Minimum Criteria for Antibiotics Tool

This decision support tool can help prescribers determine appropriate treatment for nursing home residents suspected of having one of three common infections: urinary tract, skin and soft tissue, and lower respiratory. It uses criteria from the SBAR forms included in the Minimum Criteria for Common Infections Toolkit. Notes with additional guidance on other factors are also included to assist prescribers in making decisions.

To use the tool, first select the type of suspected infection. Then answer the questions that appear on screen. When the tool has enough data to make a determination, it will tell you if the minimum criteria for antibiotics are met and identify other actions to consider.

Green check mark: minimum criteria for antibiotics are met.
Red X: minimum criteria for antibiotics are not met.

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Minimum Criteria for Antibiotics Tool

CHOOSE POTENTIAL INFECTION (CHOOSE ONE): Urinary Tract Infection2 Skin and Soft Tissue Infection11 Lower Respiratory Tract Infection15
Does the resident have: No indwelling catheter3 Indwelling catheter 7 Notes: Urine cultures should not be performed on a scheduled basis (e.g., monthly). Urine cultures should not be used to identify UTIs in the absence of symptoms. Smelly or cloudy urine is not a symptom of a UTI. Residents with an intermittent catheter or a condom catheter should be evaluated as if they are not catheterized. Urine cultures should be used to identify the most appropriate antibiotic. For residents with acute dysuria, it may be appropriate to initiate empirical antibiotic therapy; but for all other symptoms, wait for a urine culture. For residents who regularly run a lower temperature, use a temperature of 2°F (1°C) above the baseline as a definition of a fever.
Does the resident have acute dysuria? Yes 9 No 4
Fever (temperature > 100ºF [37.9ºC] or two repeated temperatures of 99°F [37°C]) Yes 5 No 6
Does the resident have any of these additional symptoms? Check all that apply. Urgency Urgency Frequency Frequency Suprapubic pain Suprapubic pain Gross hematuria Gross hematuria Costovertebral angle tenderness Costovertebral angle tenderness Urinary incontinence Urinary incontinence None of the above None of the above Continue 9 Continue 10
Does the resident have at least TWO of the following? Check all that apply. Urgency Urgency Frequency Frequency Suprapubic pain Suprapubic pain Gross hematuria Gross hematuria Urinary incontinence Urinary incontinence None of the above None of the above Continue 9 Continue 10
Does the resident have any of the following symptoms? Check all that apply. Fever (temperature > 100ºF [37.9ºC] or two repeated temperatures of 99°F [37°C]) Fever (temperature > 100ºF [37.9ºC] or two repeated temperatures of 99°F [37°C]) New or worsening costovertebral tenderness New or worsening costovertebral tenderness New suprapubic pain New suprapubic pain New or worsening delirium (sudden onset of confusion, disorientation, dramatic change in mental status) New or worsening delirium (sudden onset of confusion, disorientation, dramatic change in mental status) New or worsening rigors with or without identified cause New or worsening rigors with or without identified cause New or worsening hypotension (e.g., significant change from baseline BP or a systolic BP <90) New or worsening hypotension (e.g., significant change from baseline BP or a systolic BP <90) None of the above None of the above Continue 9 Continue 10

