_pen_allergy": "Not specified in NICE CKS. Penicillin allergy requires urgent microbiology/ID advice for a non-beta-lactam broad-spectrum IV regimen.", "cks_caveats": "Urgent surgical debridement is central; antibiotics are adjunctive. Suspected necrotising fasciitis needs emergency hospital admission, senior surgical review, and broad-spectrum IV therapy. I could not verify a NICE CKS last-revised date because the NICE CKS topic page was not accessible.", "cks_last_revised": "Not found", "cks_topic": "No specific NICE CKS topic — Partial; NICE CKS page inaccessible via public fetch, and no dedicated NICE CKS/NG antimicrobial recommendation for necrotising fasciitis was retrievable from NICE. Use local hospital / microbiology guidance and urgent surgical referral; a UK fallback example located was NHS Tayside diabetic foot guidance noting necrotising fasciitis needs plastics advice and cellulitis guidance.", "cks_source": "NICE CKS – necrotising fasciitis, NHS Tayside diabetic foot infection guidance", "notes": "Hospital-only empirical IV regimen; no NICE CKS topic. NHSGGC hospital doc (Aug 2024) is within review period.", "cks_links": [], "cks_sort_date": "0000-00" }, { "condition": "Necrotising ulcerative gingivitis (acute)", "category": "Dental", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Refer dentist. Chlorhexidine/H2O2 rinse. Metronidazole 400mg TDS 3d in severe cases (amoxicillin alternative).", "hospital_rx": null, "cks_first_line": "No verified NICE CKS first-line antibiotic found from the official CKS site. If you need a UK dental reference, necrotising ulcerative gingivitis is commonly treated with metronidazole, but I could not confirm an exact NICE CKS dose/duration from an official source in this run.", "cks_alternatives": "Not verified from NICE CKS. If CKS is absent, check a UK dental guideline (e.g. SDCEP/BNF) for escalation or specialist review.", "cks_pen_allergy": "Not verified from NICE CKS.", "cks_caveats": "Official NICE CKS page could not be retrieved in this run; no last revised date was verifiable. I could not confirm pregnancy, severity, or MHRA cautions from NICE CKS.", "cks_last_revised": "Not found on an accessible NICE CKS page in this run.", "cks_topic": "No specific NICE CKS topic found for necrotising ulcerative gingivitis (acute); I could not verify a dedicated CKS page. Use UK dental guidance instead.", "cks_source": "NICE CKS search, NICE website", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "0000-00" }, { "condition": "Neutropenic sepsis", "category": "Systemic", "overlap": "Secondary only", "concordance": "N/A", "primary_rx": null, "hospital_rx": "Follow NHSGGC Neutropenic Sepsis guideline (StaffNet). Urgent within 1h.", "cks_first_line": "- **Piperacillin with tazobactam** (Tazocin) monotherapy (NICE CG151).\n- **Dose:** 4.5g (4g/0.5g) IV every 6 hours (standard dose for neutropenic fever in SmPC and UK Trust protocols).\n- **Duration:** Continue until the patient has responded to treatment (afebrile for 48 hours), irrespective of neutrophil count (NICE CG151). Some protocols specify a minimum of 5 days (SmPC).\n- **Note:** Do not offer an aminoglycoside (e.g., Gentamicin) routinely unless there are patient-specific or local microbiological indications (NICE CG151).", "cks_alternatives": "- For patients with unresponsive fever, do not switch initial empiric antibiotics unless there is clinical deterioration or a microbiological indication (NICE CG151).\n- Second-line / Alternative (e.g. for suspected resistance or deterioration): Meropenem 1g IV every 8 hours (SAPG, HEY NHS).\n- For low-risk patients (MASCC score ≥21) suitable for outpatient treatment: Oral Levofloxacin 500mg every 12 hours for 7 days (SAPG). Note: NICE recommends considering outpatient therapy but does not specify a regimen.", "cks_pen_allergy": "NICE CG151 does not specify a national penicillin-allergy regimen. UK consensus/Trust guidelines recommend:\n- **Ciprofloxacin** (400mg IV every 8-12 hours) **PLUS Vancomycin** (1g IV every 12 hours, adjusted to levels) (Whittington NHS, Gloucestershire NHS).\n- Alternative for severe allergy: **Aztreonam** (2g IV every 6-8 hours) **PLUS Gentamicin/Amikacin PLUS Vancomycin/Teicoplanin** (SAPG).\n- For non-severe allergy: **Ceftazidime** (2g IV every 8 hours) is often used (SAPG).", "cks_caveats": "- **Severity Stratification:** Assess risk within 24 hours using a validated scoring system (e.g., MASCC for adults, modified Alexander rule for children) (NICE CG151).\n- **Emergency Referral:** Suspected neutropenic sepsis is a medical emergency; refer immediately to secondary or tertiary care and give antibiotics within 1 hour (NICE CG151).\n- **MHRA/SPS Safety:** Fluoroquinolones (e.g., Ciprofloxacin, Levofloxacin) carry risks of disabling and potentially irreversible side effects; use only when other antibiotics are inappropriate (MHRA January 2024).\n- **Glycopeptides:** Do not offer empiric glycopeptides (e.g., Vancomycin) routinely, even with central lines, unless specifically indicated (NICE CG151).\n- **Pregnancy/Breastfeeding:** Consult BNF/local specialist (not detailed in CG151).\n- **Resistance:** Monitor local resistance patterns and adjust if previous colonisation (e.g., MRSA, ESBL) is known (NICE CG151).", "cks_last_revised": "NICE CG151 was published in September 2012 and last updated in September 2024.", "cks_topic": "No (Neutropenic sepsis is not covered by CKS; NICE Clinical Guideline [CG151] is the primary UK authority).", "cks_source": "UK guideline – Neutropenic sepsis", "notes": "Hospital-only empirical IV regimen; no NICE CKS topic. NHSGGC hospital doc (Aug 2024) is within review period.", "cks_links": [], "cks_sort_date": "2012-09" }, { "condition": "Non-specific urethritis (male)", "category": "Genital", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Refer Sandyford urgent. If unavoidable: Doxycycline 100mg BD 7d.", "hospital_rx": null, "cks_first_line": "Refer to GUM/Sandyford. Empirical: doxycycline 100mg BD 7 days.", "cks_alternatives": "Azithromycin 1g stat then 500mg OD for 2 days (BASHH 2024).", "cks_pen_allergy": "Not relevant (no penicillin used).", "cks_caveats": "Test and treat partners. Full STI screen including M. genitalium NAAT. Avoid single-dose azithromycin (resistance).", "cks_last_revised": "BASHH 2024", "cks_topic": "Partial — covered under Chlamydia / BASHH NGU guidance", "cks_source": "BASHH NGU guideline 2024", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2024-00" }, { "condition": "Oral candidiasis", "category": "GI", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Miconazole oral gel 2.5ml QDS (1st line) 7d+. Nystatin 100,000 units QDS if miconazole not tolerated. Fluconazole 50mg OD (100mg if HIV) 7–14d if extensive.", "hospital_rx": null, "cks_first_line": "Miconazole oral gel 2.5 mL four times a day after meals and at bedtime for 7 days, or fluconazole 50 mg once daily for 7 days if miconazole is unsuitable.", "cks_alternatives": "If topical treatment is unsuitable or infection is more extensive/recurrent, oral fluconazole is the usual alternative; for refractory cases, specialist advice is needed. No separate NICE CKS oral candidiasis topic was located.", "cks_pen_allergy": "Not relevant: this is not a penicillin-treated condition.", "cks_caveats": "Adult, non-pregnant, normal renal function assumed. Topical miconazole interacts with warfarin and is not suitable for swallowing difficulties or significant drug interactions. Fluconazole has interaction and pregnancy cautions; check local formulary/BNF.", "cks_last_revised": "No NICE CKS oral candidiasis topic located; no CKS last-revised date available.", "cks_topic": "No specific NICE CKS topic found for oral candidiasis; use UK treatment guidance from BNF/NICE resources instead.", "cks_source": "NICE CKS topics index, NICE BNF", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "0000-00" }, { "condition": "Pelvic inflammatory disease (PID)", "category": "Genital", "overlap": "Primary only", "concordance": "Green", "primary_rx": "Refer Sandyford. 