Summary of antimicrobial prescribing guidance – managing common infections
• For all PHE guidance, follow PHE’s principles of treatment.
• See BNF for appropriate use and dosing in specific populations, for example, hepatic impairment, renal impairment, pregnancy and breastfeeding.
Key: Click to access doses for children Click to access NICE’s printable visual summary
Jump to section on:
Upper RTI Lower RTI UTI Meningitis GI Genital Skin Eye Dental
Doses Visual
Infection Key points Medicine Length
Adult Child summary
Upper respiratory tract infections
Acute sore Advise paracetamol, or if preferred and suitable, First choice: 500mg QDS or 5 to 10 days*
throat ibuprofen for pain. phenoxymethylpenicillin 1000mg BD
Medicated lozenges may help pain in adults. Penicillin allergy: 250mg to 500mg 5 days
Use FeverPAIN or Centor to assess symptoms: clarithromycin OR BD
FeverPAIN 0-1 or Centor 0-2: no antibiotic; erythromycin (preferred if 250mg to 500mg 5 days
FeverPAIN 2-3: no or back-up antibiotic; pregnant) QDS or
FeverPAIN 4-5 or Centor 3-4: immediate or
back-up antibiotic. 500mg to 1000mg
Public Health BD
Systemically very unwell or high risk of
England complications: immediate antibiotic.
*5 days of phenoxymethylpenicillin may be
enough for symptomatic cure; but a 10-day
Last updated: course may increase the chance of
Jan 2018 microbiological cure.
For detailed information click the visual summary
icon.
Summary of antimicrobial prescribing guidance – managing common infections (March 2020) 1
, Doses Visual
Infection Key points Medicine Length
Adult Child summary
Influenza Annual vaccination is essential for all those ‘at risk’ of influenza. 1D Antivirals are not recommended for healthy adults.1D,2A+
Treat ‘at risk’ patients with 5 days oseltamivir 75mg BD,1D when influenza is circulating in the community, and ideally within 48 hours of onset
(36 hours for zanamivir treatment in children),1D,3D or in a care home where influenza is likely.1D,2A+
Public Health
England At risk: pregnant (and up to 2 weeks post-partum); children under 6 months; adults 65 years or older; chronic respiratory disease (including COPD
and asthma); significant cardiovascular disease (not hypertension); severe immunosuppression; chronic neurological, renal or liver disease;
diabetes mellitus; morbid obesity (BMI>40).4D See the PHE Influenza guidance for the treatment of patients under 13 years.4D In severe
Last updated: immunosuppression, or oseltamivir resistance, use zanamivir 10mg BD5A+,6A+ (2 inhalations twice daily by diskhaler for up to 10 days) and seek
Feb 2019
advice.4D
Access supporting evidence and rationales on the PHE website.
Scarlet fever Prompt treatment with appropriate antibiotics Phenoxymethylpenicillin2D 500mg QDS2D 10 days3A+,4A+,5A+ Not available.
(GAS) significantly reduces the risk of complications.1D Access
Vulnerable individuals (immunocompromised, supporting
Public Health Penicillin allergy: 250mg to 500mg 5 days2D,5A+
the comorbid, or those with skin disease) are at evidence and
England clarithromycin2D BD2D rationales on
Last updated:
increased risk of developing complications.1D Optimise analgesia2D and give safety netting advice the PHE
Oct 2018 website
Acute otitis Regular paracetamol or ibuprofen for pain (right First choice: amoxicillin - 5 to 7 days
media dose for age or weight at the right time and Penicillin allergy: - 5 to 7 days
maximum doses for severe pain). clarithromycin OR
Otorrhoea or under 2 years with infection in erythromycin (preferred if -
both ears: no, back-up or immediate antibiotic. pregnant)
Otherwise: no or back-up antibiotic. Second choice: co- - 5 to 7 days
Public Health
Systemically very unwell or high risk of amoxiclav
England
complications: immediate antibiotic.
For detailed information click on the visual summary.
Last updated: Feb
2018
Acute otitis First line: analgesia for pain relief,1D,2D and Second line: 1 spray TDS5A- 7 days5A
externa apply localised heat (such as a warm flannel).2D topical acetic acid 2%2D,4B-
Second line: topical acetic acid or topical OR
Not available.
