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SUMMARY OF ABx Tx IN ADULTS (COMMON BACTERIAL INFECTIONS)

Summary of antibiotic treatments in adults


CENTRAL NERVOUS SYSTEM
Infection
Treatment options and dose
Option in penicillin
Notes
allergy
Suspected
Benzylpenicillin (penicillin
Urgent transfer to hospital
meningococcal
G) 1.2g single dose by iv/im
should not be delayed in
disease (meningitis inj while arranging transfer
order to give antibiotics
with nonto hospital (if administering
blanching
im, give as proximally as
rash/meningococca possible)
l septicaemia)
EAR, NOSE AND THROAT
Infection
Treatment options and dose Option in penicillin
Notes
allergy
Acute diffuse otitis
Flucloxacillin 250500mg Erythromycin 250
Oral antibiotics rarely
externa
qds for 7 days
500mg qds
indicated. Consider if signs
or clarithromycin 25 of systemic infection or if
0500mg bd for 7
infection is spreading outside
days
the ear canal.
Acute otitis media
Amoxicillin 13.3mg/kg
Clarithromycin 250 Routine prescription of
(max 1g) tds for 5 days
500mg bd for 5 days antibiotics not recommended
orerythromycin 250 in uncomplicated cases.
500mg qds for 5
days
Acute sinusitis
Amoxicillin 500mg1g tds Doxycycline 200mg Antibiotics not recommended
for 7 days
stat then 100mg od
unless high risk of
or phenoxymethylpenicillin for 6 days or
complications or acute
(penicillin V) 500mg qds
erythromycin 500mg bacterial sinusitis suspected.
for 7 days
qds or
clarithromycin 500m
g bd for 7 days
If no improvement after 48 If no improvement
hrs or poorly tolerated:
after 48 hrs or poorly
Co-amoxiclav 500/125mg
tolerated:azithromyc
tds for 7 days
in 500mg od for 3
days
Dental abscess
Amoxicillin 500mg tds for Clarithromycin 500
Antibiotics recommended
5 days
mg bd for 5 days
only if severe infection,
or phenoxymethylpenicillin
systemic symptoms or high
(penicillin V) 500mg1g
risk of complications. Treat if
qds for 5 days
no access to dentist, advise
If infection severe or
urgent dental consultation.
spreading,
add metronidazole 400mg
tds for 5 days (or if not
tolerated,clindamycin 300
mg qds for 5 days)
Sore throat
Phenoxymethylpenicillin
Erythromycin 250m Antibiotics recommended
(pharyngitis,
(penicillin V) 500mg qds
g500mg qds or
only if risk of serious

tonsillitis)

Infection
Acute infective
conjunctivitis

Infection
Acute
diverticulitis
(mild,
uncomplicated)
Gastroenteritis
H. pylori

Infection
Acute pelvic
inflammatory
disease (PID)

Acute
uncomplicated
gonorrhoea

for 10 days

clarithromycin 250m
g500mg bd for 5
days

EYE
Option in penicillin
allergy
Chloramphenicol 1 drop every 2 hrs for 2 days then
every 4 hrs or apply oint at night (if drops used
during the day) or tds or qds (if used alone); continue
for 48 hrs after cure.
Fusidic acid 1% 1 drop bd, continued for 48 hrs after
cure.
GASTROINTESTINAL TRACT
Treatment options and dose
Option in penicillin
allergy
Co-amoxiclav 500/125mg tds Metronidazole 400m
for 7 days
g tds
+ciprofloxacin 500m
g bd for 7 days
Treatment options and dose

complications, marked
systemic upset, valvular heart
disease or Centor score 3.
Consider delayed prescribing.

Notes
Remove contact lenses.
Routine prescription of
topical antibiotics not
recommended in
uncomplicated cases.
Consider delayed prescribing.
Notes
Refer to hospital if symptoms
persist after 48 hrs despite
conservative management.
Antibiotics rarely indicated.
Refer to summary of NICE
recommendations for the
eradication of H. pylori.

GENITAL TRACT
Treatment options and dose
Option in penicillin
allergy
Low risk of gonococcal
infection: Ofloxacin 400mg bd
+ oral metronidazole 400mg bd
for 14 days.
Alternatively,ceftriaxone 500m
g single dose by im inj,
then doxycycline100mg bd
+ metronidazole400mg bd,
both for 14 days; or
ceftriaxone 500mg single dose
by im inj, then azithromycin 1g
per week for 2 weeks.
High risk of gonococcal
infection: Ceftriaxone 500mg
single dose by im inj,
thendoxycycline 100mg bd
+metronidazole 400mg bd,
both for 14 days.
Ceftriaxone 500mg single dose If infection
by im inj + azithromycin 1g
sensitive to
single dose
quinolones: Ciprofl
If im inj contraindicated or
oxacin 500mg

Notes
Pregnant women with
suspected PID require
hospital admission for iv
antibiotics. Exclude ectopic
pregnancy before starting
treatment. Refer patient to
sexual health clinic for
screening/treatment of
partners. Test for STIs ideally
before starting antibiotics.