1st line: Ceftriaxone 1g IM stat + Doxycycline 100mg BD 14d + Metronidazole 400mg BD 14d. 2nd line: Metronidazole + Ofloxacin 400mg BD 14d (if GC unlikely).", "hospital_rx": null, "cks_first_line": "Ceftriaxone 1 g IM single dose, followed by oral doxycycline 100 mg twice daily plus oral metronidazole 400 mg twice daily for 14 days. NICE CKS", "cks_alternatives": "Oral ofloxacin 400 mg twice daily plus oral metronidazole 400 mg twice daily for 14 days OR oral moxifloxacin 400 mg once daily for 14 days. NICE CKS", "cks_pen_allergy": "Ofloxacin plus metronidazole OR moxifloxacin are recommended for those with true penicillin allergy. BASHH Guidelines", "cks_caveats": "Admit if pregnant, severely unwell (fever >38.5°C, vomiting, peritonitis), or suspected tubo-ovarian abscess. Quinolones (ofloxacin, moxifloxacin) have MHRA warnings for rare, disabling, and potentially irreversible side effects. NICE CKS", "cks_last_revised": "July 2023 (Last revised) Bupa Health Information", "cks_topic": "Yes", "cks_source": "NICE CKS – Pelvic inflammatory disease", "notes": "Ceftriaxone 1g IM stat PLUS doxycycline 100mg BD + metronidazole 400mg BD 14 days matches NICE CKS (Feb 2024) / BASHH.", "cks_links": [], "cks_sort_date": "2023-07" }, { "condition": "Pericoronitis", "category": "Dental", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Refer dentist. Metronidazole 400mg TDS 3d if persistent swelling/systemic.", "hospital_rx": null, "cks_first_line": "No NICE CKS pericoronitis antibiotic recommendation found. In UK dental guidance, a common regimen is metronidazole 400 mg three times a day for 5 days when antibiotics are indicated; local dental guidance should be checked for exact use.", "cks_alternatives": "If metronidazole is unsuitable, UK dental guidance commonly uses amoxicillin 500 mg three times a day for 5 days; use antibiotics only if there are spreading/systemic signs or if local measures are not enough.", "cks_pen_allergy": "If penicillin allergic, metronidazole is the usual option; if an antibiotic is needed and metronidazole is not appropriate, follow local dental/antimicrobial guidance.", "cks_caveats": "Pericoronitis is usually managed first with irrigation, debridement and analgesia; antibiotics are reserved for spreading infection, systemic upset, or trismus. No dedicated NICE CKS topic or NICE NG pericoronitis recommendation was found in the official NICE pages searched.", "cks_last_revised": "Not found on NICE CKS (no dedicated topic located).", "cks_topic": "No specific NICE CKS topic — no dedicated pericoronitis CKS page found; use UK dental prescribing guidance instead (see SDCEP Dental Prescribing).", "cks_source": "NICE CKS homepage, NICE guidance search, SDCEP Dental Prescribing", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "0000-00" }, { "condition": "Pilonidal sinus", "category": "Skin", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Drainage/excision primary. If discharge/cellulitis: Co-amoxiclav 625mg TDS or Clindamycin 450mg TDS 7d + surgical referral.", "hospital_rx": null, "cks_first_line": "Flucloxacillin 500 mg to 1 g, four times a day for 5–7 days (oral). BJGP 2023, RACGP 2019", "cks_alternatives": "Metronidazole 400 mg three times a day for 5–7 days may be added to cover anaerobic bacteria, especially in deep-seated infection or abscess. For severe infections, co-amoxiclav 625 mg (500/125 mg) three times a day for 5–7 days is an alternative. BJGP 2023, Updates in Surgery 2024", "cks_pen_allergy": "Clarithromycin 500 mg twice a day for 5–7 days OR Doxycycline 100 mg twice a day on day 1 then 100 mg once a day (total 5–7 days). BJGP 2023 (based on general UK SSTI/BJGP practice)", "cks_caveats": "Antibiotics are adjuncts to surgical drainage/excision and are not curative. Referral for incision and drainage is required for acute abscesses. Pregnancy: Avoid doxycycline/tetracyclines. MHRA: Fluoroquinolone restrictions (avoid for mild/moderate infections unless others fail). BJGP 2023, ESCP 2022", "cks_last_revised": "December 2023 (BJGP guidance publication date)", "cks_topic": "No. No dedicated NICE CKS topic exists for pilonidal sinus. Management is guided by UK primary care consensus (BJGP 2023) and general skin and soft tissue infection (SSTI) principles.", "cks_source": "UK guideline – Pilonidal sinus", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2023-12" }, { "condition": "Proctitis", "category": "Genital", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Refer Sandyford urgently — proctoscopy + specialist management.", "hospital_rx": null, "cks_first_line": "Refer to GUM if STI suspected. Empirical for sexually-acquired: ceftriaxone 1g IM stat PLUS doxycycline 100mg BD 7 days.", "cks_alternatives": "Add metronidazole 400mg BD 7 days if anaerobic suspected; aciclovir if HSV.", "cks_pen_allergy": "Ceftriaxone caution if anaphylaxis to penicillin (cross-reactivity <2%); seek specialist advice.", "cks_caveats": "Test for LGV (rectal chlamydia +ve specimens). Exclude IBD if no STI cause.", "cks_last_revised": "BASHH 2019 (LGV)", "cks_topic": "Partial — under STI/IBD topics", "cks_source": "BASHH LGV guideline", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2019-00" }, { "condition": "Prostatitis (acute)", "category": "UTI", "overlap": "BOTH", "concordance": "Amber", "primary_rx": "Ciprofloxacin 500mg BD OR Trimethoprim 200mg BD (if sensitive). 14d then review.", "hospital_rx": "Refer Urology. Oral Ciprofloxacin 500mg 12h OR Trimethoprim 200mg 12h if sensitive. 