Public Health antibiotic +/- steroid: similar cure at topical neomycin sulphate 3 drops TDS5A- 7 days (min) to Access
England 7 days.2D,3A+,4B- with corticosteroid2D,5A- 14 days (max)3A+ supporting
If cellulitis or disease extends outside ear (consider safety issues if evidence and
canal, or systemic signs of infection, start oral perforated tympanic rationales on
Last updated: the PHE
Nov 2017 flucloxacillin and refer to exclude malignant otitis membrane)6B-
externa.1D website
If cellulitis: 250mg QDS2D
flucloxacillin7B+ If severe: 500mg 7 days2D
QDS2D
Summary of antimicrobial prescribing guidance – managing common infections (March 2020) 2
, Doses Visual
Infection Key points Medicine Length
Adult Child summary
Sinusitis Advise paracetamol or ibuprofen for pain. Little First choice: 500mg QDS
5 days
evidence that nasal saline or nasal phenoxymethylpenicillin
decongestants help, but people may want to try Penicillin allergy: 200mg on day 1,
them. doxycycline (not in under then 100mg OD
Symptoms for 10 days or less: no antibiotic. 12s) OR
Symptoms with no improvement for more clarithromycin OR 500mg BD 5 days
than 10 days: no antibiotic or back-up antibiotic erythromycin (preferred if 250 to 500mg
Public Health depending on likelihood of bacterial cause. pregnant) QDS or
England Consider high-dose nasal corticosteroid (if over 500 to 1000mg BD
12 years). Second choice or first 500/125mg TDS
Systemically very unwell or high risk of choice if systemically
Last updated:
Oct 2017
complications: immediate antibiotic. very unwell or high risk 5 days
For detailed information click on the visual summary. of complications:
co-amoxiclav
Lower respiratory tract infections
Acute Many exacerbations are not caused by bacterial First choice: 500mg TDS (see
exacerbation infections so will not respond to antibiotics. amoxicillin OR BNF for severe -
of COPD Consider an antibiotic, but only after taking into infection)
account severity of symptoms (particularly doxycycline OR 200mg on day 1,
sputum colour changes and increases in volume 5 days
then 100mg OD
or thickness), need for hospitalisation, previous -
(see BNF for
exacerbations, hospitalisations and risk of severe infection)
complications, previous sputum culture and
clarithromycin 500mg BD -
susceptibility results, and risk of resistance with
repeated courses. Second choice: use alternative first choice
Public Health
England Some people at risk of exacerbations may have Alternative choice (if 500/125mg TDS
antibiotics to keep at home as part of their person at higher risk of
-
exacerbation action plan. treatment failure):
For detailed information click on the visual summary. co-amoxiclav OR
Last updated: See also the NICE guideline on COPD in over 16s.
Dec 2018 co-trimoxazole OR 960mg BD -
levofloxacin (with 500mg OD 5 days
specialist advice if co-
amoxiclav or co-
-
trimoxazole cannot be
used; consider safety
issues)
IV antibiotics (click on visual summary)
Summary of antimicrobial prescribing guidance – managing common infections (March 2020) 3
• For all PHE guidance, follow PHE’s principles of treatment.
• See BNF for appropriate use and dosing in specific populations, for example, hepatic impairment, renal impairment, pregnancy and breastfeeding.
Key: Click to access doses for children Click to access NICE’s printable visual summary
Jump to section on:
Upper RTI Lower RTI UTI Meningitis GI Genital Skin Eye Dental
Doses Visual
Infection Key points Medicine Length
Adult Child summary
Upper respiratory tract infections
Acute sore Advise paracetamol, or if preferred and suitable, First choice: 500mg QDS or 5 to 10 days*
throat ibuprofen for pain. phenoxymethylpenicillin 1000mg BD
Medicated lozenges may help pain in adults. Penicillin allergy: 250mg to 500mg 5 days
Use FeverPAIN or Centor to assess symptoms: clarithromycin OR BD
FeverPAIN 0-1 or Centor 0-2: no antibiotic; erythromycin (preferred if 250mg to 500mg 5 days
FeverPAIN 2-3: no or back-up antibiotic; pregnant) QDS or
FeverPAIN 4-5 or Centor 3-4: immediate or
back-up antibiotic. 500mg to 1000mg
Public Health BD
Systemically very unwell or high risk of
England complications: immediate antibiotic.
*5 days of phenoxymethylpenicillin may be
enough for symptomatic cure; but a 10-day
Last updated: course may increase the chance of
Jan 2018 microbiological cure.
For detailed information click the visual summary
icon.
Summary of antimicrobial prescribing guidance – managing common infections (March 2020) 1
, Doses Visual
Infection Key points Medicine Length
Adult Child summary
Influenza Annual vaccination is essential for all those ‘at risk’ of influenza. 1D Antivirals are not recommended for healthy adults.1D,2A+
Treat ‘at risk’ patients with 5 days oseltamivir 75mg BD,1D when influenza is circulating in the community, and ideally within 48 hours of onset
(36 hours for zanamivir treatment in children),1D,3D or in a care home where influenza is likely.1D,2A+
Public Health
England At risk: pregnant (and up to 2 weeks post-partum); children under 6 months; adults 65 years or older; chronic respiratory disease (including COPD
and asthma); significant cardiovascular disease (not hypertension); severe immunosuppression; chronic neurological, renal or liver disease;
diabetes mellitus; morbid obesity (BMI>40).4D See the PHE Influenza guidance for the treatment of patients under 13 years.4D In severe
Last updated: immunosuppression, or oseltamivir resistance, use zanamivir 10mg BD5A+,6A+ (2 inhalations twice daily by diskhaler for up to 10 days) and seek
Feb 2019
advice.4D
Access supporting evidence and rationales on the PHE website.
