Antibiotic prescribing in primary care – eTG summary table 2024
| Indication | Antibiotic | Dose | Notes |
|---|---|---|---|
| Acute Rhinosinusitis | Symptomatic treatment | N/A | Antibiotic treatment is required rarely—most cases are viral. |
| Acute Otitis Media in Children | Amoxicillin | 15 mg/kg up to 500 mg orally, 8-hourly for 5 days | Symptomatic treatment for most children. 80% of cases spontaneously resolve without antibiotic treatment. Advise the carer to return if symptoms do not improve within 72 hours. Consider a delayed prescription for antibiotic therapy. Treat the following groups: – Infants < 6 months of age. Children < 2 years with bilateral infection. – Systemically unwell children, e.g.: Lethargy Pallor (Note: Fever alone is not sufficient reason to treat.) – Children with otorrhoea. – Aboriginal and Torres Strait Islander (ATSI) children at high risk of complications. – Children at high risk of complications, e.g.: Immunocompromised |
| Acute Pharyngitis/Tonsillitis | Phenoxymethylpenicillin | 500 mg (child: 15 mg/kg up to 500 mg) orally, 12-hourly for 10 days | Most cases are viral – antibiotics usually not required. In patients not at high risk of acute rheumatic fever (ARF): Even with bacterial cause, antibiotic benefit is limited. In patients at high risk of ARF: Antibiotic treatment is recommended for all, as the risk of: – ARF and – Rheumatic heart disease (RHD) outweighs the potential harms of unnecessary antibiotics. |
| Acute Pharyngitis/Tonsillitis | Benzathine Benzylpenicillin | intramuscularly, as a single dose adult: 1.2 million units | Most cases are viral – antibiotics usually not required. In patients not at high risk of acute rheumatic fever (ARF): Even with bacterial cause, antibiotic benefit is limited. In patients at high risk of ARF: Antibiotic treatment is recommended for all, as the risk of: – ARF and – Rheumatic heart disease (RHD) outweighs the potential harms of unnecessary antibiotics. |
| COPD exacerbation where antibiotics are indicated | Amoxicillin | 500 mg orally, 8-hourly for 5 days | Antibiotic therapy offers limited benefit for patients with less severe COPD managed in the community: Only 8 out of 100 patients benefit from antibiotics at 4 weeks. Consider delayed antibiotic prescribing, especially if: – Symptoms are mild to moderate. – There is uncertainty about bacterial vs. viral aetiology. – The patient is reliable for follow-up or self-assessment. |
| COPD exacerbation where antibiotics are indicated | Doxycycline | 100 mg orally, daily for 5 days | Antibiotic therapy offers limited benefit for patients with less severe COPD managed in the community: Only 8 out of 100 patients benefit from antibiotics at 4 weeks. Consider delayed antibiotic prescribing, especially if: – Symptoms are mild to moderate. – There is uncertainty about bacterial vs. viral aetiology. – The patient is reliable for follow-up or self-assessment. |
| Community-acquired pneumonia in children 2 months or older: low-severity (mild) | Amoxicillin | 25 mg/kg up to 1 g orally, 8-hourly for 3 days | Viruses are the main cause of community-acquired pneumonia in children 2 months or older, but clinical features do not reliably distinguish between viral and bacterial pathogens. If the patient is not improving after 48 to 72 hours, or symptoms worsen at any time, reassess the diagnosis. |
| Community-acquired pneumonia in adults: low-severity (mild) | Amoxicillin | 1 g orally, 8-hourly; see Notes column for duration of therapy | Assess pneumonia severity, comorbidities, and social circumstances to determine need for hospital admission. Ensure patient review within 48 hours of starting treatment. Treatment duration: If significant clinical improvement within 2–3 days → treat for a total of 5 days. If slower clinical response → treat for 7 days. If no improvement after 48 hours of monotherapy, refer to Therapeutic Guidelines for further management. If follow-up within 48 hours is unlikely, consider initial combination therapy: Amoxicillin plus doxycycline |
| Community-acquired pneumonia in residents of aged-care facilities: oral therapy | Amoxicillin | 1 g orally, 8-hourly; see Notes column for duration of therapy | Consider viral aetiology as a possible cause of symptoms. Refer to Therapeutic Guidelines for: Indications for parenteral therapy. Management if atypical bacterial infection suspected (e.g., Legionella spp). Patient review within 48 hours of treatment initiation is essential. Treatment duration: If significant improvement within 2–3 days → treat for a total of 5 days. If slow clinical response → extend treatment to 7 days. If no improvement after 48 hours, consult Therapeutic Guidelines for further management. |