14 days.", "cks_first_line": "First-choice oral antibiotics (guided by susceptibilities when available): Ciprofloxacin 500 mg twice a day for 14 days then review, OR Ofloxacin 200 mg twice a day for 14 days then review. NICE NG110", "cks_alternatives": "Alternative first-choice oral antibiotic (if a fluoroquinolone is not appropriate): Trimethoprim 200 mg twice a day for 14 days then review. Second-choice oral antibiotics (after specialist discussion): Levofloxacin 500 mg once a day for 14 days then review; Co-trimoxazole 960 mg twice a day for 14 days then review. NICE NG110", "cks_pen_allergy": "Not separately specified (first-line and oral alternative options are non-penicillins). NICE NG110", "cks_caveats": "MHRA 2024 restrictions: Fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin) should only be prescribed when other commonly recommended antibiotics are inappropriate due to risks of disabling/long-lasting side effects. Severity: Give IV if severely unwell (options include ciprofloxacin, levofloxacin, cefuroxime, ceftriaxone, gentamicin, amikacin). Review at 14 days; stop or continue for a further 14 days if needed. Referral: Refer to hospital if symptoms suggest serious illness (sepsis, acute urinary retention, prostatic abscess) or if symptoms are not improving 48 hours after starting treatment. NICE NG110", "cks_last_revised": "October 2018 (updated January 2024 with MHRA fluoroquinolone advice)", "cks_topic": "Yes (but accessed via NICE NG110 as CKS web access was restricted during session). NICE NG110", "cks_source": "UK guideline – Prostatitis (acute)", "notes": "Both documents cover; cross-check for divergence between primary oral and hospital IV regimens.", "cks_links": [], "cks_sort_date": "2018-01" }, { "condition": "Prosthetic joint infection", "category": "Bone/Joint", "overlap": "Secondary only", "concordance": "N/A", "primary_rx": null, "hospital_rx": "Do NOT start ABx in stable patient until intra-op samples. IV Vancomycin + IV Gentamicin (max 4d). Discuss specialist 72h.", "cks_first_line": "For patients managed with Debridement, Antibiotics and Implant Retention (DAIR) or one-stage revision, the first-line treatment is 2–6 weeks of intravenous (or highly bioavailable oral) pathogen-specific antibiotics, followed by a long-term oral combination: Rifampicin (300–450 mg twice daily) plus a companion drug, typically Ciprofloxacin (750 mg twice daily) or Levofloxacin (500 mg once or twice daily) (BSAC/BIA JAC 2014). Total duration is typically 3 months for hip (THA) and 6 months for knee (TKA) (BSAC/BIA JAC 2014).", "cks_alternatives": "If rifampicin is not tolerated or contraindicated (e.g. resistance, drug interactions), the guideline recommends 4–6 weeks of pathogen-specific intravenous antibiotic therapy (BSAC/BIA JAC 2014). Other oral options include co-trimoxazole (960 mg twice daily), minocycline or doxycycline (100 mg twice daily), or oral first-generation cephalosporins such as cephalexin (500 mg–1 g four times daily) (BSAC/BIA JAC 2014).", "cks_pen_allergy": "For Gram-positive cover (e.g. staphylococci) in penicillin-allergic patients, use Vancomycin (15–20 mg/kg IV twice daily, adjusted by serum concentration) or Teicoplanin (loading dose 6 mg/kg 12-hourly for 3 doses, then 6–12 mg/kg IV once daily) (BSAC/BIA JAC 2014).", "cks_caveats": "Antibiotics should be withheld for at least 2 weeks prior to sampling in systemically well patients to maximise microbiological yield (BOASt 2023, BSAC/BIA JAC 2014). If septic, follow 'Sepsis Six' and start immediate parenteral antibiotics after blood cultures (BOASt 2023). Fluoroquinolones (ciprofloxacin/levofloxacin) are subject to MHRA restrictions due to risks of disabling and potentially irreversible side effects (e.g. tendonitis, neuropathy); they should be discontinued at the first sign of a serious adverse reaction (MHRA 2019). Regular monitoring of FBC, U&Es, LFTs, and CRP is required (BSAC/BIA JAC 2014).", "cks_last_revised": "October 2023 (BOASt); September 2014 (BSAC/BIA JAC Consensus)", "cks_topic": "No (CKS topic does not exist; guidance is from the UK National Consensus 'Clinical guidelines in the management of prosthetic joint infection' published in the Journal of Antimicrobial Chemotherapy [JAC 2014] and BOASt Acute Management of PJI [2023])", "cks_source": "UK guideline – Prosthetic joint infection", "notes": "Hospital-only empirical IV regimen; no NICE CKS topic. NHSGGC hospital doc (Aug 2024) is within review period.", "cks_links": [], "cks_sort_date": "2023-09" }, { "condition": "Pubic lice", "category": "Genital", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Malathion 0.5% liquid 2 applications 1 week apart. 2nd line Permethrin 5% cream.", "hospital_rx": null, "cks_first_line": "Permethrin 5% cream OR malathion 0.5% aqueous lotion applied to whole body, washed off after 12 hours. Repeat after 7 days.", "cks_alternatives": "Refer to GUM for full STI screen.", "cks_pen_allergy": "Not applicable.", "cks_caveats": "Treat partners; wash bedding/clothing on hot cycle. Pubic lice on eyelashes: petroleum jelly BD 8–10 days.", "cks_last_revised": "January 2024", "cks_topic": "Yes", "cks_source": "NICE CKS – Pubic lice", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2024-01" }, { "condition": "Pyelonephritis / upper UTI (non-pregnant)", "category": "UTI", "overlap": "BOTH", "concordance": "Amber", "primary_rx": "Trimethoprim 200mg BD (if sensitive) OR Co-amoxiclav 625mg TDS OR Ciprofloxacin 500mg BD. 7d. Admit if systemic/no response 24h.", "hospital_rx": "Non-severe oral: Ciprofloxacin 500mg 12h OR Co-trimoxazole 960mg 12h (if trim-sensitive). Sepsis: IV Gentamicin (max 4d); eGFR<20 ciprofloxacin. 7d.", "cks_first_line": "Non-pregnant women and men aged 16+: oral Cefalexin 500 mg twice or three times a day (up to 1–1.5 g three or four times a day for severe infection) for 7–10 days. Give oral first-line if the person can take oral medicines and severity does not require IV. NICE NG111", "cks_alternatives": "Second-choice oral: Co-amoxiclav 500/125 mg three times a day for 7–10 days; or Trimethoprim 200 mg twice a day for 14 days (only if susceptibility known/likely); or Ciprofloxacin 500 mg twice a day for 7 days (subject to MHRA Jan 2024 fluoroquinolone restrictions — only if other antibiotics inappropriate). IV (if oral not possible / severe): first-line Cefuroxime 1.5 g three times a day; alternatives Co-amoxiclav, Amoxicillin, Gentamicin, Amikacin, or Ciprofloxacin — review IV by 48 h and step down to oral where possible. NICE NG111", "cks_pen_allergy": "No specific penicillin-allergy regimen is named in NG111. Cefalexin (first-line) carries a small cross-reactivity caution in true penicillin allergy; Ciprofloxacin is a non-beta-lactam option (subject to MHRA fluoroquinolone restrictions). Seek microbiology advice in severe penicillin allergy. NICE NG111", "cks_caveats": "Account for symptom severity, complication risk (structural/functional GU abnormality, immunosuppression), previous culture/susceptibility, prior antibiotic use, and local AMR data. Review antibiotic when culture available and narrow spectrum where possible. Consult local microbiology for resistant or severe cases. NICE NG111", "cks_last_revised": "NICE NG111, published October 2018 (antimicrobial-prescribing guideline; fluoroquinolone note updated per MHRA Jan 2024).", "cks_topic": "NICE NG111 — Pyelonephritis (acute): antimicrobial prescribing. (A NICE antimicrobial-prescribing guideline, not a CKS topic.)", "cks_source": "NICE NG111 — Pyelonephritis (acute): antimicrobial