Antibiotic treatment of patients with asymptomatic bacteriuria is generally not indicated as it does not decrease the incidence of symptomatic urinary tract infection. This also includes patients with indwelling urinary catheters. Exceptions to this are pregnant women and those undergoing an urological procedure.
Lower leg ulcers, most commonly venous ulcers are often treated with oral antibiotics, even in the absence of evidence of clinical infection. There is no evidence to support this use, except if screening for carriage of multi-resistant organisms. Also a swab for microscopy and culture, in the absence of signs of infection is not recommended. Unnecessary antibiotics and swabbing will add to healthcare costs, antimicrobial resistance and patient allergy.
Most uncomplicated upper respiratory infections are viral in aetiology and antibiotic therapy is not indicated. Oral antibiotic therapy of presumed URTI in febrile young infants is not only ‘low value’ but can be actively dangerous, in delaying presentation to hospital (inappropriately reassuring parents and confounding investigations of sepsis). This is a major issue for paediatrics primary care and ED presentations. Patient education is an important component of management together with symptomatic treatment. Infections with Streptococcus pyogenes and Bordetella pertussis do require antibiotic therapy.
Testing of faeces for microscopy and culture or by PCR methods should not be performed in the absence of diarrhoea or other gastro-intestinal symptoms. Similarly antimicrobial treatment for a gastrointestinal pathogen is not indicated in the absence of symptoms. For immunocompetent non-traveller children with acute gastroenteritis, there are very few circumstances when a stool test for infection would alter clinical management. Possible exceptions include refugee screening and some neurological syndromes such as enteroviral testing for acute flaccid paralysis.
Multiple serological testing as investigation for a patient with fatigue, is not recommended. If such testing is not clinically indicated there is a risk of false positive results leading to further unnecessary investigations and useless treatments.
An initial list of 10 low value interventions was compiled by the Lead Fellow of the Australasian Society for Infectious Diseases (ASID) Inc following an online discussion in ASID’s discussion forum, Ozbug. The Royal Australasian College of Physicians (RACP) then facilitated a consultation of all ASID members via a survey distributed through the society’s e-newsletter. In the survey, members were asked to rank the 10 suggested interventions and suggest additional items for consideration. A subsequent shortlist of items was created by selecting the top 7 interventions as ranked by the members from the initial list.
The shortlist was sent to ASID’s special interest groups and selected members who had agreed to assist, who were asked to recommend the items to comprise the ‘top 5’. This final list was endorsed by ASID Council on 31 July 2015. The Top 5 was then circulated again to the ASID members for final comments before being signed off by ASID’s Executive Committee.