12 Common Nursing Home Situations in Which Systemic Antibiotics are Generally Not Indicated
1. Positive urine culture in an asymptomatic resident.
2. Urine culture ordered solely because of change in urine appearance.
3. Nonspecific symptoms or signs not referable to the urinary tract, such as falls or mental status change (with or without a positive urine culture).
4. Upper respiratory infection (common cold).
5. Bronchitis or asthma in a resident who does not have COPD.
6. “Infiltrate” on chest x-ray in the absence of clinically significant symptoms.
7. Suspected or proven influenza in the absence of a secondary infection (but DO treat influenza with antivirals).
8. Respiratory symptoms in a resident with advanced dementia, on palliative care, or at the end of life.
9. Skin wound without cellulitis, sepsis, or osteomyelitis (regardless of culture result).
10. Small (<5cm) localized abscess without significant surrounding cellulitis (drainage is required of all abscesses).
11. Decubitus ulcer in a resident at the end of life.
12. Acute vomiting and/or diarrhea in the absence of a positive culture for shigella or salmonella, or a positive toxin assay for Clostridium difficile