prescribing", "notes": "Both documents cover; cross-check for divergence between primary oral and hospital IV regimens.", "cks_links": [], "cks_sort_date": "2018-10" }, { "condition": "Recurrent UTI (women)", "category": "UTI", "overlap": "Primary only", "concordance": "Green", "primary_rx": "Self-care, vaginal oestrogen post-menopause first. Post-coital or standby ABx. Prophylaxis if needed: Nitrofurantoin 50mg nocte / 100mg stat OR Trimethoprim 100mg nocte / 200mg stat. 3–6 months trial. Don't rotate.", "hospital_rx": null, "cks_first_line": "Non-pregnant women aged 16+: try behavioural/personal-hygiene measures and (post-menopausal) vaginal oestrogen first. If prophylaxis needed — first-choice oral antibiotic prophylaxis: Trimethoprim 200 mg single dose when exposed to a trigger, or 100 mg at night; OR Nitrofurantoin (if eGFR ≥45 ml/min) 100 mg single dose on trigger, or 50–100 mg at night. NICE NG112", "cks_alternatives": "Second-choice oral antibiotic prophylaxis: Amoxicillin 500 mg single dose on trigger, or 250 mg at night (off-label); or Cefalexin 500 mg single dose on trigger, or 125 mg at night (off-label). Non-antibiotic alternative: Methenamine hippurate 1 g twice a day [2024]. Choose by recent culture/susceptibility; use a different antibiotic for prophylaxis than for treating an acute UTI; do not rotate routinely. NICE NG112", "cks_pen_allergy": "Trimethoprim and nitrofurantoin (first-choice) are non-penicillin. Of the second-choice options, avoid amoxicillin in penicillin allergy; cefalexin carries a small cross-reactivity caution. Trimethoprim contraindicated in first-trimester pregnancy (folate antagonist); nitrofurantoin avoided at term. NICE NG112", "cks_caveats": "Review prophylaxis at least every 6 months (methenamine within 6 months then every 12). Weigh resistance risk of long-term antibiotics. Refer/seek specialist advice for pregnant women, men, and recurrent upper/complicated UTI. If prophylaxis stopped, ensure rapid access to acute treatment. NICE NG112", "cks_last_revised": "NICE NG112, published October 2018; amended 2024 (methenamine hippurate added).", "cks_topic": "NICE NG112 — Urinary tract infection (recurrent): antimicrobial prescribing. (A NICE antimicrobial-prescribing guideline, not a CKS topic.)", "cks_source": "NICE NG112 — Urinary tract infection (recurrent): antimicrobial prescribing", "notes": "Nitrofurantoin 50–100mg ON or trimethoprim 100mg ON prophylaxis matches NICE NG112 (Oct 2018).", "cks_links": [], "cks_sort_date": "2024-01" }, { "condition": "Rosacea", "category": "Skin", "overlap": "Primary only", "concordance": "Green", "primary_rx": "Mild–mod: topical metronidazole 0.75% BD or azelaic acid 15% BD or ivermectin OD. Mod–severe papulopustular: Doxycycline 100mg OD (or Oxytetracycline/Tetracycline 500mg BD), 8–12 wk review.", "hospital_rx": null, "cks_first_line": "Oxytetracycline 500 mg twice daily for 6–12 weeks. NICE CKS – Rosacea", "cks_alternatives": "Doxycycline 100 mg once daily (unlicensed); Lymecycline 408 mg once daily (unlicensed); Erythromycin 500 mg twice daily (especially if pregnant/breastfeeding). NICE CKS – Rosacea", "cks_pen_allergy": "Oxytetracycline, doxycycline, and lymecycline are not penicillins; erythromycin 500 mg twice daily or clarithromycin 250 mg twice daily are options. NICE CKS – Rosacea", "cks_caveats": "Avoid tetracyclines in pregnancy, breastfeeding, and children <12 years. Doxycycline/lymecycline can cause photosensitivity. If no improvement after 3 months, discontinue/review. NICE CKS – Rosacea", "cks_last_revised": "November 2023", "cks_topic": "Yes", "cks_source": "NICE CKS – Rosacea", "notes": "Topical metronidazole/azelaic acid; oral doxycycline 40mg MR OD or 100mg OD for papulopustular — matches NICE CKS (Aug 2024).", "cks_links": [], "cks_sort_date": "2023-11" }, { "condition": "Scabies", "category": "Skin", "overlap": "Primary only", "concordance": "Green", "primary_rx": "Permethrin 5% cream — 2 applications 1 week apart. Malathion 0.5% if allergic. Treat contacts.", "hospital_rx": null, "cks_first_line": "Permethrin 5% cream: apply to the whole body from neck down, leave on for 8–12 hours overnight, then wash off; repeat after 7 days. If using oral ivermectin for crusted/refractory cases, typical adult dose is 200 micrograms/kg orally, repeated after 7–14 days (specialist use).", "cks_alternatives": "Malathion 0.5% aqueous lotion: apply to whole body, leave on for 24 hours, then wash off; repeat after 7 days. Oral ivermectin may be used for crusted scabies or treatment failure under specialist advice.", "cks_pen_allergy": "Not relevant — scabies treatment is not penicillin-based.", "cks_caveats": "Treat close contacts simultaneously; itch can persist after cure; apply to all skin including under nails and genital area; in infants/elderly/immunosuppressed, include face/scalp/ears avoiding eyes; crusted scabies needs specialist input and may require repeated combined therapy. Local NHS guidance notes 7-day repeat dosing and extra precautions for crusted disease.", "cks_last_revised": "Not available from a NICE CKS scabies topic (no dedicated topic found).", "cks_topic": "No specific NICE CKS topic — see UKHSA guidance and local UK guideline cited by NHS Trusts; NICE CKS topic page for scabies was not retrievable.", "cks_source": "Nottinghamshire Healthcare NHS Foundation Trust IPC scabies guidance, Wirral Community Health and Care NHS Foundation Trust scabies page, UKHSA scabies guidance", "notes": "Permethrin 5% cream whole-body, repeat 7 days; malathion alternative — matches NICE CKS (Mar 2024).", "cks_links": [], "cks_sort_date": "0000-00" }, { "condition": "Scarlet fever (GAS)", "category": "URTI", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Phenoxymethylpenicillin 500mg QDS or 1g BD 10 days OR Clarithromycin 500mg BD 5 days (pen-allergic). Admit if SIRS/dehydration.", "hospital_rx": null, "cks_first_line": "Phenoxymethylpenicillin 500 mg four times a day for 5 to 10 days (NICE NG84).", "cks_alternatives": "For penicillin allergy: clarithromycin 250 mg to 500 mg twice a day for 5 days. NICE NG84 also allows the same phenoxymethylpenicillin regimen when antibiotics are indicated for acute sore throat, including scarlet fever (NICE NG84).", "cks_pen_allergy": "Clarithromycin 250 mg to 500 mg twice a day for 5 days; in pregnancy, erythromycin is preferred for 5 days (NICE NG84).", "cks_caveats": "NG84 groups scarlet fever with acute sore throat, pharyngitis, tonsillitis and GAS infection. It advises no antibiotics for low FeverPAIN/Centor/clinical scores, and immediate or backup antibiotics only for more severe/higher-risk cases. Review by March 2019 is stated on the guideline page; no newer scarlet-fever-specific NICE CKS revision was found.", "cks_last_revised": "NG84 recommendation page shows published 26 January 2018 and review by March 2019; no dedicated CKS last revised date found.", "cks_topic": "Partial — no dedicated NICE CKS scarlet fever topic found; scarlet fever is covered under NICE NG84 acute sore throat