Antibiotic guidelines
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The following is based on current BNF guidelines:
Skin
Ear, nose & throat
Genital system
Gastrointestinal
*a combined topical antibiotic and corticosteroid is generally used for mild/moderate cases of otitis externa
Respiratory system
| Condition | Recommended treatment |
|---|---|
| Exacerbations of chronic bronchitis | Amoxicillin or tetracycline or clarithromycin |
| Uncomplicated community-acquired pneumonia | Amoxicillin (Doxycycline or clarithromycin in penicillin allergic, add flucloxacillin if staphylococci suspected e.g. In influenza) |
| Pneumonia possibly caused by atypical pathogens | Clarithromycin |
| Hospital-acquired pneumonia | Within 5 days of admission: co-amoxiclav or cefuroxime More than 5 days after admission: piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin) |
Urinary tract
| Condition | Recommended treatment |
|---|---|
| Lower urinary tract infection | Trimethoprim or nitrofurantoin. Alternative: amoxicillin or cephalosporin |
| Acute pyelonephritis | Broad-spectrum cephalosporin or quinolone |
| Acute prostatitis | Quinolone or trimethoprim |
Skin
| Condition | Recommended treatment |
|---|---|
| Impetigo | Topical fusidic acid, oral flucloxacillin or erythromycin if widespread |
| Cellulitis | Flucloxacillin (clarithromycin or clindomycin if penicillin-allergic) |
| Erysipelas | Phenoxymethylpenicillin (erythromycin if penicillin-allergic) |
| Animal or human bite | Co-amoxiclav (doxycycline + metronidazole if penicillin-allergic) |
| Mastitis during breast-feeding | Flucloxacillin |
Ear, nose & throat
| Condition | Recommended treatment |
|---|---|
| Throat infections | Phenoxymethylpenicillin (erythromycin alone if penicillin-allergic) |
| Sinusitis | Amoxicillin or doxycycline or erythromycin |
| Otitis media | Amoxicillin (erythromycin if penicillin-allergic) |
| Otitis externa* | Flucloxacillin (erythromycin if penicillin-allergic) |
| Periapical or periodontal abscess | Amoxicillin |
| Gingivitis: acute necrotising ulcerative | Metronidazole |
Genital system
| Condition | Recommended treatment |
|---|---|
| Gonorrhoea | Intramuscular ceftriaxone + oral azithromycin |
| Chlamydia | Doxycycline or azithromycin |
| Pelvic inflammatory disease | Oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole |
| Syphilis | Benzathine benzylpenicillin or doxycycline or erythromycin |
| Bacterial vaginosis | Oral or topical metronidazole or topical clindamycin |
Gastrointestinal
| Condition | Recommended treatment |
|---|---|
| Clostridium difficile | First episode: metronidazole Second or subsequent episode of infection: vancomycin |
| Campylobacter enteritis | Clarithromycin |
| Salmonella (non-typhoid) | Ciprofloxacin |
| Shigellosis | Ciprofloxacin |
*a combined topical antibiotic and corticosteroid is generally used for mild/moderate cases of otitis externa