Summary of Antibiotic Treatments in Adults
Dose regimens for common bacterial infections.
| Summary of antibiotic treatments in adults | |||
|---|---|---|---|
| Central Nervous System | |||
| Infection | Treatment options and dose | Option in penicillin allergy | Notes |
| Suspected meningococcal disease (meningitis with non-blanching rash/meningococcal septicaemia)* | Benzylpenicillin (Penicillin G) 1.2g single dose by iv/im inj while arranging transfer to hospital | Urgent transfer to hospital should not be delayed in order to give antibiotics | |
| Ear, Nose and Throat | |||
| Infection | Treatment options and dose | Option in penicillin allergy | Notes |
| Acute diffuse otitis externa | Flucloxacillin 250–500mg qds for 7 days |
Erythromycin 250–500mg qds or clarithromycin 250–500mg bd for 7 days | Oral antibiotics rarely indicated. Consider if signs of systemic infection or if infection is spreading outside the ear canal. |
| Acute necrotising ulcerative gingivitis |
Metronidazole 200–400mg tds for 3 days | Urgent referral to a dentist required. | |
| Amoxicillin 250–500mg tds for 3 days | |||
| Acute otitis media | Amoxicillin 500mg–1g tds for 5 days | Erythromycin 500mg qds for 5 days or clarithromycin 250mg bd for 5 days | Routine prescription of antibiotics not recommended in uncomplicated cases. |
| Acute sinusitis | Amoxicillin 1g tds for 7 days | Erythromycin 500mg qds or clarithromycin 500mg bd for 7 days or doxycycline 200mg stat then 100mg od for 6 days | Antibiotics not recommended for most people unless symptoms persistent (>7 days) or severe/worsening significantly. |
| In pregnancy: Erythromycin 500mg qds for 7 days |
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| Dental abscess | Amoxicillin 250–500mg tds for 5 days or 3g oral powder stat repeated once after 8 hours | Antibiotics recommended only if signs of severe infection, systemic symptoms or high risk of complications. Treat if no access to dentist, advise urgent dental consultation. | |
| Metronidazole 200–400mg tds for 5 days | |||
| Sore throat (pharyngitis, tonsillitis) | Phenoxymethylpenicillin (Penicillin V) 500mg qds for 10 days | Clarithromycin 250mg–500mg bd or erythromycin 500mg qds for 5 days | Antibiotics not usually indicated. See NICE guidance on when antibiotics should be prescribed.** |
| Eye | |||
| Infection | Treatment options and dose | Option in penicillin allergy | Notes |
| Acute infective conjunctivitis | Chloramphenicol 1 drop every 2 hours for 2 days then every 4 hours for 5 days (+/– oint at bedtime for 7 days) or apply oint qds for 2 days then bd for 5 days. | Remove contact lenses. Routine prescription of topical antibiotics not recommended in uncomplicated cases. |
|
| Fusidic acid 1% 1 drop bd for 7 days. | |||
| Gastrointestinal tract | |||
| Infection | Treatment options and dose | Option in penicillin allergy | Notes |
| Acute diverticulitis | Co-amoxiclav 500/125mg tds for 7 days | Refer to hospital if symptoms persist after 48 hours despite conservative management at home. Also if significant co-morbidity or suspected complications, pain cannot be managed by paracetamol or hydration cannot easily be maintained. | |
| Metronidazole 400mg tds + ciprofloxacin 500mg bd for 7 days | |||
| Gastroenteritis | Antibiotics rarely indicated. | ||
| H. pylori | Refer to summary of NICE recommendations for the eradication of H. pylori. | ||
| Genital tract | |||
| Infection | Treatment options and dose | Option in penicillin allergy | Notes |
| Acute pelvic inflammatory disease | High risk of gonococcal infection: Ceftriaxone 250mg single dose by im inj followed by doxycycline 100mg bd + metronidazole 400mg bd for 14 days Low risk of gonococcal infection: Ofloxacin 400mg bd + metronidazole 400mg bd for 14 days |
Pregnant women with suspected PID require hospital admission for iv antibiotics. | |
| Acute uncomplicated gonorrhoea |
Ceftriaxone 500mg single dose by im inj + azithromycin 1g single dose. If im inj contraindicated or refused: Cefixime 400mg orally as single dose + azithromycin 1g single dose. | Ciprofloxacin 500mg single dose + azithromycin 1g single dose or ofloxacin 400mg single dose + azithromycin 1g single dose | Note local antibiotic sensitivity patterns. Ideally, refer patient to GUM clinic or a general practice providing an enhanced sexual health service for treatment. |
| Bacterial vaginosis | Oral metronidazole 400mg bd for 7 days (or a single dose of 2g – not recommended if pregnant or breastfeeding) | ||
