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 younger than 6 months, children younger than 2 years with bilateral infection, children who are systemically unwell (e.g., lethargic, pale; fever alone is not sufficient), children with otorrhoea, ATSI at high risk of complications, children at high risk of complications (e.g., immunocompromised children). |
| Acute Pharyngitis/Tonsillitis | Phenoxymethylpenicillin | 500 mg (child: 15 mg/kg up to 500 mg) orally, 12-hourly for 10 days | Most cases are viral. In patients not at high risk of acute rheumatic fever, even if infection is bacterial, antibiotic treatment is of limited benefit. In patients at high risk of acute rheumatic fever, antibiotic treatment is recommended for all patients because the increased risk of acute rheumatic fever and resultant rheumatic heart disease outweighs the risk of harms from potentially unnecessary antibiotic treatment. |
| Acute Pharyngitis/Tonsillitis | Benzathine Benzylpenicillin | intramuscularly, as a single dose adult: 1.2 million units | Most cases are viral. In patients not at high risk of acute rheumatic fever, even if infection is bacterial, antibiotic treatment is of limited benefit. In patients at high risk of acute rheumatic fever, antibiotic treatment is recommended for all patients because the increased risk of acute rheumatic fever and resultant rheumatic heart disease outweighs the risk of harms from potentially unnecessary antibiotic treatment. |
| COPD exacerbation where antibiotics are indicated | Amoxicillin | 500 mg orally, 8-hourly for 5 days | Antibiotic treatment has little benefit for patients managed in the community with less severe COPD: for every 100 patients treated with antibiotics, only 8 patients will be better by 4 weeks because they took antibiotics. Consider a delayed prescription for antibiotic therapy. See Therapeutic Guidelines for more information and resources to support discussion with the patient or carer. |
| COPD exacerbation where antibiotics are indicated | Doxycycline | 100 mg orally, daily for 5 days | Antibiotic treatment has little benefit for patients managed in the community with less severe COPD: for every 100 patients treated with antibiotics, only 8 patients will be better by 4 weeks because they took antibiotics. Consider a delayed prescription for antibiotic therapy. See Therapeutic Guidelines for more information and resources to support discussion with the patient or carer. |
| 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 the patient’s pneumonia severity, comorbidities and social circumstances to decide whether to admit the patient to hospital. Patient review within 48 hours is essential. If the patient has significantly improved after 2 to 3 days, treat for 5 days. If the clinical response is slow, treat for 7 days. If the patient is not improving after 48 hours of monotherapy, see Therapeutic Guidelines. If patient follow-up within 48 hours may not occur, consider using initial combination therapy with amoxicillin plus doxycycline instead. |
| 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 whether a viral infection could be the cause of symptoms. See Therapeutic Guidelines for indications for parenteral therapy. If infection caused by atypical bacteria (e.g., Legionella species) is suspected, see Therapeutic Guidelines. Patient review within 48 hours is essential. If the patient has significantly improved after 2 to 3 days, treat for 5 days. If the clinical response is slow, treat for 7 days. See Therapeutic Guidelines if the patient is not improving. |
| 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. See Therapeutic Guidelines for indications for taking a urine sample for culture and susceptibility testing. 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 | The recommended management of bites and clenched-fist injuries is thorough cleaning, irrigation, debridement, elevation and immobilisation. Check the patient’s tetanus immunisation status. Antibiotic treatment may not be required if the wound is not infected. Initial intravenous therapy is needed for bite or clenched-fist injury infection associated with systemic features or involving deeper tissues (such as bones, joints, or tendons). |
| 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 | If Streptococcus pyogenes is suspected based on clinical presentation. Staphylococcus aureus is often associated with penetrating trauma or ulceration. Purulent cellulitis (e.g., associated abscess, furuncle) is typically caused by S. aureus. Initial intravenous therapy is needed if the patient has 2 or more systemic symptoms. |
| Cellulitis without systemic symptoms | Dicloxacillin | 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 days | If Staphylococcus aureus is suspected based on clinical presentation. Staphylococcus aureus is often associated with penetrating trauma or ulceration. Purulent cellulitis (e.g., associated abscess, furuncle) is typically caused by S. aureus. Initial intravenous therapy is needed if the patient has 2 or more systemic symptoms. |
| 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, increased breastfeeding and gentle expression of milk from the affected breast for 24 to 48 hours may resolve symptoms without antibiotic treatment. If this fails to resolve symptoms, and in all patients with systemic symptoms, antibiotic treatment is recommended to minimise the risk of abscess. Advise the patient to continue breastfeeding and gentle milk expression. Consider lactation support. |
| Indication | First-line treatment | Notes |
| acute rhinosinusitis | symptomatic treatment | Antibiotic treatment is required rarely—most cases are viral. |
| acute otitis media in children | 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 younger than 6 months • children younger than 2 years with bilateral infection • children who are systemically unwell (eg lethargic, pale; fever alone is not sufficient) • children with otorrhoea • ATSI at high risk of complications—for risk assessment and treatment recommendations, • children at high risk of complications (eg immunocompromised children). Amoxicillin is first-line treatment for these groups: amoxicillin 15 mg/kg up to 500 mg orally, 8-hourly for 5 days |