Minimum criteria for initiating antibiotics are MET
Minimum criteria for initiating antibiotics are NOT MET Consider initiating the following: Encourage liquid intake daily until urine is light yellow in color (suggest an amount and duration). Record fluid intake (suggest frequency and duration). Assess vital signs, including temp (suggest frequency and duration). Request notification if symptoms worsen or if unresolved (suggest duration).
Does the resident have new or increasing purulent drainage at a wound, skin, or soft-tissue site? Yes 13 No 12 Notes: For residents who regularly run a lower temperature, use a temperature of 2°F (1°C) above the baseline as a definition of a fever. Herpes zoster is a virus and therefore does not require antibiotics but appropriate antivirals. Deeper infections such as bursitis may present with similar signs/symptoms. Underlying osteomyelitis should be considered when managing a resident with an infected diabetic or decubitus ulcer. Thromboembolic disease should be considered when a resident presents with an erythematous or swollen leg. These criteria do not apply to residents with burns. Gout can at times be mistaken for cellulitis or vice versa.
Does the resident have at least TWO of the following? Check all that apply. Fever (temperature > 100ºF [37.9ºC] or two repeated temperatures of 99°F [37°C]) Fever (temperature > 100ºF [37.9ºC] or two repeated temperatures of 99°F [37°C]) Redness Redness Tenderness Tenderness Warmth Warmth Swelling that is new or increasing at the affected site Swelling that is new or increasing at the affected site None of the above None of the above Continue13 Continue14
Minimum criteria for initiating antibiotics are MET Consider initiating the following: For discomfort or prior to cleaning/dressing changes, use acetaminophen or other pain relievers as needed.
Minimum criteria for initiating antibiotics are NOT MET Consider initiating the following: For discomfort or prior to cleaning/dressing changes, use acetaminophen or other pain relievers as needed. Assess vital signs, including temp (suggest frequency and duration) ; and/or Notify physician/nurse practitioner/physician assistant if symptoms worsen or if unresolved in (suggest duration).
Does the resident have: No Fever16 Fever of 100ºF (37.9ºC) but less than 102ºF (38.9ºC)18 Fever of >102ºF (38.9ºC)20
Does the resident have chronic obstructive pulmonary disease (COPD)? Yes 17 No 17
Is the resident over the age of 65? Yes 21 No 24
Does the resident have a productive cough? Yes 19 No 24
What symptoms does the resident have? (check all that apply) Respiratory rate >25 breaths per minute Respiratory rate >25 breaths per minute Pulse >100 Pulse >100 Delirium (sudden onset of confusion, disorientation, dramatic change in mental status) Delirium (sudden onset of confusion, disorientation, dramatic change in mental status) Rigors (shaking chills) Rigors (shaking chills) None of the above None of the above Continue23 Continue24
What symptoms does the resident have? (check all that apply) Respiratory rate >25 breaths per minute Respiratory rate >25 breaths per minute Delirium (sudden onset of confusion, disorientation, dramatic change in mental status) Delirium (sudden onset of confusion, disorientation, dramatic change in mental status) Productive cough Productive cough None of the above None of the above Continue23 Continue24
Does the resident have new or increased cough with purulent sputum production? Yes 22 No 24
What symptoms does the resident have? (check all that apply) Respiratory rate >25 breaths per minute Respiratory rate >25 breaths per minute Delirium (sudden onset of confusion, disorientation, dramatic change in mental status) Delirium (sudden onset of confusion, disorientation, dramatic change in mental status) None of the above None of the above Continue23 Continue24
Minimum criteria for initiating antibiotics are MET Avoid antihistamines (especially Benadryl) and consider initiating the following: For cough, consider using a cough suppressant. For discomfort, consider using acetaminophen or other pain reliever. Consider using a heating pad or hot water bottle on the chest at bedtime (suggest duration in minutes), although caution is advised. Raise upper body (use multiple pillows) to sleep/rest. Encourage fluid by mouth or gastrostomy tube (G-tube) until urine is light yellow in color (suggest duration in minutes). Encourage saltwater gargles. Record fluid intake (suggest duration) Initiate intravenous fluid hydration and/or initiate hypodermoclysis Request a chest x ray.
Minimum criteria for initiating antibiotics are NOT MET Consider initiating the following: Assess vital signs, including temperature (suggest frequency and duration). Notify physician/nurse practitioner/physician assistant if symptoms worsen or if unresolved (suggest duration). For cough, consider using a cough suppressant. For discomfort, consider using acetaminophen or other pain reliever. Consider using a heating pad or hot water bottle on the chest at bedtime for (suggest duration in minutes), although caution is advised. Raise upper body (use multiple pillows) to sleep/rest. Encourage fluid by mouth or gastrostomy tube (G-tube) until urine is light yellow in color (suggest frequency and duration). Encourage saltwater gargles. Record fluid intake (suggest duration). Initiate intravenous fluid hydration and/or initiate hypodermoclysis. Request a chest x ray.
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