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Antimicrobial Prescribing Guidelines for BNSSG Health Community 08/09 (Short Version) Folder Ref No: 50 (short version)

Signed: ......................................................... Clinical Governance Lead GP Signed: ......................................................... Executive Director

Date : ......................

Date : ......................

Date of Issue: September 2008 Version No: 1 Date of Review: July 2010 Author: D Campbell NSPCT

Antimicrobial Prescribing Guidelines for BNSSG Health Community 08/09 (Short Version)


1ST Choice Antibiotic(s)

Cefalexin Erythromycin* Amoxicillin Erythromycin* (*if true penicillin allergy)


500mg tds -qds 500mg bd or tds 500mg bd or 250mg qds <10 yrs:125- 250mg tds >10 yrs: 250-500mg tds <2 yrs 125 mg qds 2-8 yrs 250 mg qds Other: 250-500 mg qds 250-500mg tds 250mg qds/500mg bd 100mg od (200mg day1) 1 drop 2 hrly reducing to qds. Ointment may be used qds or at night with drops 500mg tds 100mg od (200mg day1) 250-500mg tds 100mg od (200mg day1) 625mg tds 500mg-1g tds 500mg qds


7 to 10 days 5 to 7 days 5 to 10 days 5 days 5 days

UPPER RESPIRATORY TRACT INFECTIONS Penicillin V or Pharyngitis/ tonsillitis Otitis Media (children) (Many are viral. 80% resolve without antibiotics)

Rhinosinusitis (Acute or chronic) Many are viral Conjunctivitis

Amoxicillin or Erythromycin* or Doxycycline Choramphenicol 0.5% drops +/- 1% ointment

7 days 7 days 7 days Continue for 48hrs after resolution


(Little benefit in otherwise healthy adults) Doxycycline Amoxicillin or Doxycycline Repeated Episodes: Co-amoxiclav Amoxicillin or Erythromycin* Benzyl penicillin (IV or IM)

5 days 5 days 5 - 10 days 5 - 10 days 5 - 10 days Up to 10 days Up to 10 days

Acute exacerbation COPD

(Many viral, antibs not indicated in absence of purulent or mucopurulent sputum)

Community Acquired Pneumonia MENINGITIS

Suspected Meningitis

Transfer to hospital immediately

Adults & Children over 10 : 1200mg Children 1-9yrs : 600mg Under 1 yr: 300mg

PREVENTION OF MENINGITIS Ring CCDC: 0117 900 2620 or Out of Hours 01454 455433

URINARY TRACT INFECTIONS Uncomplicated UTI UTI in pregnancy and Men

(Suggest MSU for sensitivities).

(Trim + Nitro. can be used short term unlikely to affect foetus).

UTI in catheterised pts (Treat ONLY if systemically unwell) Recurring UTI in woman > 3 years UTI in children See NICE Guidance:

Trimethoprim or Nitrofuranton Trimethoprim Nitrofurantoin Cefalexin (or as per sensitivity) Ciprofloxacin Nitrofurantoin Trimethoprim Trimethoprim, Nitrofurantoin Cefalexin Ciprofloxacin or Co-amoxiclav

200mg bd 50mg qds 200mg bd 50mg qds 500mg bd 500mg bd 50mg 100mg See BNF for doses

3 days/7 days (Elderly) 7 days 7 days 7 days 5 days Stat post coital or od at night 7 days

Acute Pyelonephritis

(no response within 48 hrs consider referral)

500mg bd 625mg tds

7 days 14 days

GASTRO-INTESTINAL TRACT INFECTIONS Lansoprazole+ Eradication Helicobacter pylori

Amoxicillin + either Clarithromycin or Metronidazole

30mg bd 1g bd 500mg bd 400mg bd

All for 7 days

Gastroenteritis Travellers Diarrhoea

Fluid replacement. If bacterial infection suspected and patient systemically unwell send stool sample and await micro. advice. Notify CCDC if suspected food poisoning 0117 900 2620 Limit prescription of antibacterial to be carried abroad and taken if illness develops (ciprofloxacin 500mg single dose) to people traveling to remote areas and for people in whom an episode of infective diarrhoea could be dangerous.

