Choosing Wisely Australia is an organisation that aims to improve the quality of healthcare provided to Australians by urging healthcare providers to reconsider tests, procedures or treatments where the evidence suggests no benefit or may lead to harm in some cases. Today the organisation released 50 new recommendations from 12 new Australian professional bodies to encourage consumers and healthcare professionals to “choose wisely”.The recommendations of interest to us here at AIMED include:

• Avoid blood cultures in patients who are not systemically septic, have a clear source of infection and in whom a direct specimen for culture is possible (Australian College for Emergency Medicine)
• Do not use antibiotics in asymptomatic bacteriuria (Australasian Society for Infectious Diseases)
• Do not take a swab or use antibiotics for the management of a leg ulcer without clinical infections (Australasian Society for Infectious Diseases)
• Avoid prescribing antibiotics for upper respiratory tract infection (Australasian Society for Infectious Diseases)
• Do not investigate or treat for faecal pathogens in the absence of diarrhoea or other gastro-intestinal symptoms (Australasian Society for Infectious Diseases)
• In a patient with fatigue, avoid performing multiple serological investigations, without a clinical indication or relevant epidemiology (Australasian Society for Infectious Diseases)
• Consider antibiotic de-escalation daily (Australian and New Zealand Intensive Care Society & College of Intensive Care Medicine of Australia and New Zealand)
• Do not assume that bilateral redness and swelling of both lower legs is due to infection. Do not prescribe antibiotics unless there is clinical evidence of sepsis or microbiological confirmation of infection (Australasian College of Dermatologists)
• Do not routinely prescribe antibiotics for inflamed epidermal cysts of the skin evaluated in the first 3-4 days of appearance unless infection is confirmed microbiologically (Australasian College of Dermatologists)
• Do not prescribe topical or systemic anti-fungal medication for patients with thickened, distorted toenails unless microbiological confirmation of a dermatophyte infection has been obtained (Australasian College of Dermatologists)
• Monotherapy for acne with either topical or systemic antibiotics should be avoided. Combine with topical antiseptics such as benzoyl peroxide to reduce antibiotic resistance (Australasian College of Dermatologists)
• Don’t treat otitis media with antibiotics, in non-Indigenous children aged 2-12 years, where reassessment is a reasonable option (Royal Australian College of General Practitioners)
• Do not perform surveillance urine cultures or treat bacteriuria in elderly patients in the absence of symptoms or signs of infection (Royal College of Pathologists of Australasia)
• Don’t initiate an antibiotic without an identified indication and a predetermined length of treatment or review date (Society of Hospital Pharmacists of Australia)

As you can see this initiative covers a wide range of practice. More information on each recommendation is available from the Choosing Wisely website, including resources for consumers, and we will talk more about them here over the next few months. Until then continue to “choose wisely” and promote antimicrobial stewardship.