Introduction
These antibiotic guidelines are intended to give a basic overview of the types of antibiotic used to treat various kinds of infection. They should not be used as clinical guidelines. Resistance patterns and drug approvals vary from country to country, and hospital to hospital and as such national and / or local antibiotic guidelines should be used wherever possible. If uncertainty still exists, you may wish to contact your local infectious diseases consultant for specific advice.
Antibiotic Guidelines in Adults
Key:
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- Penicillin allergy alternative (generally this is erythromycin or clarithromycin)
Remember that the doses below are adults doses; children’s doses (and the drugs and antibiotic guidelines used for children) may be different.
Condition | Drug | Dose | Info | |
U R O L O G Y | UTI – uncomplicated | Nitrofurantoin Trimethoprim Cefalexin – and fluids Co-amoxiclav/ciprofloxacin used for resistant organisms MRSA – nitrofurantoin and trimethoprim and doxycycline | 50mg qds – 3 days 200mg bd – 3 days 500mg bd – 3 days | Nitro drugs is contra-indicated when GFR <50, so be careful in the elderly! always assume in men that a UTI is complicated until proven otherwise |
Ciprofloxacin Trimethoprim Tetracycline | 500mg bd – 28 days 200mg bd – 28 days 500mg bd – 28 days | |||
Pyelonephritis (and complicated UTI’s) | Ciprofloxacin / cefuroxime Co-amoxiclav IV – gentamycin | 500mg bd – 7 days 625mg tds – 14 days 5mg/Kg when pathogen unknown | Nitrofurantoin is NOT effective. | |
Genital bacterial infections (General) | Metronidazole | 400mg bd 5-7 days | ||
PID | Metronidazole Doxycycline | 400mg bd 14 days 100mg bd 14 days | ||
Doxycycline | 100mg bd 7 days | Can also give Azithromycin one off dose to increase compliance | ||
Ciprofloxacin Amoxicilin Probenicid | 500mg single dose 3g single dose 1g single dose | |||
Herpes virus (and for freq. Reccur.) | Aciclovir Aciclovir | 200mg x5 for 5 days 400mg bd – 6 months | Herpes virus also causes shingles. In which case, give 800mg x5, for 5 days | |
Vaginal fungal infections | Clotrimazole pessary | 500mg – single dose | ||
R E S P I R A T O R Y | Lower respiratory tract infection (LRTI) in previously well patients | Amoxicillin Erythromycin | 500mg tds – 10 days 1g bd – 10 days | Amoxicillin can cause allergic reaction in those allergic to penicillin. Clarithromycin is the alternative used normally. |
COPD acute exacerbation | Amoxicillin Co-amoxiclav Ciprofloxacin Clarithromycin | 500mg tds – 7 days 625mg tds – 7days 500mg bd – 7 days 500mg bd – 7 days | ||
Erythromycin | 500mg qds – 14 days | |||
————————– | ————————- | A LRT infection usually in the first 2 years of life. Viral; don’t give antibiotics! | ||
Amoxicillin Doxycycline | 500mg tds – 14 days 100mg bd 14 days | |||
Pneumonia | 0 – Amoxicillin (clarithro) 1 – Amoxicillin + clarithro. 2- IV Amox. + clarithro. 3-5 – IV augmentin + clarith | 1g (500mg) single dose, or 500mg (500mg) – 7 days 500mg (each) – 7 days 1g IV + 500mg IV – review @ 24hours | Treatment is dependent on CURB 65 score. | |
E N T | Amoxicillin Erythromycin Co-amoxiclav | 500mg tds – 10 days 250mg qds – 5 days 375mg tds – 5 days | Special rules apply for children (often antibiotics are not used | |
Topical: Oral: For fungus: | Locorten-viofrom Betnesol-N Flucloxacillin Erythromycin Clotrimazole 1% soln | 3 drops bd – 7days 3 drops qds – 7 days 250mg qds – 7 days 250mg qds – 7 days 3 drops tds – 4 weeks | Don’t forget anaesthesia – it is very painful! If this condition is recurrent consider underlying pathology such as diabetes, or exfoliative skin conditions. | |
Dental infections(gingivitis and abscess) | Penicillin V – AND – Chlorohexidine mouthwash Erythromycin Metronidazole | 500mg qds – 5-7 days 10 ml bd 500mg qds – 5-7 days 400mg tds – 5-7 days | ||
Pharyngitis | Penicillin V Erythromycin | 500mg qds – 7 days 1g bd – 7 days | Remember – most sore throats are viral and you should not prescribe anything – see the algrythmn. It is estimated up to 75% of patients are prescribed antibiotics – probably due to patient expectations and the doctor not wanting to let them down | |
Oral candidiasis | Nystatin (can be pastille or suspension) Fluconazole (tablet) | 100k units 4xday – 7days 50mg od – 7-14 days | Remember – this is common in immunosupressed individuals. Fluconazole can also be used in loads of other fungal infections | |
Acute Sinusitis | Amoxicillin Oxytetracycline | 500mg tds – 5 days 250mg qds – 5 days | ||