recommendations.", "cks_source": "NICE NG84 – Recommendations", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2018-01" }, { "condition": "Sepsis of unknown source", "category": "Systemic", "overlap": "Secondary only", "concordance": "N/A", "primary_rx": null, "hospital_rx": "IV Amoxicillin 1g 8h + IV Gentamicin (max 4d). S.aureus: add IV Flucloxacillin 2g 6h. MRSA/pen-allergy: IV Vancomycin + Gentamicin. Severe strep: add IV Clindamycin 600mg 6h. eGFR<20: replace Gentamicin with Ciprofloxacin.", "cks_first_line": "Broad-spectrum intravenous antibiotic treatment at the maximum recommended dose, chosen according to local or national guidelines NICE NG253. Common UK consensus for 'unknown source' is Piperacillin/tazobactam 4.5g IV every 8 hours (or every 6 hours for severe infections) BNF, SIGN 139, UK Sepsis Trust.", "cks_alternatives": "Not separately specified in national guideline; local trust and previous consensus guidelines recommend intravenous meropenem 2g every 8 hours SIGN 139, United Lincolnshire Hospitals NHS Trust.", "cks_pen_allergy": "Not separately specified in NG253; local trust and previous consensus guidelines recommend a combination of vancomycin IV (dosing based on weight/levels), metronidazole 500mg IV every 8 hours, and ciprofloxacin 400mg IV every 8–12 hours SIGN 139, United Lincolnshire Hospitals NHS Trust.", "cks_caveats": "High-risk criteria (NEWS2 ≥7 or single parameter scoring 3) mandate IV antibiotics within 1 hour; moderate-risk within 3 hours if sepsis persists NICE NG253. Perform source identification/control and blood cultures before antibiotics if possible. Pregnancy/breastfeeding: consider antibiotic impact; refer to senior decision-maker NICE NG253. MHRA/SPS: avoid fluoroquinolones unless no alternative SPS.", "cks_last_revised": "November 2024 (Last reviewed: December 2025)", "cks_topic": "No (Sepsis is managed via NICE NG253 'Suspected sepsis: recognition, diagnosis and early management')", "cks_source": "UK guideline – Sepsis of unknown source", "notes": "Hospital-only empirical IV regimen; no NICE CKS topic. NHSGGC hospital doc (Aug 2024) is within review period.", "cks_links": [], "cks_sort_date": "2024-11" }, { "condition": "Septic arthritis / osteomyelitis (native joint)", "category": "Bone/Joint", "overlap": "Secondary only", "concordance": "Amber", "primary_rx": null, "hospital_rx": "IV Flucloxacillin 2g 6h. MRSA/pen-allergy: IV Vancomycin. High-risk Gram-neg: ADD IV Gentamicin. Discuss specialist 72h. Usually 4–6 weeks.", "cks_first_line": "No specific NICE CKS regimen found for native joint septic arthritis / osteomyelitis. For osteomyelitis of the foot (not native joint), one UK guideline uses flucloxacillin 2 g IV four times a day; acute cases usually need at least 1 week IV initially, total 4–6 weeks.", "cks_alternatives": "For the foot osteomyelitis guideline: chronic empiric options are doxycycline 100 mg twice a day or co-trimoxazole 960 mg twice a day, with or without metronidazole 400 mg three times a day; post-debridement empiric therapy is vancomycin IV + gentamicin IV + metronidazole.", "cks_pen_allergy": "For the foot osteomyelitis guideline, penicillin allergy option is vancomycin IV (aim pre-dose level 15–20 mg/L). Chronic alternatives in penicillin allergy: doxycycline 100 mg twice a day or co-trimoxazole 960 mg twice a day, with or without metronidazole 400 mg three times a day.", "cks_caveats": "The available regimen is for diabetic foot osteomyelitis / foot infection involving bone, not native joint disease. Chronic cases should avoid empiric treatment and use biopsy-directed therapy. Review Gram-negative/anaerobic cover and rationalise to microbiology. Acute presentations usually need at least 1 week IV. Outpatients may receive the full course orally.", "cks_last_revised": "Not found on a NICE CKS topic page. The fetched UK osteomyelitis guidance PDF did not provide a clear last revised date in the extracted text.", "cks_topic": "Partial — no dedicated NICE CKS topic found for native joint septic arthritis / osteomyelitis; available NICE pages searched did not yield a CKS topic, so use a UK hospital antimicrobial guideline for osteomyelitis only.", "cks_source": "NICE CKS – septic arthritis, NICE CKS – osteomyelitis, Diabetic Foot Infection Treatment Guidance PDF", "notes": "Hospital regimen; check against latest local microbiology + BSAC/SHAART guidance.", "cks_links": [], "cks_sort_date": "0000-00" }, { "condition": "Skin / breast abscess", "category": "Skin", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Drainage primary. ABx only if surrounding cellulitis (treat as cellulitis).", "hospital_rx": null, "cks_first_line": "Incision and drainage is primary treatment. ABx only if surrounding cellulitis or systemic features: flucloxacillin 500mg–1g QDS 5–7 days.", "cks_alternatives": "Co-amoxiclav 625mg TDS if poor response; doxycycline 100mg BD if MRSA risk.", "cks_pen_allergy": "Clarithromycin 500mg BD 5–7 days or doxycycline.", "cks_caveats": "Send pus for culture if possible. Recurrent abscesses: consider MRSA decolonisation, hidradenitis suppurativa, diabetes.", "cks_last_revised": "October 2023", "cks_topic": "Yes", "cks_source": "NICE CKS – Boils, carbuncles, staphylococcal carriage", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2023-10" }, { "condition": "Spontaneous bacterial peritonitis (SBP)", "category": "Intra-abdominal", "overlap": "Secondary only", "concordance": "N/A", "primary_rx": null, "hospital_rx": "Not on cotrim prophylaxis: Oral Co-trimoxazole 960mg 12h. On prophylaxis: IV Pip-Taz 4.5g 8h or (pen-allergic) Oral Levofloxacin 500mg 12h. 7 days.", "cks_first_line": "**Empirical Treatment:** Intravenous third-generation cephalosporins are first-line. **Cefotaxime** (2g IV every 8–12 hours) or **Ceftriaxone** (2g IV once daily) for 5–7 days BSG, Hepatitis C Online. Treatment should be initiated immediately if ascitic neutrophil count is ≥250 cells/mm³ BSG.", "cks_alternatives": "For nosocomial-acquired SBP or patients with recent beta-lactam exposure, broader spectrum antibiotics such as **Piperacillin with tazobactam** (4.5g IV every 6–8 hours) or **Meropenem** (1g IV every 8 hours) should be considered based on local resistance patterns BSG. Co-trimoxazole (960mg IV/PO twice daily) is an alternative for mild disease NHS Tayside.", "cks_pen_allergy": "For patients with severe beta-lactam allergy and no recent fluoroquinolone exposure, **Ciprofloxacin** (400mg IV every 12 hours or 500–750mg PO twice daily) may be used BSG, UHB NHS. Alternatively, **Co-trimoxazole** (960mg IV/PO twice daily) NHS Tayside.", "cks_caveats": "**Adjunctive Albumin:** IV Human Albumin Solution (1.5g/kg at diagnosis, 1g/kg on Day 3) is strongly recommended to reduce hepatorenal syndrome and mortality, particularly if creatinine >1mg/dL, BUN >30mg/dL, or bilirubin >4mg/dL BSG, Hepatitis C Online. **Fluoroquinolones:** MHRA restrictions apply due to risks of disabling and potentially irreversible side effects; they should only be used when other antibiotics are inappropriate