Antibiogram patterns in the 3DHB regions

Please find attached the 2017 community antibiograms for Wellington and Hutt DHBs. Wairarapa results do not differ significantly

These data are used to determine which antibiotics are recommended as first line empiric therapy. In general it is best to await culture and susceptibility results for complicated or unusual situations.

Little has changed in the susceptibility patterns.

Flucloxacillin remains the drug of choice for skin and soft tissue infection. The gradual increase in community MRSA means that cotrimoxazole is recommended for skin and soft tissue infection in those of Pacific, Maori or Asian ethnicity in whom MRSA is more common. Many patients will respond well initially to flucloxacillin, but a change to cotrimoxazole (or doxycycline) is often needed when the culture results come back.

Nitrofurantoin is the empiric drug of choice for UTI; local and most international guidelines only recommend trimethoprim when a culture has been shown that the organism is susceptible. Amoxicillin-clavulanate is also a reliable alternative, but like nitrofurantoin requires 5 days of therapy for uncomplicated cystitis.

We have also analysed the urine results for the over 75 year age group, and found very little difference in overall susceptibility results. There is a slight difference in breakdown of bacteria isolated, as would be expected. E. coli becomes relatively less frequent, with more Klebsiella and other gram negative rods.

The sputum data are hard to interpret. We grow Haemophilus much more often than S. pneumoniae, but this reflects the fact that it is a common coloniser of those with chronic airways disease. It is almost impossible to eradicate in that setting, and the response of chest symptoms to antibiotics seldom bears any correlation to what is grown in the lab! Doxycycline or amoxicillin would be our first line recommendations when antibiotics are reluctantly prescribed.