Scarlet fever Prompt treatment with appropriate antibiotics Phenoxymethylpenicillin2D 500mg QDS2D 10 days3A+,4A+,5A+ Not available.
(GAS) significantly reduces the risk of complications.1D Access
Vulnerable individuals (immunocompromised, supporting
Public Health Penicillin allergy: 250mg to 500mg 5 days2D,5A+
the comorbid, or those with skin disease) are at evidence and
England clarithromycin2D BD2D rationales on
Last updated:
increased risk of developing complications.1D Optimise analgesia2D and give safety netting advice the PHE
Oct 2018 website
Acute otitis Regular paracetamol or ibuprofen for pain (right First choice: amoxicillin - 5 to 7 days
media dose for age or weight at the right time and Penicillin allergy: - 5 to 7 days
maximum doses for severe pain). clarithromycin OR
Otorrhoea or under 2 years with infection in erythromycin (preferred if -
both ears: no, back-up or immediate antibiotic. pregnant)
Otherwise: no or back-up antibiotic. Second choice: co- - 5 to 7 days
Public Health
Systemically very unwell or high risk of amoxiclav
England
complications: immediate antibiotic.
For detailed information click on the visual summary.
Last updated: Feb
2018
Acute otitis First line: analgesia for pain relief,1D,2D and Second line: 1 spray TDS5A- 7 days5A
externa apply localised heat (such as a warm flannel).2D topical acetic acid 2%2D,4B-
Second line: topical acetic acid or topical OR
Not available.
Public Health antibiotic +/- steroid: similar cure at topical neomycin sulphate 3 drops TDS5A- 7 days (min) to Access
England 7 days.2D,3A+,4B- with corticosteroid2D,5A- 14 days (max)3A+ supporting
If cellulitis or disease extends outside ear (consider safety issues if evidence and
canal, or systemic signs of infection, start oral perforated tympanic rationales on
Last updated: the PHE
Nov 2017 flucloxacillin and refer to exclude malignant otitis membrane)6B-
externa.1D website
If cellulitis: 250mg QDS2D
flucloxacillin7B+ If severe: 500mg 7 days2D
QDS2D
Summary of antimicrobial prescribing guidance – managing common infections (March 2020) 2
, Doses Visual
Infection Key points Medicine Length
Adult Child summary
Sinusitis Advise paracetamol or ibuprofen for pain. Little First choice: 500mg QDS
5 days
evidence that nasal saline or nasal phenoxymethylpenicillin
decongestants help, but people may want to try Penicillin allergy: 200mg on day 1,
them. doxycycline (not in under then 100mg OD
Symptoms for 10 days or less: no antibiotic. 12s) OR
Symptoms with no improvement for more clarithromycin OR 500mg BD 5 days
than 10 days: no antibiotic or back-up antibiotic erythromycin (preferred if 250 to 500mg
Public Health depending on likelihood of bacterial cause. pregnant) QDS or
England Consider high-dose nasal corticosteroid (if over 500 to 1000mg BD
12 years). Second choice or first 500/125mg TDS
Systemically very unwell or high risk of choice if systemically
Last updated:
Oct 2017
complications: immediate antibiotic. very unwell or high risk 5 days
For detailed information click on the visual summary. of complications:
co-amoxiclav
Lower respiratory tract infections
Acute Many exacerbations are not caused by bacterial First choice: 500mg TDS (see
exacerbation infections so will not respond to antibiotics. amoxicillin OR BNF for severe -
of COPD Consider an antibiotic, but only after taking into infection)
account severity of symptoms (particularly doxycycline OR 200mg on day 1,
sputum colour changes and increases in volume 5 days
then 100mg OD
or thickness), need for hospitalisation, previous -
(see BNF for
exacerbations, hospitalisations and risk of severe infection)
complications, previous sputum culture and
clarithromycin 500mg BD -
susceptibility results, and risk of resistance with
repeated courses. Second choice: use alternative first choice
Public Health
England Some people at risk of exacerbations may have Alternative choice (if 500/125mg TDS
antibiotics to keep at home as part of their person at higher risk of
-
exacerbation action plan. treatment failure):
For detailed information click on the visual summary. co-amoxiclav OR
Last updated: See also the NICE guideline on COPD in over 16s.
Dec 2018 co-trimoxazole OR 960mg BD -
levofloxacin (with 500mg OD 5 days
specialist advice if co-
amoxiclav or co-
-
trimoxazole cannot be
used; consider safety
issues)
IV antibiotics (click on visual summary)
Summary of antimicrobial prescribing guidance – managing common infections (March 2020) 3