| acute pharyngitis/ tonsillitis | patients not at high risk of acute rheumatic fever: symptomatic treatment for most cases patients at high risk of acute rheumatic fever: phenoxymethylpenicillin 500 mg (child: 15 mg/kg up to 500 mg) orally, 12-hourly for 10 days OR benzathine benzylpenicillin intramuscularly, as a single dose adult: 1.2 million units (2.3 mL) child less than 10 kg: 0.45 million units (0.9 mL) child 10 kg to less than 20 kg: 0.6 million units (1.2 mL) child 20 kg or more: 1.2 million units (2.3 mL) | Most cases are viral. In patients not at high risk of acute rheumatic fever, even if infection is bacterial, antibiotic treatment is of limited benefit. In patients at high risk of acute rheumatic fever, antibiotic treatment is recommended for all patients because the increased risk of acute rheumatic fever and resultant rheumatic heart disease outweighs the risk of harms from potentially unnecessary antibiotic treatment. |
| acute bronchitis | symptomatic treatment | Antibiotic treatment is not indicated—over 90% of cases are viral. |
| COPD exacerbation where antibiotics are indicated | amoxicillin 500 mg orally, 8-hourly for 5 days OR doxycycline 100 mg orally, daily for 5 days | Antibiotic treatment has little benefit for patients managed in the community with less severe COPD: for every 100 patients treated with antibiotics, only 8 patients will be better by 4 weeks because they took antibiotics. Consider a delayed prescription for antibiotic therapy. See Therapeutic Guidelines for more information and resources to support discussion with the patient or carer. |
| 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. Children who have widespread pulmonary wheeze or crackles but no focal changes on chest X-ray are more likely to have viral pneumonia. Consider performing NAAT (eg PCR) to detect respiratory viruses. If a viral cause is suspected or confirmed, symptomatic treatment alone is recommended. If the patient is not improving after 48 to 72 hours, or symptoms worsen at any time, reassess the diagnosis— see Therapeutic Guidelines. |
| community- acquired pneumonia in adults: low-severity (mild) | amoxicillin 1 g orally, 8-hourly; see Notes column for duration of therapy | Assess the patient’s pneumonia severity, comorbidities and social circumstances to decide whether to admit the patient to hospital—see Therapeutic Guidelines. See Therapeutic Guidelines for risk factors for infection caused by atypical bacteria and adjustment of empirical therapy. Patient review within 48 hours is essential. If the patient has significantly improved after 2 to 3 days, treat for 5 days. If the clinical response is slow, treat for 7 days. If the patient is not improving after 48 hours of monotherapy, see Therapeutic Guidelines. If patient follow-up within 48 hours may not occur, consider using initial combination therapy with amoxicillin plus doxycycline instead—see Therapeutic Guidelines. |
| 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 whether a viral infection could be the cause of symptoms. See Therapeutic Guidelines for indications for parenteral therapy. If infection caused by atypical bacteria (eg Legionella species) is suspected, see Therapeutic Guidelines. Patient review within 48 hours is essential. If the patient has significantly improved after 2 to 3 days, treat for 5 days. If the clinical response is slow, treat for 7 days. See Therapeutic Guidelines if the patient is not improving. |
| localised odontogenic infection | dental treatment | 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. See Therapeutic Guidelines for indications for taking a urine sample for culture and susceptibility testing. Do not use ciprofloxacin, norfloxacin or fosfomycin unless susceptibility testing rules out all alternative antibiotics—see Therapeutic Guidelines. |
| 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—see Therapeutic Guidelines. |
| 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 | The recommended management of bites and clenched-fist injuries is thorough cleaning, irrigation, debridement, elevation and immobilisation. Check the patient’s tetanus immunisation status. Antibiotic treatment may not be required if the wound is not infected—see Therapeutic Guidelines. Initial intravenous therapy is needed for bite or clenched-fist injury infection associated with systemic features or involving deeper tissues (such as bones, joints, or tendons)—see Therapeutic Guidelines. |
| 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—see Therapeutic Guidelines. |
| cellulitis without systemic symptoms | if Streptococcus pyogenes is suspected based on clinical presentation: – phenoxymethylpenicillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 days if Staphylococcus aureus is suspected based on clinical presentation: dicloxacillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 days OR flucloxacillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 days | Streptococcus species are the most common cause of nonpurulent, recurrent cellulitis and spontaneous, rapidly spreading cellulitis. Staphylococcus aureus is often associated with penetrating trauma or ulceration. Purulent cellulitis (eg associated abscess, furuncle) is typically caused by S. aureus. Initial intravenous therapy is needed if the patient has 2 or more systemic symptoms |
| 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 OR flucloxacillin 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; see Therapeutic Guidelines. For management of impetigo in endemic settings, see Therapeutic Guidelines. |
| acute mild diabetic foot infection | dicloxacillin 500 mg orally, 6-hourly OR flucloxacillin 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 OR flucloxacillin 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, increased breastfeeding and gentle expression of milk from the affected breast for 24 to 48 hours may resolve symptoms without antibiotic treatment. If this fails to resolve symptoms, and in all patients with systemic symptoms, antibiotic treatment is recommended to minimise the risk of abscess. Advise the patient to continue breastfeeding and gentle milk expression. Consider lactation support. |
| COPD = chronic obstructive pulmonary disease; MRSA = methicillin-resistant Staphylococcus aureus; NAAT = nucleic acid amplification testing; PCR = polymerase chain reaction | ||