| Localised odontogenic infection | Dental treatment | N/A | Prescribe analgesia and refer the patient to the dentist. Explain that antibiotic treatment without dental intervention will not be effective. If dental treatment will be delayed or the infection is spreading, see Therapeutic Guidelines. |
| Acute cystitis in nonpregnant women | Trimethoprim | 300 mg orally, daily for 3 days | Half of cases in nonpregnant women younger than 65 years resolve within 7 days without antibiotic treatment. Do not use ciprofloxacin, norfloxacin or fosfomycin unless susceptibility testing rules out all alternative antibiotics. |
| Acute cystitis in pregnancy | Nitrofurantoin | 100 mg orally, 6-hourly for 5 days | Take a urine sample for culture and susceptibility testing before starting treatment, and repeat 1 to 2 weeks after treatment is completed. Avoid using nitrofurantoin close to delivery. |
| Infected bites and other wounds caused by teeth (including human, cat, dog) | Amoxicillin+Clavulanate | 875+125 mg (child 2 months or older: 22.5+3.2 mg/kg up to 875+125 mg) orally, 12-hourly for 5 days | Initial Wound Care: – Thorough cleaning and irrigation – Debridement of devitalised tissue – Elevation of the affected area – Immobilisation to reduce spread and support healing Other Key Steps: – Check tetanus immunisation status and update if required Antibiotic therapy: – Not routinely required if the wound is clean and uninfected – Indicated if there are signs of infection or high-risk features Initial intravenous antibiotics are recommended if: – Systemic features are present (e.g. fever, malaise) – Infection involves deep structures (e.g. bone, joint, tendon) |
| Erysipelas without systemic symptoms | Phenoxymethylpenicillin | 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 days | Initial intravenous therapy is needed if the patient has 2 or more systemic symptoms. |
| Cellulitis without systemic symptoms | Phenoxymethylpenicillin | 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 days | Streptococcus pyogenes: – Suspected if typical clinical presentation (e.g., diffuse erythema, rapid spread, lymphangitis) without purulence. Staphylococcus aureus: More likely in cases of: – Penetrating trauma Ulceration – Purulent cellulitis (e.g., abscess, furuncle) Systemic Features – Indication for IV Therapy Initial IV antibiotic therapy is indicated if the patient has ≥2 systemic symptoms, such as: – Fever or hypothermia – Tachycardia – Hypotension – Tachypnoea – Elevated WCC or CRP |
| Cellulitis without systemic symptoms | Dicloxacillin | 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 days | as above |
| Impetigo: localised sores (nonendemic settings) | Mupirocin | 2% ointment or cream topically to crusted areas, 8-hourly for 5 days | Use soap and water topically three times a day to soften crusts. For management of impetigo in endemic settings, see Therapeutic Guidelines. |
| Impetigo: multiple or recurrent sores (nonendemic settings) | Dicloxacillin | 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 7 days | Stop therapy earlier if the infection has resolved. If treatment is unsuccessful, see Therapeutic Guidelines. Eradication of staphylococcal carriage may be indicated. For management of impetigo in endemic settings, see Therapeutic Guidelines. |
| Acute mild diabetic foot infection | Dicloxacillin | 500 mg orally, 6-hourly | Typically 1 to 2 weeks of therapy is sufficient. See Therapeutic Guidelines if the patient has systemic symptoms, chronic diabetic foot infection, has recently received antibiotics, or has risk factors for MRSA infection. |
| Lactational mastitis | Dicloxacillin | 500 mg orally, 6-hourly. If symptoms and signs resolve rapidly, 5 days of therapy may be sufficient; otherwise continue treatment for 10 days | For patients without systemic symptoms: – Encourage increased breastfeeding from the affected breast. – Advise gentle milk expression (e.g., hand expression or pumping) for 24–48 hours. – This approach may resolve symptoms without antibiotics. If no improvement after 24–48 hours, or if systemic symptoms are present: – Initiate antibiotic treatment to reduce the risk of breast abscess. – Continue: — Breastfeeding (do not cease) — Gentle expression of milk Additional considerations: – Offer lactation support (e.g., referral to lactation consultant or breastfeeding clinic) – Provide analgesia as needed (e.g., paracetamol, ibuprofen) |