This decision support tool can help prescribers determine appropriate treatment for nursing home residents suspected of having one of three common infections: urinary tract, skin and soft tissue, and lower respiratory. It uses criteria from the SBAR forms included in the Minimum Criteria for Common Infections Toolkit. Notes with additional guidance on other factors are also included to assist prescribers in making decisions.
To use the tool, first select the type of suspected infection. Then answer the questions that appear on screen. When the tool has enough data to make a determination, it will tell you if the minimum criteria for antibiotics are met and identify other actions to consider.
Green check mark: minimum criteria for antibiotics are met.
Red X: minimum criteria for antibiotics are not met.
CHOOSE POTENTIAL INFECTION (CHOOSE ONE):
Urinary Tract Infection2
Skin and Soft Tissue Infection11
Lower Respiratory Tract Infection15
Does the resident have:
No indwelling catheter3
Indwelling catheter 7
Notes:
Urine cultures should not be performed on a scheduled basis (e.g., monthly).
Urine cultures should not be used to identify UTIs in the absence of symptoms.
Smelly or cloudy urine is not a symptom of a UTI.
Residents with an intermittent catheter or a condom catheter should be evaluated
as if they are not catheterized.
Urine cultures should be used to identify the most appropriate antibiotic. For residents
with acute dysuria, it may be appropriate to initiate empirical antibiotic therapy;
but for all other symptoms, wait for a urine culture.
For residents who regularly run a lower temperature, use a temperature of 2掳F (1掳C)
above the baseline as a definition of a fever.
Does the resident have acute dysuria?
Yes 9
No 4
Fever (temperature > 100潞F [37.9潞C] or two repeated temperatures of 99掳F [37掳C])
Yes 5
No 6
Does the resident have any of these additional symptoms? Check all that apply.
Urgency
Frequency
Suprapubic pain
Gross hematuria
Costovertebral angle tenderness
Urinary incontinence
None of the above
Continue 9
Continue 10
Does the resident have at least TWO of the following? Check all that apply.
Urgency
Frequency
Suprapubic pain
Gross hematuria
Urinary incontinence
None of the above
Continue 9
Continue 10
Does the resident have any of the following symptoms? Check all that apply.
Fever (temperature > 100潞F [37.9潞C] or two repeated
temperatures of 99掳F [37掳C])
New or worsening costovertebral tenderness
New suprapubic pain
New or worsening delirium (sudden onset of confusion,
disorientation, dramatic change in mental status)
New or worsening rigors with or without identified
cause
New or worsening hypotension (e.g., significant
change from baseline BP or a systolic BP <90)
None of the above
Continue 9
Continue 10
Minimum criteria for
initiating antibiotics are MET
Minimum criteria for initiating antibiotics are NOT MET
Consider initiating the following:
Encourage
liquid intake daily until urine is light yellow in color (suggest an amount and
duration). Record fluid
intake (suggest frequency and duration). Assess vital
signs, including temp (suggest frequency and duration). Request notification
if symptoms worsen or if unresolved (suggest duration).
Does the resident have new or increasing purulent drainage at a wound, skin, or
soft-tissue site?
Yes 13
No 12
Notes:
For residents who regularly run a lower temperature, use a temperature of 2掳F (1掳C)
above the baseline as a definition of a fever.
Herpes zoster is a virus and therefore does not require antibiotics but appropriate
antivirals.
Deeper infections such as bursitis may present with similar signs/symptoms.
Underlying osteomyelitis should be considered when managing a resident with an infected
diabetic or decubitus ulcer.
Thromboembolic disease should be considered when a resident presents with an erythematous
or swollen leg.
These criteria do not apply to residents with burns.
Gout can at times be mistaken for cellulitis or vice versa.
Does the resident have at least TWO of the following? Check all that apply.
Fever (temperature > 100潞F [37.9潞C] or two repeated
temperatures of 99掳F [37掳C])
Redness
Tenderness
Warmth
Swelling that is new or increasing at the affected
site
None of the above
Continue13
Continue14
Minimum criteria for
initiating antibiotics are MET
Consider initiating the following:
For discomfort
or prior to cleaning/dressing changes, use acetaminophen or other pain relievers
as needed.
Minimum criteria for initiating antibiotics are NOT MET
Consider initiating the following:
For discomfort
or prior to cleaning/dressing changes, use acetaminophen or other pain relievers
as needed. Assess vital
signs, including temp (suggest frequency and duration) ; and/or Notify physician/nurse practitioner/physician assistant
if symptoms worsen or if unresolved in (suggest duration).
Does the resident have:
No Fever16
Fever of 100潞F (37.9潞C) but less than 102潞F (38.9潞C)18
Fever of >102潞F (38.9潞C)20
Does the resident have chronic obstructive pulmonary disease (COPD)?
Yes 17
No 17
Is the resident over the age of 65?
Yes 21
No 24
Does the resident have a productive cough?
Yes 19
No 24
What symptoms does the resident have? (check all that apply)
Respiratory rate >25 breaths per minute
Pulse >100
Delirium (sudden onset of confusion, disorientation,
dramatic change in mental status)
Rigors (shaking chills)
None of the above
Continue23
Continue24
What symptoms does the resident have? (check all that apply)
Respiratory rate >25 breaths per minute
Delirium (sudden onset of confusion, disorientation,
dramatic change in mental status)
Productive cough
None of the above
Continue23
Continue24
Does the resident have new or increased cough with purulent sputum production?
Yes 22
No 24
What symptoms does the resident have? (check all that apply)
Respiratory rate >25 breaths per minute
Delirium (sudden onset of confusion, disorientation,
dramatic change in mental status)
None of the above
Continue23
Continue24
Minimum criteria for
initiating antibiotics are MET
Avoid antihistamines (especially Benadryl) and consider initiating the following:
For cough,
consider using a cough suppressant. For discomfort,
consider using acetaminophen or other pain reliever. Consider
using a heating pad or hot water bottle on the chest at bedtime (suggest duration
in minutes), although caution is advised. Raise upper
body (use multiple pillows) to sleep/rest. Encourage
fluid by mouth or gastrostomy tube (G-tube) until urine is light yellow in color (suggest duration
in minutes). Encourage
saltwater gargles. Record fluid
intake (suggest duration) Initiate
intravenous fluid hydration and/or initiate hypodermoclysis Request a
chest x ray.
Minimum criteria for initiating antibiotics are NOT MET
Consider initiating the following:
Assess vital
signs, including temperature (suggest frequency and duration). Notify physician/nurse practitioner/physician assistant
if symptoms worsen or if unresolved (suggest duration). For cough,
consider using a cough suppressant. For discomfort,
consider using acetaminophen or other pain reliever. Consider
using a heating pad or hot water bottle on the chest at bedtime for (suggest duration
in minutes), although caution is advised. Raise upper
body (use multiple pillows) to sleep/rest. Encourage
fluid by mouth or gastrostomy tube (G-tube) until urine is light yellow in color (suggest frequency
and duration). Encourage
saltwater gargles. Record fluid
intake (suggest duration). Initiate
intravenous fluid hydration and/or initiate hypodermoclysis.
Request a
chest x ray.
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Page last reviewed September 2017
Page originally created August 2017
Internet Citation: Minimum Criteria for Antibiotics Tool. Content last reviewed September 2017. 大象视频, Rockville, MD. /nhguide/toolkits/determine-whether-to-treat/antibiotic-tool.html
Minimum criteria for
initiating antibiotics are MET
Minimum criteria for initiating antibiotics are NOT MET
Encourage
liquid intake daily until urine is light yellow in color (suggest an amount and
duration).
