Antibiotic guidelines

The following is based on current BNF guidelines:

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 hydrogen peroxide, oral flucloxacillin or erythromycin if widespread| Cellulitis _ Flucloxacillin (clarithromycin, erythromycin or doxycycline if penicillin-allergic)| Cellulitis (near the eyes or nose) _ Co-amoxiclav (clarithromycin, + metronidazole if penicillin-allergic)| Erysipelas _ Flucloxacillin* (clarithromycin, erythromycin or doxycycline 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 _ Phenoxymethylpenicillin | Otitis media _ Amoxicillin (erythromycin if penicillin-allergic)| Severe 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| 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| Clostridioides difficile _ First episode: oral vancomycin Second or subsequent episode of infection: oral fidaxomicin| Campylobacter enteritis _ Clarithromycin| Salmonella (non-typhoid)_ Ciprofloxacin| Shigellosis _ Ciprofloxacin|

*phenoxymethylpenicillin was previously the recommended antibiotic until the 2019 NICE guidelines

**a combined topical antibiotic and corticosteroid is generally used for mild/moderate cases of otitis externa