Uncomplicated UTI Guidelines

• These are guidelines for managing several common infections
• They are for use by healthcare professionals

Uncomplicated Urinary Tract Infection (UTI)

• For women aged 16-64 years with suspected lower UTIs
• Exclude pregnant individuals, those with a urinary catheter, and recurrent UTIs (2 episodes in last 6 months, or 3 episodes in last 12 months)
• Check for any new signs/symptoms of pyelonephritis (kidney infection)
• Pyelonephritis symptoms can include kidney pain/tenderness in back under ribs, new/different myalgia or flu-like illness, shaking chills (rigors) or temperature of 37.9°C or above, and nausea/vomiting
• If pyelonephritis symptoms are present, calculate NEWS2 score and signpost to A&E or call 999 if life-threatening
• Also check if the patient has vaginal discharge, urethritis, signs/symptoms of pregnancy or is immunosuppressed
• If the patient has any of the key diagnostic symptoms like dysuria, new nocturia, and urine cloudy to the naked eye: shared decision-making approach using TARGET UTI resources
• If the patient describes symptoms as mild, consider pain relief and self-care as the first-line treatment
• If the patient has moderate to severe symptoms, provide nitrofurantoin for 3 days (subject to inclusion/exclusion criteria in PGD) plus self-care
• Advise all patients to return for medical attention if symptoms worsen rapidly or significantly at any time, or do not improve in 48 hours of taking antibiotics
• Share self-care and safety-netting advice using the TARGET UTI leaflet

Shingles

• For adults aged 18 years and over, excluding pregnant individuals
• Diagnose shingles based on typical clinical features
• Look for and rule out serious complications like meningitis, encephalitis, or facial nerve paralysis
• Serious complications warrant a NEWS2 score to assess for signposting to A&E or calling 999 if life threatening
• Suspect herpes zoster ophthalmicus if shingles is in the ophthalmic distribution, Hutchinson's sign or visual symptoms
• Shingles in immunosuppressed patients can look severe, widespread or affect the whole body
• Verify the patient has the typical progression of shingles clinical features
• Symptoms start with abnormal skin sensation and pain
• Then, a fever and headache may develop
• Rash starts as a group of red spots
• The red spots quickly turn into small fluid-filled blisters
• After a few days the blisters burst and crust over
• Look for a rash in a dermatomal distribution (affects one side of the body) on the torso
• If shingles is diagnosed within 72 hours of rash onset, offer aciclovir (subject to inclusion/exclusion criteria in PGD) plus self-care
• If shingles is diagnosed up to one week after rash onset, and the patient is immunosuppressed, offer valaciclovir (subject to inclusion/exclusion criteria in PGD) plus self-care
• If symptoms worsen rapidly or significantly at any time, or do not improve after completion of 7 days treatment course, onward referral is needed
• For pain management, recommend a trial of paracetamol, a NSAID such as ibuprofen, or co-codamol over the counter
• Signpost eligible individuals to information and advice about receiving the shingles vaccine after they have recovered from this episode of shingles

Impetigo

• For non-bullous impetigo, in adults and children aged 1 year and over
• Exclude bullous impetigo, recurrent impetigo, and pregnant individuals under 16 years
• Confirm the diagnosis of impetigo through visual examination
• Confirm risk of deterioration or serious illness
• Impetigo patients should be assessed for if immunosuppresed and if the infection is widespread
• Severe complications should be suspected such as deeper soft tissue infection if the patient is immunosupressed
• In severe cases consider calculating NEWS2 Score ahead of signposting patient to A&E or calling 999 in a life threatening emergency
• Initial lesion presents as thin-walled vesicle which is easily ruptured
• Exudate dries to form honey-colored crusts
• Lesions commonly develop on face, limbs, and skin folds like armpits
• Satellite lesions can develop due to autoinoculation
• Infection is usually asymptomatic, however mildly itchy
• The patient should have ≤3 lesions/clusters present
• Offer hydrogen peroxide 1% cream for 5 days, fusidic acid cream for 5 days, or flucloxacillin
• All patients: Provide advise on importance of good hygeine to reduce spread of impetigo and advise on how to take their medicines to encourage adherence

Infected Insect Bites

• For adults and children aged 1 year and over
• Exclude pregnant individuals under 16 years
• The patient should be assessed for if severely immunosupressed and have signs of systemic infection
• Stings where the there is risk of airway obstruction require a NEWS2 score evaluation for possible admittance to A&E
• Assess patient history:
• Have they been bitten or scratched by an animal or human recently?
• Have they been bitten by a parasite causing infection recently?
• Check if it has been at least 48 hours after the inital insect bite or sting
• Confirm if symptoms worsening or not
• If symptoms worsen or are severe (redness of skin, pain or tenderness to the area or swelling) offer flucloxacillin, clarithromycin, or erythromycin for 5 days

Acute Sore Throat

• For adults and children aged 5 years and over
• Exclude pregnant individuals under 16 years.
• Suspect conditions such as Epiglottitis and severe complications
• Check for signs of scarlet fever, quinsy or glandular fever
• Check if patient is immunosuppressed
• Use FeverPAIN Score to assess
• One point for each: Fever, Purulence, First Attendance, Severely Inflamed tonsils and No Cough

Acute Sinusitis

• For adults and children ages 12 and over
• Exclude: pregnant individuals under 16 years
• Check to see if the symptoms are consistent with sinusitis, such as Nasal blockage and discharge
• Is there signs of meningitis as well?

Acute Otitis Media

• For children ages 1 to 17
• If a patient has otitis media with symptoms like ear rubbing, ear ache, fever and tugging offer: General practice, pain management, possible antibiotics