S K I N | Animal and human bites | Co-amoxiclav | 375 tds – 7 days | Cat and dog bites are generally infected with anaerobic bacteria |
Impetigo / Cellulitis | Flucloxacillin Fusidic acid cream Clarithrymycin Erythromycin | 500mg qds – 5-14 days Qds – 5 days 500mg bd 7-14 days | Consider combining both oral and topical treatments. When cellulitis, give flucoloxacillin and penicillin. | |
Benzoyl peroxide cream +/- Clindamycin / tetracycline Oxytetracycline doxycycline | This is not an antibiotic. If infected 500mg bd – 3 months+ 100mg od – 3 months+ | Only give antibiotics when this is infected. | ||
MRSA colonation / infection AND/OR patient systemically unwell | Vancomycin IV –AND- Oral ciprofloxacin | 500mg bd | Make sure you give two antibiotics! Also advisable to cover infected area with iodine or chlorohexadine dressing | |
Fungal hair skin and nails | Various topical and oral agents – too many to list | FLUCONAZONE – is probably the most widely used agent. | Fluconazole is given once weekly | |
Mastitis | Metronidazole | |||
Necrotising Fascitis | Give all of the following: Vanomycin IV Clindamycin IV Ciprofloxacin IV | 900mg tds 400mg bd | Do this whilst you are waiting for advice! Seek urgent surgical and microbiological advice | |
G I | Primary care: 1)Salmonella / shingella 2)Campylobacter 3)Giardia | 1)Ciprofloxacin 2)Erythromycin 3)Metronidazole | 500mg bd – 3 days 500mg bd – 3 days 2g od – 3 days | The vast majority are self- limiting and do not require intervention. When causatory organism is not known, use ciprofloxacin. Note that the public health department needs to be notified of all cases of food poisoning. Also remember that many antibiotics can cause diarrhoea! – by killing the ‘good’ bacteria, and allowing the resistant strains to multiply . Metronidazole is good because it is good at attacking anaerobic bacteria. |
Peritonitis | Amoxicillin – AND – Gentamycin – AND – Metronidazole Vancomycin (instead of amoxicillin) | 1g IV tds 5mg/Kg od 500mg IV tds | Use 3 antibiotics! | |
Intra-abdominal sepsis – hospital acquired Oral continuation: | Peperacillin – AND – Gentamycin Amoxicillin – AND – ciprofloxacin – AND – Metronidazole | 4.5g IV tds 5mg/Kg od 500mg tds 500mg bd 400mg tds | Consider MRSA – particularly if hospital acquired. If it is present use IV vanomycin | |
– | – | Should be managed surgically, and antibiotics only used when there are signs of systemic infection | ||
Severe Acute pancreatitis | – | – | Very severe disease requires antibiotic therapy. Usually involving co-amoxiclav / amoxicillin. | |
Sepsis – this is a word that basically means serious systemic inflammation caused by infections (SIRS). The term septicaemia is an older word that has a similar meaning. | Tazocin* Gentamicin | 4.5g every 8 hours 5mg/Kg – but – only use if there is septic shock with hypotension | Patients in shock and who are seriously ill should be started on fluid replenishment and antibiotics right away without waiting for any test results. | |
O T H E R S | Trauma | Flucloxacillin IV + Metronidazole IV OR – if more serious Co-amoxiclav IV | 1g 6hrs – review@24hrs 500mg 8 hrs 1.2g tds – 3 days+ | These treatments are prophylactic for bone/joint infections. |
Isoniazid Rifampicin Pyrazinamide Ethambutol | 300mg od – 6 months 600mg od – 6 months 2g daily – 2 months 15mg/Kg od – 2 months | Ethambutol can be omitted if HIV negative, and low risk of isoniazid resistance (i.e. no previous treatment for TB) there are several combination pills available for use after discharge from hospital | ||
Ceftriaxone IV Chloramphenicol | 2g bd until improvement, then 3g od | All patients with suspected meningitis need to receive the first dose within 30 minutes of arrival | ||
Indolent (not acutely unwell) Benzylepenicillin IV + Gentamicin IV Acutely unwell (or IV drug user) Flucloxacillin IV | 1.2g 6x a day 1mg/Kg 3x a day 2g qds if <85Kg 2g 6xday >85Kg | Note that the dose of flucloxacillin varies with patient’s weight. | ||
Flucloxacillin + Amoxicillin clarithromycin | 1g qds 500mg qds 500mg bd |
*brand name for piperacillin + tazobactam combination
Antibiotic guidelines and alcohol
Of all the antibiotics, only METRONIDAZOLE truly reacts with alcohol. It will cause severe vomiting and GI disturbance if alcohol is taken with the drug.
However, you should still advise patients that taking alcohol with antibiotics may prolong the recovery time, as it is generally a toxin.
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