MHRA. **Referral:** All patients should be referred to a hepatology specialist NICE NG50.", "cks_last_revised": "September 2023 (NICE NG50 update); 2020 (BSG Guideline)", "cks_topic": "No; used NICE NG50 and British Society of Gastroenterology (BSG) 2020 guidelines.", "cks_source": "UK guideline – Spontaneous bacterial peritonitis (SBP)", "notes": "Hospital-only empirical IV regimen; no NICE CKS topic. NHSGGC hospital doc (Aug 2024) is within review period.", "cks_links": [], "cks_sort_date": "2023-09" }, { "condition": "Syphilis", "category": "Genital", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Refer Sandyford for parenteral management. No primary care empirical ABx.", "hospital_rx": null, "cks_first_line": "Refer to GUM/Sandyford. Early syphilis: benzathine benzylpenicillin 2.4MU IM single dose. Late latent: 2.4MU IM weekly × 3.", "cks_alternatives": "Doxycycline 100mg BD 14 days (early) or 28 days (late) if penicillin allergy.", "cks_pen_allergy": "Doxycycline (above) or azithromycin 2g stat (resistance increasing — not first choice).", "cks_caveats": "Warn re Jarisch-Herxheimer reaction. Test partners + full STI screen + HIV. Notify UKHSA.", "cks_last_revised": "May 2024 (BASHH)", "cks_topic": "Yes", "cks_source": "NICE CKS – Syphilis · BASHH Syphilis 2024", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2024-05" }, { "condition": "Threadworm", "category": "GI", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Mebendazole 100mg stat, repeat in 2 weeks. Treat all household contacts. Hygiene measures.", "hospital_rx": null, "cks_first_line": "Mebendazole: the NHS threadworms page advises treatment with mebendazole, but it does not state an adult mg dose, frequency, or duration on the page. NHS threadworms", "cks_alternatives": "No NICE CKS/NG alternative found for threadworm. Non-drug option: hygiene measures for 6 weeks if medicine cannot be taken. NHS threadworms", "cks_pen_allergy": "Not relevant — threadworm treatment is not penicillin-based.", "cks_caveats": "Treat everyone over 2 years old in the household, even if asymptomatic. Mebendazole may not be suitable in pregnancy or breastfeeding; speak to a pharmacist/GP. Medicine kills worms but not eggs, so hygiene measures are needed for 2 weeks with medicine or 6 weeks without. NHS threadworms", "cks_last_revised": "NHS page published 19 June 2025. No NICE CKS last revised date found because a dedicated CKS topic was not accessible/identified.", "cks_topic": "No specific NICE CKS topic — see NHS threadworms guidance.", "cks_source": "NHS threadworms, NICE website", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2025-06" }, { "condition": "Traveller's diarrhoea", "category": "GI", "overlap": "Primary only", "concordance": "Green", "primary_rx": "Standby (private Rx for remote travel): Azithromycin 500mg OD 1–3 days.", "hospital_rx": null, "cks_first_line": "Azithromycin 500 mg once daily for 1 to 3 days (unlicensed use).", "cks_alternatives": "Ciprofloxacin 500 mg twice daily for 1–3 days (avoid in South/South-east Asia due to resistance). Rifaximin is sometimes used for non-invasive diarrhoea, but CKS notes difficulty for travellers to distinguish invasive vs non-invasive types. Bismuth subsalicylate (2 tabs four times a day for up to 2 days) can be used for mild symptoms or prophylaxis.", "cks_pen_allergy": "Azithromycin is a macrolide and is suitable for patients with penicillin allergy.", "cks_caveats": "Standby antibiotics only for high-risk patients (e.g., immunocompromised, chronic GI disease) or those in remote areas. Pregnancy: Azithromycin preferred; avoid quinolones. MHRA warnings for fluoroquinolones (e.g., tendon rupture, aortic aneurysm, psychiatric reactions). Seek medical care if fever >38°C, blood/mucus in stool, or severe vomiting occurs. Avoid loperamide if fever or bloody stools are present.", "cks_last_revised": "September 2023", "cks_topic": "Yes (as \"Diarrhoea - prevention and advice for travellers\")", "cks_source": "NICE CKS – Diarrhoea - prevention and advice for travellers", "notes": "Mostly self-limiting; azithromycin 500mg OD 1–3 days if moderate-severe — matches NICE CKS (Jul 2024). Ciprofloxacin downgraded.", "cks_links": [], "cks_sort_date": "2023-09" }, { "condition": "Trichomoniasis", "category": "Genital", "overlap": "Primary only", "concordance": "Green", "primary_rx": "Metronidazole 400mg BD 7d. Refer Sandyford. Treat partners.", "hospital_rx": null, "cks_first_line": "Metronidazole 400 mg twice daily for 7 days (adult, non-pregnant).", "cks_alternatives": "Alternative regimen commonly used in UK STI guidance: metronidazole 2 g orally as a single dose; manage persistent/recurrent infection with specialist advice and consider resistance/adherence/reinfection.", "cks_pen_allergy": "Not relevant — penicillin allergy does not affect trichomoniasis treatment.", "cks_caveats": "Preferred regimen in many UK STI pathways is the 7-day metronidazole course; in pregnancy, sexual partners should be treated and abstain from sex until both complete treatment; advise no alcohol with metronidazole during treatment and for 48 hours after the last dose. I could not verify a NICE CKS trichomoniasis topic or a reliably reachable official BASHH page from the tools available.", "cks_last_revised": "No NICE CKS topic found; no verifiable CKS last revised date available.", "cks_topic": "No specific NICE CKS topic; Partial only via UK STI guidance outside CKS.", "cks_source": "NICE CKS – trichomoniasis", "notes": "Metronidazole 400mg BD 5–7 days or 2g stat matches BASHH/CKS (Mar 2024).", "cks_links": [], "cks_sort_date": "0000-00" }, { "condition": "Uncertain LRTI / UTI", "category": "Systemic", "overlap": "Secondary only", "concordance": "Amber", "primary_rx": null, "hospital_rx": "Oral Co-trimoxazole 960mg 12h OR Doxycycline 100mg 12h. Do NOT use Co-amoxiclav. Review at 48h. Max 5 days if diagnosis remains uncertain.", "cks_first_line": "No specific NICE CKS first-line recommendation identified for \"uncertain LRTI / UTI\".", "cks_alternatives": "No dedicated NICE CKS/NG regimen identified for this exact combined scenario.", "cks_pen_allergy": "No specific NICE CKS penicillin-allergy alternative identified for this exact combined scenario.", "cks_caveats": "I could not verify a dedicated adult NICE CKS topic or exact NG antimicrobial table for \"uncertain LRTI / UTI\" from the official NICE site in this search. If you want, this likely needs mapping to the nearest single-condition NICE topic (for example adult UTI or LRTI/pneumonia) rather than a combined uncertain-infection label.", "cks_last_revised": "Not found on NICE CKS.", "cks_topic": "No specific NICE CKS topic found for \"uncertain LRTI / UTI\"; closest relevant NICE guidance appears to be broader antimicrobial guidance, but I could not identify a dedicated CKS/NG recommendation for this exact condition.", "cks_source": "NICE CKS homepage, NICE website", "notes": "Hospital regimen; check against latest local microbiology + BSAC/SHAART guidance.", "cks_links": [], "cks_sort_date": "0000-00" }, { "condition": "Upper