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 cefuroximeMore 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)
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