MICA · FIRST-LINE LEARNING NOTES
Understand, prioritise and organise follow-up
Appropriate antibiotic use addresses a likely bacterial infection, its severity and local microbiology. Withholding antibiotics can be an active decision supported by explanation and follow-up.
Establish a clinical indication
Identify the suspected site and distinguish infection, colonisation and non-infectious causes. With acute cough, first assess for pneumonia and vulnerability: sputum colour alone does not establish bacterial infection. Routine antibiotics are not indicated for uncomplicated acute bronchitis. Explain the expected course and agree on appropriate symptom management.
[1][2]Match treatment to patient and infection
Clarify reported drug allergy, recent antibiotics, hospital exposure, kidney function and concomitant medicines. Check pregnancy, immunosuppression and resistance risk. Use the site-specific local protocol and susceptibility data. Foreign guidance provides principles; its first-line agents should not automatically be transferred to Algerian resistance patterns.
[3][2][4]Sputum colour does not establish bacterial infection. Before prescribing, identify the suspected focus and explain why antibiotics should improve the outcome. Indication, medicine choice, dose, route and duration are separate decisions. Culture results may support de-escalation but do not justify treating colonisation without a compatible clinical context.
[1][3]Prescribe with a review plan
Where useful, collect microbiological samples before treatment without delaying emergency care. Suspected severe bacterial infection requires immediate escalation and protocol-based antibiotics. Record indication, agent, route, intended duration and review date. Look for a source requiring drainage or another intervention rather than repeatedly changing empirical treatment.
[3]Review response and tolerability
At review, reassess clinical progress, results and the initial diagnosis. The prescriber may continue, narrow, change route or stop therapy accordingly. In outpatient care, specify when worsening, breathlessness, confusion, intolerance or failure to improve should prompt reassessment. Do not share antibiotics or reuse leftovers; treatment changes require clinical advice.
[3][2]A learning situation
FICTIONAL CASE · SELF-REFLECTION WITHOUT A SCORE
An otherwise healthy adult has a recent cough with green sputum. They are stable; examination and observations do not suggest pneumonia. They request an antibiotic that seemed helpful last year.
Does sputum colour justify an antibiotic?
Read the reasoning
No. Colour alone does not distinguish viral bronchitis from bacterial infection. Explain the decision, offer appropriate symptom care and agree on reassessment criteria. Deterioration or a new warning sign requires another examination without waiting for the scheduled review.
References and scope
- Outpatient Clinical Care for Adults ↗
- Core Elements of Outpatient Antibiotic Stewardship ↗
- Start smart then focus: antimicrobial stewardship toolkit for inpatient care settings ↗
- Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use — Recommendations ↗
Original educational synthesis for adult first-line practice. International references must be interpreted with the clinical setting and local care pathways. Independent human scientific review remains to be confirmed.