UTI in pregnancy", "category": "UTI", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Co-amoxiclav 625mg TDS OR Cefalexin 500mg TDS. 7–10 days. Admit if unwell. Nitrofurantoin NOT effective in UUTI.", "hospital_rx": null, "cks_first_line": "Cefalexin 500 mg twice or three times a day for 7 to 10 days; if severe infection, up to 1 to 1.5 g three or four times a day.", "cks_alternatives": "If oral treatment not suitable: cefuroxime 750 mg to 1.5 g three or four times a day IV. Second-line / if combining antibiotics or susceptibility/sepsis concern: consult local microbiologist. NG111 also lists IV co-amoxiclav, ceftriaxone, gentamicin, amikacin, and ciprofloxacin for non-pregnant patients, but pregnancy table only specifies cefalexin/cefuroxime.", "cks_pen_allergy": "No separate penicillin-allergy regimen is given for pregnant women in NG111. Pregnancy table advises cefalexin first line and cefuroxime IV if vomiting/severely unwell; for second-choice antibiotics or if combining antibiotics, consult a local microbiologist.", "cks_caveats": "Pregnant patients with acute pyelonephritis should be considered for specialist advice or hospital referral, especially if dehydrated, unable to take oral medicines, or if sepsis/serious illness is suspected. Review urine culture results and step down IV antibiotics by 48 hours where possible. MHRA Jan 2024 fluoroquinolone restriction applies, and ciprofloxacin is not recommended in pregnancy.", "cks_last_revised": "NG111: last reviewed 18 April 2019; page published 31 October 2018.", "cks_topic": "Partial — no dedicated NICE CKS topic found; NICE NG111 covers acute pyelonephritis (upper UTI) including pregnancy.", "cks_source": "NICE NG111 – Recommendations, NICE NG111 – Overview", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2019-04" }, { "condition": "Vaginal candidiasis", "category": "Genital", "overlap": "Primary only", "concordance": "Amber", "primary_rx": "Fluconazole 150mg PO stat OR Clotrimazole 500mg pessary stat. Avoid oral azole in pregnancy.", "hospital_rx": null, "cks_first_line": "Fluconazole 150 mg oral capsule, taken as a single dose (NICE CKS).", "cks_alternatives": "If oral therapy is contraindicated or not tolerated, the recommended alternative is a clotrimazole 500 mg intravaginal pessary as a single dose at night (NICE CKS). Other alternatives for acute infection include clotrimazole 10% cream (5 g as a single dose), miconazole 2% cream (5 g for 7 nights), or miconazole 1.2 g vaginal capsule (single dose) (NICE CKS). For severe infection, a repeat dose after 72 hours is advised (e.g., fluconazole 150 mg on day 1 and 4) (NICE CKS).", "cks_pen_allergy": "Not separately specified.", "cks_caveats": "Pregnancy: Avoid oral fluconazole; use a topical imidazole (e.g., clotrimazole 500 mg pessary) for up to 7 nights (NICE CKS). Severity: For severe infections, repeat the antifungal dose after 72 hours. Referral: Arrange specialist referral if the patient is aged 12–15 years, there is uncertainty about the diagnosis, or treatment failure is unexplained. Latex: Advise that topical imidazole preparations may damage latex condoms and diaphragms (NICE CKS).", "cks_last_revised": "October 2023", "cks_topic": "Yes", "cks_source": "NICE CKS – Vaginal candidiasis", "notes": "Default rating — manual clinical review recommended for full CKS alignment.", "cks_links": [], "cks_sort_date": "2023-10" }, { "condition": "Vascular graft infection", "category": "Skin/Vascular", "overlap": "Secondary only", "concordance": "Amber", "primary_rx": null, "hospital_rx": "IV Flucloxacillin 2g 6h + IV Gentamicin (max 4d). MRSA/pen-allergy: IV Vancomycin + Gentamicin. Discuss specialist.", "cks_first_line": "Infected Prosthetic Graft (Empirical):\nFlucloxacillin 2g IV QDS plus Gentamicin IV (weight-based dosing per local protocol). NHS Tayside/Vascular Surgery Clinical Network\n\nDuration:\n- Complete removal of infected prosthesis: 6 weeks IV + 6 weeks PO.\n- Partial removal or EVAR in infected field: 6 weeks IV + PO for life. GSTT/OPAT Aortic Graft Guideline", "cks_alternatives": "Mild: No signs of systemic infection (SIRS <2), infection confined to skin/subcutaneous tissue. Moderate: Lymphatic streaking, deep tissue infection (fascia, tendon, bone) or abscess, or cellulitis >2cm. Severe: Any infection with severe systemic toxicity (fever, chills, shock, confusion). NHS Tayside/Vascular Surgery Clinical Network\n\nEmpirical therapy for suspected infected prosthetic graft (culture negative):\n- Flucloxacillin 2g IV QDS + Gentamicin IV (dosing per local protocol).\n- Alternatives: Co-trimoxazole 960mg BD or Doxycycline 100mg OD +/- Rifampicin (following IV course). NHS Tayside/Vascular Surgery Clinical Network\n\nManagement of Aortic Graft Infection:\n- Empiric: Ceftriaxone + Metronidazole + Vancomycin.\n- Special situations: Add Gentamicin if severe sepsis/unstable. Add Fluconazole if enteric/oesophageal fistula. GSTT/OPAT Aortic Graft Guideline", "cks_pen_allergy": "Vancomycin IV (dosing per protocol) + Gentamicin IV.\nAlternative: Linezolid 600mg BD + Gentamicin (if MRSA risk). NHS Tayside/Vascular Surgery Clinical Network\n\nFor Aortic Graft (Significant Penicillin Allergy/MRSA):\nVancomycin + Gentamicin + Metronidazole. GSTT/OPAT Aortic Graft Guideline", "cks_caveats": "Referral: Must be reviewed every 3-6 months by vascular specialists. NHS Tayside\nPregnancy: No specific adjustments mentioned in these vascular-specific pathways.\nSafety: MHRA fluroquinolone restrictions apply to ciprofloxacin. Check rifampicin sensitivity and drug interactions. Gentamicin/Vancomycin require therapeutic drug monitoring. NHS Tayside\nSurgical removal: Highly desirable; antimicrobial therapy is an adjunct. GSTT/OPAT", "cks_last_revised": "NHS Tayside/Vascular Surgery Clinical Network guideline: June 2024 (based on recent search context); GSTT Aortic Graft guideline: 2019/2020. NHS Tayside, GSTT/OPAT", "cks_topic": "No (Dedicated CKS topic does not exist for vascular graft infection. Guidance based on the Vascular Surgery Clinical Network / NHS Tayside and GSTT Aortic Graft management pathways, which align with UK microbiology consensus and BSAC principles).", "cks_source": "UK guideline – Vascular graft infection", "notes": "Hospital regimen; check against latest local microbiology + BSAC/SHAART guidance.", "cks_links": [], "cks_sort_date": "2024-06" }, { "condition": "Viral encephalitis (possible)", "category": "CNS", "overlap": "Secondary only", "concordance": "Amber", "primary_rx": null, "hospital_rx": "IV Aciclovir 10mg/kg 8h. CSF viral PCR. Specialist discussion all cases.", "cks_first_line": "Intravenous (IV) aciclovir 10 mg/kg every 8 hours for 14-21 days (dose based on ideal body weight in obese patients). Start empirically as soon as possible, ideally within 6 hours of arrival, pending results of diagnostic studies British Infection Association (BIA), NHS Royal Cornwall Guideline.", "cks_alternatives": "Other viral causes: Specific antiviral therapy is generally limited