Which guidelines are carried over from the previous edition?
Treatment of respiratory infections represents approximately two-thirds of antibiotic use outside of hospitals. A recent Norwegian study has shown that prescribing of antibiotics for respiratory infections is still widespread for conditions such as acute otitis, acute sinusitis and acute bronchitis (7) and should be reduced. The guidelines recommend continued use of delayed prescriptions, especially for respiratory infections. In another recent Norwegian study it was shown that with these types of prescriptions only around half of the prescribed antibiotics are consumed (8).
The guidelines maintain the recommendation on use of narrow-spectrum antibiotics. This primarily implies penicillin V as the first choice for respiratory infections. For urinary tract infections, alternation between the three equivalent alternatives mecillinam, nitrofurantoin and trimethoprim is maintained, as well as the avoidanceof ciprofloxacin.
Norwegian doctors prescribe too high a proportion of macrolides, despite documented development of resistance. Macrolides should in essence not be prescribed for anything other than atypical pneumonias (Mycoplasma pneumoniae, Chlamydophila pneumoniae) and in case of allergy to penicillin.
Where staphylococcal skin infection is suspected, the recommendation of dicloxacillin is maintained. Penicillin V is recommended for streptococcal infection.