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Independent, reliable, respected
Therapeutic Guidelines is a leading source of independent, evidence-based, practical treatment advice to assist practitioners with decision making at the point-of-care.
Therapeutic Guidelines are regularly updated, based on the latest international literature, interpreted by Australia’s most respected experts, with input from an extensive network of general practitioners, pharmacists and other users.
May 2023 updates:
- Addiction guidelines
- Cardiovascular guidelines
- Liver Disorders, selected topics
For a summary of other practice-changing updates in the May 2023 release, see Updates.
Independence is an essential feature of Therapeutic Guidelines. Funded only by subscribers, meaning no grants, advertising, shareholders or sponsors. To protect and maintain independence, a strict conflict of interest policy is in place.
May 2023 Update
Other practice-changing updates:
Antibiotic prescribing in primary care: summary table
- The freely available Antibiotic prescribing in primary care summary table has been updated to include temporary advice on alternative recommendations to first-line antibiotics for use in shortage situations. The listed alternatives should only be considered if first-line treatment is unavailable as the alternatives may be less efficacious, have a suboptimal spectrum of activity and have a less favourable harm–benefit profile.
- Shortage of oral liquid formulations of some antibiotics is particularly an issue. To enable the preferred antibiotic to be used in children when an oral liquid formulation is not available, the summary table also includes temporary advice developed by The Society of Hospital Pharmacists of Australia, from Don’t Rush To Crush, on the suitability of crushing or dispersing oral solid-dose formulations.
- For more information about the development of the table, see the news article.
Antibiotic guidelines
- The pneumonia topics have been updated to indicate that pneumonia can be a feature of coronavirus disease (COVID-19), and to provide links to the COVID-19 topic for resources on diagnosis and management.
Diabetes guidelines
- Following the discontinuation of the modified-release formulation of exenatide in Australia in 2021, the immediate-release formulation was discontinued in December 2022; there are now no formulations of exenatide available in Australia, so use of alternative glucagon-like peptide-1 (GLP-1) receptor agonists (dulaglutide, liraglutide, semaglutide) should be considered for type 2 diabetes in adults.
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Aetiology of bite and clenched-fist injury infections
Bites, including clenched-fist injuries (in which the hand is lacerated by contact with another person's teeth), often become infected. The bacteria associated with human bites (including clenched-fist injuries) are Staphylococcus aureus, Eikenella corrodens, Streptococcus species and beta-lactamase–producing anaerobic bacteria. The bacteria associated with animal bites are Pasteurella species, S. aureus, Capnocytophaga canimorsus, Streptococcus species and anaerobic bacteria. Cat bites have a higher incidence of deep infection than dog bites.
A different spectrum of bacteria is associated with marine animal bites—see
Principles of management of bites and clenched-fist injuries
The recommended management of bites and clenched-fist injuries is thorough cleaning, irrigation, debridement, elevation and immobilisation.
Carefully examine bite wounds and clenched-fist injuries to identify deeper injuries, devitalised tissue and retained foreign bodies, particularly for bites inflicted by animals with small teeth.
Postexposure rabies or lyssavirus prophylaxis is required for some bites, for example bat bites (see the
For patients with bite or clenched-fist injuries, ensure that tetanus immunisation is up-to-date (see
Antibiotic therapy is required for infected bites and clenched-fist injuries (see
For bites and clenched-fist injuries that are not infected, antibiotic therapy is usually not necessary for otherwise healthy individuals if the risk of wound infection is low (eg small wounds not involving deeper tissues that present within 8 hours and can be adequately debrided and irrigated). Give presumptive therapy if the risk of wound infection is high, including if:
- presentation to medical care is delayed by 8 hours or more
- the wound is a puncture wound that cannot be debrided adequately
- the wound is on the hands, feet or face
- the wound involves deeper tissues (eg bones, joints, tendons)
- the wound involves an open fracture—see
Open fractures for management - the patient is immunocompromised (eg due to asplenia or immunosuppressive medications), or has alcoholic liver disease or diabetes
- the wound is a cat bite.
For wounds on the hands, feet or face, or if infection progresses despite antibiotic therapy, consider surgical consultation. Surgical advice may also be sought on the appropriateness of primary versus delayed wound closure.