Abx Prescribing Pathways 💊

Eye: Conjunctivitis

Chloramphenicol

Counselling for Chloramphenicol

(For use of conjunctivitis)

Avoid in pregnancy (esp. 3rd trimester) - can cause “Grey baby” syndrome

👃Nose - Sinusitis

1. Non-life threatening - Phenoxymethylpenicillin

2. Life threatening/severe - Coamoxiclav

3. Doxycycline/ Clarithromycin/ Erythromycin is the safe option in pregnancy

👄Oral - mouth infections

1. Broad spec antibiotics - coamoxicillin, amoxicillin, Phenoxymethylpenicillin

2. Cephalosporins: Cefalexin and Cefradine

3. Anaerobic infections with pen allergy - Metronidazole or tinidazole

4. Pen allergy - Macrolides: Clarithromycin, erythromycin

5. Oral anaerobic infection - Doxycycline

Ear: Otitis Externa

FACE

1st: Flucloxacillin

2nd: Azithromycin/Clarithromycin/ Erythromycin - Pen allergy

Pseudomonas: Ciprofloxacin/glycoside

Counselling for Flucloxacillin

Take 1hr before food or 2 hours after

(Take on an empty stomach)

Ear: Otitis Media

MACCE

1st: Amoxicillin

• Co-amoxiclav = With worsening symptoms

• Penicillin allergy or pregnant = Clarithromycin/Erythromycin

❤Endocarditis - initial blind therapy

1. Amoxicillin/ampicillin

2. Add low dose gentamicin

3. Low dose gentamicin + vancomycin (if penicillin allergic/MRSA suspected or severe sepsis)

❤Endocarditis - caused by staphlycocci

1. Flucloxacillin

2. Pen allergy/MRSA - Vancomycin + Rifampicin

❤Endocarditis - caused by Streptococci

1. Benzylpenicillin sodium

2. Pen allergy - Vancomycin + low dose Gentamicin

🩸Septicaemia - community/hospital acquired

1. Piperacillin with tazobactam/ticarcillin with clauvulanic acid/cephalosporin broad spectrum e.g. Cefuroxime

2. MRSA - Add vancomycin or teicoplanin

3. Anaerobic infection - add metronidazole to cephalosporin

   if other infection use broad spec e.g. meropenem

Gastrointestinal- Campylobacter enteritis

1. Clarithromycin/azithromycin/erythromycin, Ciprofloxacin

Gastrointestinal - Salmonella/Shigellosis/Typhoid/Biliary tract infection

Mainly - Ciprofloxacin, azithromycin, Cefotaxime, Gentamicin

• Salmonella - Ciprofloxacin or cefotaxime

• Shigellosis - Ciprofloxacin or azithromycin

• Typhoid fever - Cefotaxime or ceftriaxone (alt: azithromycin)

• Biliary tract infection - Ciprofloxacin or gentamicin or a cephalosporin

GI - C. Difficile

1. Vancomycin

2. Fidaxomicin

GI - Diverticulitis

Co-amoxiclav

🚻Genitals - Bacterial Vaginosis

1. Metronidazole (oral/topical)

2. Clindamycin (topical)

🚻Genitals - Chlamydia

1. Doxycycline ,then azithromycin

2. Erythromycin

🚻Genitals - Gonorrhoea

1. Azithromycin + IM Ceftriaxone/cefixime/ciprofloxaxin

(TRI & FIX ACE-Ci Milan

M = intramuscular

🚻Genitals - Syphillis

BED - (catch it in bed since it’s an STI)

1. Benzylpenicillin

2. Erythromycin

3. Asymptomatic: Doxycycline

Symptoms of Syphillis

An STI that causes:

• Small painless sores/ulcers on penis, anus, vagina➡ other areas: lips, in mouth, hands and bum

• White patches in mouth

• Rash on palms of hands and soles of feet, can spread all over your body - not usually itchy

• Flu-like symptoms e.g. high temp, headaches & tiredness

• Swollen glands

• Patchy hair loss on head, beard and eyebrows

🧻UTI: lower UTI, non-pregnant

1. Nitrofurantoin or Trimethoprim

2. Fosfomycin, Amoxicillin or Pivmecillinam

🧻Lower UTI: Pregnant

1. Nitrofurantoin - safe in 1st and 2nd trimester but avoided in 3rd trimester

2. Amoxicillin or Cefalexin

⬆For 7 days!