Ideally, refer patient to sexual


health clinic. Partners should
also be treated.

refused: Cefixime 400mg


orally as single dose
+ azithromycin 1g single dose
Bacterial
vaginosis

Chlamydia
(uncomplicated)

Infection
Acute bronchitis

Communityacquired
pneumonia

Exacerbation of
COPD

Infection
Acute cellulitis

+ azithromycin 1g,
or ofloxacin 400mg
+azithromycin 1g,
all as single doses
Oral metronidazole 400mg bd for 57 days (or a
single dose of 2g not recommended in pregnancy
or lactation)
Intravaginal metronidazole 0.75% gel: 1 applicatorful
every night for 5 nights
Intravaginal clindamycin 2% cream: 1 applicatorful
every night for 7 nights
Azithromycin 1g single dose
Doxycycline 100mg bd for 7
days
In pregnancy or
lactation:Azithromycin 1g
single dose or
amoxicillin 500mg tds for 7
days or erythromycin 500mg
qds for 7 days
RESPIRATORY TRACT
Treatment options and dose
Option in penicillin
allergy
Amoxicillin 500mg tds for 5 Clarithromycin 500
days
mg bd for 5 days
Doxycycline 200mg stat then
100mg od for 4 days
2nd-line treatment: Coamoxiclav 500/125mg tds for
5 days
Amoxicillin 500mg tds for 7 Doxycycline 200mg
days
stat then 100mg od
Severe infection: Consider
for 710 days
amoxicillin 500mg tds +
or clarithromycin500
clarithromycin 500mg bd, or mg bd for 7 days
doxycycline (see next
column); treat for 710 days
Amoxicillin 500mg tds for 5 Erythromycin 500m
days
g qds or
Doxycycline 200mg stat then clarithromycin 500m
100mg od for 4 days
g bd for 5 days
Risk factors for antibiotic
resistance: Co-amoxiclav
500/125mg tds for 5 days
SKIN AND SOFT TISSUE
Treatment options and
Option in penicillin
dose
allergy
Flucloxacillin 500mg qds Erythromycin 500mg
for 7 days
qds
Mild facial infection: Co- orclarithromycin 500mg
amoxiclav 500/125mg tds bd for 7 days
for 7 days

Partners should also be


treated.

Notes
Antibiotics not recommended
for patients who are
otherwise well. Consider
delayed prescribing.

Consider doxycycline alone


or with amoxicillin if
Mycoplasma
pneumoniae suspected.

Notes
Add ciprofloxacin (750mg bd
for 7 days) if exposed to
fresh water
ordoxycycline (100mg bd for

Bites: animal
(cats and dogs)

Bites: human

Impetigo

Infection
Acute bacterial
prostatitis

Acute
pyelonephritis

Uncomplicated
lower UTI

Co-amoxiclav 250/125mg
500/125mg tds for 7
days

7 days) if exposed to salt


water.
Give antibiotics for all cat
bites, puncture wounds, bites
to the hand, foot, face, joints,
tendons or ligaments, or if
suspected fracture.
Antibiotics not usually
required if bite >48 hours old
and no sign of infection.
Prophylactic antibiotic
recommended for all bites
<72 hours old, even if no
sign of infection.

Metronidazole 400mg
tds
+doxycycline 100mg bd
for 7 days
Metronidazole 400mg
tds
+oxytetracycline 250
500mg qds for 7 days
Co-amoxiclav 250/125mg Metronidazole 400mg
500/125mg tds for 7
tds + :
days
doxycycline 100mg bd
or erythromycin 250
500mg qds or
clarithromycin 250
500mg bd, all for 7 days
Localised non-bullous infection: Fusidic acid 2%
If fusidic acid ineffective:
cream/oint tdsqds for 7 days
retapamulin 1% oint bd for 5
days
Extensive, severe or bullous
Clarithromycin 250
infection or if impractical to
500mg bd for 7 days
use topical therapy:
or
Flucloxacillin 250500mg
erythromycin 250
qds for 7 days
500mg qds for 7
days
URINARY TRACT
Treatment options and dose
Option in penicillin
Notes
allergy
Ciprofloxacin 500mg bd for 28 days
Review treatment when urine
or ofloxacin 200mg bd for 28 days
culture results available.
If quinolone contraindicated: Trimethoprim 200mg
bd for 28 days
Ciprofloxacin 500mg bd for
Review treatment when urine
7 days
culture results available.
Co-amoxiclav 500/125mg tds
Admit to hospital if no
for 14 days
response to antibiotics within
In
24 hrs.
pregnancy: Cefalexin 500mg
bd for 1014 days
Trimethoprim 200mg bd for
Follow local antibiotic
3 days in women (510 days
policies. Review treatment
if renal impairment,
when urine culture results
abnormal urinary tract or
available. Nitrofurantoin is
immunosuppression) and 7
preferred to trimethoprim in
days in men or indwelling
recurrent infection. Treatment
catheter
may be delayed in nonNitrofurantoin 50mg qds (or
pregnant, non-catheterised
100mg modified-release bd)
women with mild symptoms,
for 3 days in women, 7 days
no visible haematuria, and
in men or indwelling catheter

In
pregnancy: Nitrofurantoin or
trimethoprim as above but for
7 days, or cefalexin 500mg
bd or 250mg qds for 7 days

normal immunity, renal


function and renal tract.

Key: od= once daily, bd= twice daily, tds= three times daily, qds= four times daily, stat= at once.

Treatment options and adult dosages derived from NICE CKS, HPA Management of Infection
Guidance for Primary Care for Consultation and Local Adaptation 2013 and/or SPCs
Ref: http://www.mims.co.uk/summary-antibiotic-treatments-adults/infections-andinfestations/article/882429