| Intravaginal metronidazole: 1 applicatorful 0.75% gel each night for 5 nights | |||
| Intravaginal clindamycin: 1 applicatorful 2% cream each night for 7 nights |
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| Chlamydia (uncomplicated) | 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 | |||
| Infection | Treatment options and dose | Option in penicillin allergy | Notes |
| Acute bronchitis | Amoxicillin 500mg tds for 5 days | Doxycycline 200mg stat then 100mg od for 4 days or clarithromycin 250mg bd for 5 days | Antibiotics not recommended for patients who are otherwise well. 2nd-line treatment: Co-amoxiclav 500/125mg tds for 5 days or doxycycline (if not taken before) 200mg stat then 100mg od for 4 days. |
| Community-acquired pneumonia |
Amoxicillin 500mg tds for 7 days | Clarithromycin 500mg bd for 7 days or doxycycline 200mg stat then 100mg od for 6 days | Consider amoxicillin + clarithromycin if severe. Consider doxycycline alone or with amoxicillin if Mycoplasma pneumoniae suspected. |
| Exacerbation of COPD | Amoxicillin 500mg tds for 7 days | Erythromycin 500mg qds for 7 days or clarithromycin 500mg bd for 7 days or doxycycline 200mg stat then 100mg od for 6 days | If patient has risk factors for antibiotic resistance: Co-amoxiclav 500/125mg tds for 7 days. |
| Skin and soft tissue | |||
| Infection | Treatment options and dose | Option in penicillin allergy | Notes |
| Acute cellulitis | Flucloxacillin 500mg qds for 7 days | Erythromycin 500mg qds or clarithromycin 500mg bd for 7 days | Add ciprofloxacin(750mg bd for 7 days) if exposed to fresh water or doxycycline(200mg stat then 100mg od for 6 days) if exposed to salt water. |
| If mild facial infection: Co-amoxiclav 500/125mg tds for 7 days | |||
| Bites: animal (cats and dogs) |
Co-amoxiclav 250/125mg–500/125mg tds for 7 days | Metronidazole 400mg tds + oxytetracycline 250–500mg qds for 7 days or metronidazole 400mg tds + doxycycline 100mg bd for 7 days | Antibiotics not usually required if bite >48 hours old and no sign of infection. Consider tetanus prophylaxis. |
| Bites: human | Co-amoxiclav 250/125mg–500/125mg tds for 7 days | Metronidazole 400mg tds + erythromycin 250–500mg qds for 7 days or metronidazole 400mg tds + clarithromycin 500mg bd for 5 days or metronidazole 400mg tds + doxycycline 100mg bd for 7 days | Prophylactic antibiotic recommended for all bites <72 hours old, even if no sign of infection. Consider tetanus prophylaxis. |
| Impetigo | Localised infection: Fusidic acid 2% cream/oint tds for 7 days |
If fusidic acid ineffective or not tolerated: try retapamulin 1% oint bd for 5 days | |
| Extensive, severe infection or if impractical to treat topically: Flucloxacillin 250–500mg qds for 7 days | Erythromycin 250–500mg qds or clarithromycin 250–500mg bd for 7 days | ||
| Urinary tract | |||
| Infection | Treatment options and dose | Option in penicillin allergy | Notes |
| Acute bacterial prostatitis | Ciprofloxacin 500mg bd for 28 days | Review treatment when urine culture results available. | |
| Ofloxacin 200mg bd for 28 days | |||
| If quinolone contraindicated: Trimethoprim 200mg bd for 28 days |
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| Acute pyelonephritis | Ciprofloxacin 500mg bd for 7 days | Follow local antibiotic policies. Review treatment when culture results available. | |
| Co-amoxiclav 500/125mg tds for 14 days In pregnancy: Cefalexin 500mg bd for 10–14 days |
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| Uncomplicated lower UTI | Trimethoprim 200mg bd for 3 or 7 days in women and 7 days in men, pregnancy or indwelling catheter | Review treatment when urine culture results available. | |
| Nitrofurantoin 50mg qds (or 100mg modified release bd) for 3 or 7 days in women and 7 days in men, pregnancy or indwelling catheter | |||
Treatment options and adult dosages as recommended by PRODIGY (formerly CKS) [accessed: October 2011], unless otherwise indicated.
For recommended treatment options and doses in children please refer to relevant MIMS records or SPCs.
* Health Protection Agency, 2011. Guidance for public health management of meningococcal disease in the UK.
**National Institute for Health and Clinical Excellence, 2008. Respiratory tract infections - antibiotic prescribing.
Key:
od= once daily, bd= twice daily, tds= three times daily, qds= four times daily, stat= at once.