• Catheter - pregnant: Cefalexin or IV Cefuroxime

🧻Lower UTI: Men

1. Nitrofurantoin or trimethoprim

If no improvement after at least 48hrs - consider pyelonephritis or prostatitis

🧻Lower UTI: Acute Prostatitis

1. Ciprofloxacin or Ofloxacin ➡ (if unable to take fluoroquinolones: Trimethoprim)

2. Levofloxacin or Co-trimoxazole

🧻Acute Pyelonephritis: Non-pregnant women & men

(Upper UTI)

1. Cefalexin or Ciprofloxacin (if sensitivity know: co-amoxiclav or trimethoprim)

2. IV (if unwell & can’t take oral meds) - Amikacin, Ceftriaxone, Cefuroxime, Ciprofloxacin or Gentamicin.

🧻Acute Pyelonephritis: Pregnant women

1. Cefalexin

2. IV (if unwell/can’t take oral med) - Cefuroxime

🧻Recurrent UTI: women & men

1. Trimethoprim or Nitrofurantoin

2. Amoxicillin or Cefalexin

🧻Catheter associated UTI: Non-pregnant women and men (no upper UTI symptoms)

1. Amoxicillin, Nitrofurantoin or Trimethoprim

2. Pivemecillinam

🧻Catheter associated UTI: Non-pregnant women and men (upper UTI symptoms)

1. Cefalexin, Ciprofloxacin, co-amoxiclav or trimethoprim

2. Amikacin, Ceftriaxone, Cefuroxime, Ciprofloxacin, gentamicin or co-amoxiclav

🦶Diabetic foot

1. Flucloxacillin (mild infection)

2. Pen allergy - Clarithromycin/Doxycycline/Erythromycin

🩻Musculoskeletal: Osteomyelitis

1. Flucloxacillin

2. Pen allergy: Clindamycin - if diarrhoea occurs stop immediately‼

(Osteomyelitis- inflammation of the bone or bone marrow due to infection)

🧠 CNS - suspected Meningitis, before causative organism known

• 1L: Ceftriaxone

• 2L: if contraindicated = Cefotaxime

• IV Amoxicillin + Cefotaxime & Ceftriaxone = to people with risk factors of Listeria monocytogenes

🧠CNS - Meningitis caused by meningocci

1. Benzylpenicillin or Cefotaxime

2. Chloramphenicol

🧠Meningitis caused by Pneumococci

1. Cefotaxime- add dexamethasone

2. Benzylpenicillin ➡ pen allergy - Cephalosporin + Vancomycin

🧠CNS: Meningitis caused by Listeria

1. Amoxicillin (or ampicillin) + Gentamicin (or pen allergy: Co-trimoxazole)

🧠CNS - Meningitis caused by Haemophilus influenza

Cefotaxime or ceftriaxone

🫁Respiratory - Epiglottis

1. Cefotaxime or Ceftriaxone

2. Pen allergy - Chloramphenicol

🫁Respiratory - COPD

1. Amoxicillin/Clarithromycin/Doxycycline

2. Co-amoxiclav, Levofloxacin or Co-trimoxazole

🫁Respiratory - Acute Cough

1. Doxycycline or Amoxicillin, Clarithromycin or Erythromycin

2. Pregnancy = amoxicillin or erythromycin

🫁Respiratory - community acquired pneumonia

1. Amoxicillin

2. Pen allergy: Clarithromycin / Erythromycin/ Doxycycline

Skin: Impetigo - Topical

Localised bullous impetigo

1. Topical hydrogen peroxide 1% cream

2. Fusidic acid - Alternative if it becomes systemic and widespread rather than localised

Skin: Impetigo - Oral

1. Flucloxacillin (if impetigo is around the mouth)

2. Clarithromycin, erythromycin for pen allergy

Cellulitis

1. Flucloxacillin

   1. Clarithromycin, Doxycycline, Erythromycin- for penicillin allergy

2. Co-amoxiclac, Clindamycin

Leg ulcer

1. Flucloxacillin (Clarithromycin, Doxycycline, Erythromycin if penicillin allergy)

2. Co-trimoxazole (pen allergy)

Animal and human bite

1. Co-amoxiclav

2. Doxycycline + Metronidazole = pen allergy

Tick bites (Lyme disease)

1. Doxycycline (100mg BD)

2. Amoxicillin (1000mg TDS)

Try duration: 21 days

Mastitis - during breastfeeding

1. Flucloxacillin

2. Erythromycin = pen allergy