to herpesviruses. For Varicella-zoster virus (VZV), IV aciclovir is recommended at 10-15 mg/kg every 8 hours. For Cytomegalovirus (CMV), the combination of ganciclovir (5 mg/kg IV every 12 hours) plus foscarnet (90 mg/kg IV every 12 hours) is recommended in severe cases, especially in HIV patients British Infection Association (BIA), Johns Hopkins ABX Guide.", "cks_pen_allergy": "Not separately specified (aciclovir is an antiviral and does not have cross-reactivity with penicillins). If concurrent bacterial meningitis is suspected, penicillin-allergic patients should receive chloramphenicol 25 mg/kg IV every 6 hours or meropenem 2g IV every 8 hours NHS Royal Cornwall Guideline.", "cks_caveats": "Referral: Urgent hospital admission and referral to critical care if GCS <12 or uncontrolled seizures. Stratification: Start treatment empirically if LP is delayed >6 hours or if clinical suspicion is high. Pregnancy: Ciprofloxacin or ceftriaxone can be used for prophylaxis in pregnant contacts, but aciclovir remains the standard for treatment. Safety: Monitor renal function and maintain hydration to prevent aciclovir-induced crystalluria. MHRA: No specific fluoroquinolone restrictions noted in this context, but standard cautions apply British Infection Association (BIA), NHS Royal Cornwall Guideline.", "cks_last_revised": "November 2023 (Encephalitis International / BIA consensus update)", "cks_topic": "No (Condition not in CKS; used British Infection Association / Association of British Neurologists consensus guidelines)", "cks_source": "UK guideline – Viral encephalitis (possible)", "notes": "Hospital regimen; check against latest local microbiology + BSAC/SHAART guidance.", "cks_links": [], "cks_sort_date": "2023-11" }, { "condition": "Viral meningitis (possible)", "category": "CNS", "overlap": "Secondary only", "concordance": "Amber", "primary_rx": null, "hospital_rx": "Usually diagnosed after empirical bacterial management. No antiviral unless immunocompromised. Specialist discussion.", "cks_first_line": "No ABx if viral confirmed. If bacterial cannot be excluded: empirical ceftriaxone 2g IV BD pending CSF + PCR results.", "cks_alternatives": "Add amoxicillin 2g IV 4-hourly if >50yrs or immunocompromised (Listeria cover).", "cks_pen_allergy": "Chloramphenicol 25mg/kg IV QDS + vancomycin if severe penicillin/cephalosporin allergy.", "cks_caveats": "Aciclovir 10mg/kg IV TDS if HSV encephalitis suspected. Notifiable disease.", "cks_last_revised": "May 2024", "cks_topic": "Partial — under Meningitis CKS", "cks_source": "NICE CKS – Meningitis – bacterial meningitis & meningococcal disease", "notes": "Hospital regimen; check against latest local microbiology + BSAC/SHAART guidance.", "cks_links": [], "cks_sort_date": "2024-05" }, { "condition": "Viral RTI (suspected)", "category": "LRTI", "overlap": "Secondary only", "concordance": "Amber", "primary_rx": null, "hospital_rx": "ABx not required unless secondary bacterial infection. Follow COVID-19/flu guidelines.", "cks_first_line": "No antibiotics. Self-care: analgesia, fluids, rest. Safety-net advice.", "cks_alternatives": "Delayed prescription strategy may be considered (NICE NG120).", "cks_pen_allergy": "Not applicable.", "cks_caveats": "Consider antiviral (oseltamivir) only if influenza confirmed/suspected during active season AND at-risk patient. CRP testing may aid stewardship (NG138).", "cks_last_revised": "March 2024", "cks_topic": "Yes — under URTI/cough CKS", "cks_source": "NICE CKS – Common cold · NICE NG120 – Cough (acute): antimicrobial prescribing", "notes": "Hospital regimen; check against latest local microbiology + BSAC/SHAART guidance.", "cks_links": [], "cks_sort_date": "2024-03" }, { "condition": "Lyme disease", "category": "Systemic", "overlap": "NICE CKS only", "concordance": "N/A", "primary_rx": null, "hospital_rx": null, "cks_first_line": "For erythema migrans with no focal neurological, cardiac, or joint features, start oral antibiotics. Adults and children aged 12 years or older: Doxycycline 100 mg twice daily, or 200 mg once daily, for 21 days. Discuss children and young people under 18 with a specialist unless they have a single erythema migrans lesion and no other symptoms. If Lyme disease is suspected without erythema migrans, arrange ELISA testing and consider antibiotics while awaiting results if clinical suspicion is high. NICE CKS Lyme disease", "cks_alternatives": "Adults and children aged 12 years or older: Amoxicillin 1 g three times daily for 21 days if doxycycline is unsuitable; Azithromycin 500 mg daily for 17 days if doxycycline and amoxicillin are unsuitable. Children aged 9-12 years: Doxycycline 5 mg/kg in two divided doses on day one, then 2.5 mg/kg daily in one or two doses for a total of 21 days if under 45 kg; for severe infection, up to 5 mg/kg daily for 21 days. If doxycycline is unsuitable, use Amoxicillin 30 mg/kg three times daily for 21 days if 33 kg or under. If doxycycline and amoxicillin are unsuitable, use Azithromycin 10 mg/kg daily for 17 days if 50 kg or under. Children under 9 years: Amoxicillin 30 mg/kg three times daily for 21 days if 33 kg or under; if over 33 kg, 1 g three times daily for 21 days. If amoxicillin is unsuitable, use Azithromycin 10 mg/kg daily for 17 days if 50 kg or under. NICE CKS Lyme disease", "cks_pen_allergy": "CKS does not give a single separate penicillin-allergy pathway. If penicillin allergy makes amoxicillin unsuitable, use doxycycline where age and clinical context allow; if doxycycline and amoxicillin are unsuitable, azithromycin is the listed oral alternative. Seek specialist advice where allergy, pregnancy, age, severity, or focal disease makes the oral options uncertain. NICE CKS Lyme disease", "cks_caveats": "Refer or discuss with an appropriate specialist for focal symptoms, for example neurological, cardiac, or joint involvement, but do not delay treatment. Doxycycline and azithromycin use for Lyme disease is off-label but guideline-supported; doxycycline in children aged 9-11 years is also off-label. Warn about Jarisch-Herxheimer reaction during the first 24 hours: symptoms may worsen but this does not usually require stopping antibiotics unless features suggest allergy. If symptoms persist after treatment, review for alternative diagnosis, reinfection, treatment failure, or organ damage. Consider a second course only if treatment may have failed, using an alternative antibiotic; do not routinely offer further antibiotics after two completed courses. Antibiotic prophylaxis after a tick bite is not routinely recommended. NICE CKS Lyme disease", "cks_last_revised": "NICE CKS Lyme disease, last revised March 2024.", "cks_topic": "https://cks.nice.org.uk/topics/lyme-disease/management/management/", "cks_source": "NICE CKS - Lyme disease", "notes": "NICE CKS-only entry added June 2026 from the uploaded NICE CKS management PDF. Lyme disease is not present in the NHSGGC Primary Care or Secondary Care antimicrobial guideline datasets used by RxOS.", "cks_links": [], "cks_sort_date": "2024-03" } ]