*Erythromycin should be used if `true' penicillin allergy. Clarithromycin may be substituted if patient cannot tolerate erythromycin due to GI side effects.


(Consider treating partner)

Bacterial Vaginosis Chlamydia trachomatis

(Uncomplicated Chlamydia, nongonococcal urethritis )

Clotrimazole 10% + Clotrimazole 1% Metronidazole Doxycycline or Azithromycin Ofloxacin or Trimethoprim Ofloxacin

Acute Prostatitis Acute Epididymitis

If older than 60yrs Ciprofloxacin can be used (500mg bd)

5g vaginal cream or 500mg pessary Cream 2-3 times a day 400mg bd 100mg bd 1g stat (1hr pre or 2hr post food) 200mg bd 200mg bd 200mg bd

Stat at night Stat at night 5 days 7 days 7 days Single dose 28 days 28 days 5 days

Trichomoniasis (treat partner) Pelvic Inflammatory Disease (PID) Genital Herpes

(Suppression therapy seek advice from GUM)

Metronidazole Metronidazole plus Ofloxacin Aciclovir

400mg bd 400mg bd 400mg bd 200mg 5 x day

5 ­ 7 days Both 14 days 5 days

Anogenital Warts Refer to GUM for treatment SKIN and SOFT TISSUE INFECTIONS Mupirocin 2% ointment Apply qds Impetigo

(Oral therapy preferred)

Acne (When topical preps. have failed) Cellulitis

Leg / Foot Ulcers

(Seek specialist advice if severe)

5 days Or Hydrogen peroxide 1% Apply 2-3 times a day Up to 3 weeks cream (minor infections only) Flucloxacillin or 7 days 500mg qds 7 days Erythromycin 500mg qds At least 8 weeks Lymecycline 408mg daily 7 - 14 days 500mg qds Flucloxacillin +/7 - 14 days 500mg qds Amoxicillin 7 - 14 days Or Erythromycin* 500mg qds 7 ­ 14 days 625 mg qds Co-Amoxiclav (if severe) Routine swabs are NOT recommended. Only use antibiotics if diabetic, or evidence of clinical infection e.g. inflammation/redness/cellulitis etc. 500mg QDS Flucloxacillin 500mg QDS 7 ­ 10 days and review or Erythromycin Flucloxacillin Co-amoxiclav Co-amoxiclav Terbinafine 1% cream Clotrimazole 1% cream Amorolfine paint

(superficial or if symptoms only present for few weeks)

Mastitis Breast Abscess Animal Bite + Human Bite

(Treatment and Prophylaxis)

500mg qds 625mg tds 625mg tds Apply 1-2/day Apply 1-2/day Apply 1-2 / week 250mg od 250mg od 800mg 5 x day

7 days 7 days 7 days 7 days 4 - 6 weeks Fingers ­ 6 months Toes ­ 12 months Fingers 6 - 12 weeks Toes 3 - 6 months 2-6 weeks 7 days

Dermatophyte Infection of skin Dermatophyte Infection of proximal fingernail or toenail

(Take nail clippings treat only if infection confirmed by lab)

Terbinafine Terbinafine Aciclovir

Dermatophyte Infection of scalp VIRAL INFECTIONS Shingles

(Only if within 72 hrs rash)


See BNF Mebendazole 100mg stat dose (Adults and over 2yrs) Piperazine (under 2yrs) See BNF TREATMENT OF Clostridium difficile INFECTIONS ­ If multiple relapses or severe disease contact Microbiology 400mg tds Metronidazole 10 days 1st Episodes and 1st relapse (Mild to moderate disease) If still symptomatic after 5 days seek advice.


DC/Med Man. July 08 Review July 10 Doc. No MM/Guid/007.3

All doses are for adults (unless stated)


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Microsoft Word - Antib colour short version July08 final.doc