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.

Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A , Hooton TM. Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults. Clinical Infectious Diseases 2005;40:643-54.

Ariathianto Y. Asymptomatic bacteriuria: Prevalence in the elderly population. Australian Family Physician. 2011:40(10):805-9.

Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2014.

Jarvis TR, Chan L, Gottlieb T. Assessment and management of lower urinary tract infection in adults. Australian Prescriber 2014;37:7-9.

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 lead to increased risk of antimicrobial resistance and patient allergy, and add to healthcare costs.

O’Meara S, Al-Kurdi D, Olugun Y. Antibiotics and Antiseptics for Venus Ulcers. Cochrane Database Systematic Review 2014; CD003557.

Hansson C, Hoborn J, Moller A, Swanbeck G. The microbial flora in venous leg ulcers without clinical signs of infection. Repeated culture using a validated standardised microbiological technique. Acta Dermato Venereologica 1995; 75:24.

Most uncomplicated upper respiratory tract 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 which may inappropriately reassure parents and confound investigations of sepsis. This is a major issue for paediatric primary care and ED presentations.  Patient education is an important component of management together with symptomatic treatment. However, infections with streptococcus pyogenes and bordetella pertussis do require antibiotic therapy.

Group A Streptococcal pharyngitis can be followed by “nonsuppurative” complications such as acute rheumatic fever or post Streptococcal glomerulonephritis. These conditions are very rare in most populations but are more likely to occur in Aboriginal and Torres Strait Islander Australians, Maori and Pacific Islander people aged from 2 to 25 years, or those with known rheumatic heart disease.

Kenealy T, Arroll B.  Antibiotics for the common cold and acute purulent rhinitis.  Cochrane Database Systemic Review 2013; CD000247.

Hersh AL, Jackson MA, Hicks LAl. Principles of judicious antibiotic prescribing for upper respiratory tract infections in paediatrics. Paediatrics 2013;132(6):114654.

Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

RHDAustralia (ARF/RHD writing group), National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (2nd edition). 2012

Testing of faeces for microscopy and culture or by PCR methods should not be performed in the absence of diarrhoea or other gastrointestinal 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.

Cohen SH, Gerding DN, Johnson S. Clinical practice guidelines for clostridium difficile infection in adults: 2010 Update. Infection Control and Hospital Epidemiology 2010;31(5):431-55.

Letter, dated 26/05/15, from the Australian and New Zealand Paediatric Infectious Diseases Group (ANZPID) to the Royal College of Pathologists of Australasia (RCPA) concerning the significant impact that stool multiplex PCR was having on requests for ID physician opinions and appointments for children, particularly regarding positive results for Blastocystis hominis and Dientamoeba fragilis.

Hewison CJ, Heath CH, Ingram PR. Stool culture. Australian Family Physician 2012:41(10).

Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guideline.

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.

Oldmeadow M, Lloyd A. Fatigue states following infection. Infectious Diseases: A clinical approach. Third Edition. 2010, Chapter 17, 202-212.

Lane TJ, Matthews DA, Manu P. The low yield of physical examinations and laboratory investigations of patients with chronic fatigue. The American Journal of Medical Science 1990:299(5):313-8.

Therapeutic Guidelines Limited. Fatigue: diagnostic approach to fatigue in primary care.  Melbourne, 2011.