Bpac Antibiotics Booklet PDF
Bpac Antibiotics Booklet PDF
Bpac Antibiotics Booklet PDF
bpac nz
better medicine
Respiratory
Eyes
Skin
Gastrointestinal
10
Genito-urinary
13
CNS
17
A safe and effective strategy for antibiotic use involves only prescribing an
antibiotic when it is needed and selecting an effective agent at the correct dose
with the narrowest spectrum, fewest adverse effects and lowest cost.
General principles of antibiotic prescribing:
1. Only prescribe antibiotics for bacterial infections if:
Symptoms are significant or severe
There is a high risk of complications
The infection is not resolving
2. Use first-line antibiotics first
3. Reserve broad spectrum antibiotics for indicated conditions only
The following information is intended to guide selection of an appropriate
antibiotic for infections commonly seen in general practice. Individual patient
circumstances may alter treatment choices.
Data on national resistance patterns are available from the ESR website:
www.surv.esr.cri.nz
Regional resistance patterns may vary slightly, check with your local laboratory.
The information in this guide is correct as at the time of publication (April, 2011).
Respiratory
Acute exacerbation of chronic bronchitis or COPD
Management
Common pathogens
Antibiotic treatment
First choice
Alternatives
Pneumonia adult
Consider chest x-ray to confirm diagnosis.
Patients with two or more of the following features: age
>65 years, confusion, respiratory rate >30/min, diastolic BP
<60mm Hg, have a predicted mortality of 10% or higher and
admission to hospital should be considered.
Patients can generally be adequately treated with an agent
that covers Streptococcus pneumoniae. Ciprofloxacin should
not be used as it does not reliably treat infections due to
Streptococcus pneumoniae.
Common pathogens
RESPIRATORY
Management
Antibiotic treatment
First choice
Alternatives
Respiratory (continued)
Pneumonia child
Management
Common pathogens
RESPIRATORY
Antibiotic treatment
First choice
Alternatives
Pertussis
Management
Common pathogens
Bordetella pertussis
Antibiotic treatment
First choice Erythromycin 10 mg/kg (up to 500 mg), four times daily, for 14
days
Alternatives None
Common pathogens
Antibiotic treatment
First choice
Alternatives
Antibiotic treatment
First choice
Alternatives
Management
Common pathogens
Antibiotic treatment
First choice
Alternatives
Amoxicillin weight > 30 kg 1500 mg, once daily, for ten days,
weight <30 kg 750 mg, once daily, for ten days
or
Phenoxymethylpenicillin (penicillin V) adults 500 mg, twice
daily, for ten days, children 20 mg/kg/day in two to three
divided doses, for ten days
or (if compliance is an issue)
stat IM benzathine 0.6 MU if <27 kg or 1.2 MU if > 27 kg
Erythromycin
Cotrimoxazole does not reliably eradicate pharyngeal
carriage and should not be used
Sinusitis (acute)
Management
Common pathogens
Antibiotic treatment
First choice
Alternatives
Amoxicillin 500 mg, three times daily, for seven days (Child
40 mg/kg/day in two to three divided doses)
Doxycycline, co-trimoxazole or cefaclor
If anaerobes suspected, use amoxicillin clavulanate
Eyes
Conjunctivitis
Management
Common pathogens
EYES
Skin
Bites and clenched fist infections*
Management
Common pathogens
Antibiotic treatment
First choice
Alternatives
SKIN
Boils
Management
Common pathogens
Staphylococcus aureus
Consider MRSA if there is a lack of response to flucloxacillin.
Antibiotic treatment
First choice
Alternatives
Flucloxacillin 500 mg, four times daily, for seven to ten days
Erythromycin, co-trimoxazole
Cellulitis
Management
Common pathogens
Antibiotic treatment
First choice
Alternatives
Flucloxacillin 500 mg, four times daily, for seven to ten days
(the addition of penicillin is not required)
Erythromycin, roxithromycin, cefaclor or co-trimoxazole
SKIN
Common pathogens
Antibiotic treatment
First choice
Alternatives
Impetigo
Management
Common pathogens
Antibiotic treatment
First choice
Alternatives
Skin (continued)
Mastitis
Management
SKIN
Common pathogens
Antibiotic treatment
First choice
Alternatives
Gastrointestinal
GASTROINTESTINAL
Campylobacteriosis
Management
Campylobacter jejuni
Antibiotic treatment
First choice
Alternatives
10
Common pathogens
Clostridium difficile
Antibiotic treatment
First choice
Alternatives
Management
Common pathogens
Giardia lamblia
Antibiotic treatment
First choice
GASTROINTESTINAL
Giardiasis
11
Gastrointestinal (continued)
Salmonellosis
Management
Common pathogens
Antibiotic treatment
First choice
Alternatives
GASTROINTESTINAL
Travellers diarrhoea
Management
Common pathogens
Antibiotic treatment
First choice
Alternatives
12
Genito-urinary
Cystitis
Management Non-pregnant women with uncomplicated cystitis do not
require a urine culture. However, those who fail to respond to
empiric treatment within two days as well as males, children
and pregnant women do require a urine culture.
Antibiotic therapy is indicated for all people who are
symptomatic. Asymptomatic bacteriuria requires antibiotic
treatment in pregnant women but not in elderly women or
patients with long-term indwelling urinary catheters.
Treat for longer in pregnant women (seven days) and in men
(10 to 14 days). Pregnant women should have repeat urine
culture one to two weeks after completing treatment to ensure
cure.
Common pathogens Escherichia coli, Staphylococcus saprophyticus, Proteus sp.,
Klebsiella sp., Enterococcus sp.
First choice Trimethoprim 300 mg, once daily for three days (avoid during
the 1st trimester in pregnancy)
or
Nitrofurantoin 50 mg, four times daily, for five days (avoid at
36+ weeks in pregnancy)
Alternatives Norfloxacin but should be reserved for isolates resistant to
initial empiric choices and avoid during pregnancy
GENITO-URINARY
Antibiotic treatment
Acute pyelonephritis
Management Only treat as an outpatient if mild symptoms, e.g. low fever
and no nausea or vomiting. If systemically unwell or vomiting
refer for IV treatment.
A urine culture and susceptibility test should be performed.
Nitrofurantoin is not an appropriate choice for pyelonephritis.
Common pathogens Escherichia coli, Proteus sp., Klebsiella sp., Enterococcus sp.
Antibiotic treatment
First choice Ciprofloxacin 500 mg, twice daily, for seven days
Alternatives Co-trimoxazole 400+80 mg, two tablets, twice daily, for 10 to
14 days or amoxicillin clavulanate 500/125 mg, three times
daily, for 10 to 14 days or cefaclor 500 mg, three times daily, for
10 to 14 days
13
Genito-urinary (continued)
Chlamydia
Management Sexual partners of a person who has tested positive for
chlamydia should also be treated. A test of cure should be
done at four weeks post treatment in rectal infection, in
pregnant women and when amoxicillin or erythromycin is
used.
Repeat STI screen in three months for patients with confirmed
chlamydia.
Common pathogens Chlamydia trachomatis
Antibiotic treatment
GENITO-URINARY
Gonorrhoea
Management Sexual partners of a person who has tested positive for
gonorrhoea should also be treated. Test of cure is not usually
required as standard treatment is >95% effective (provided
compliant and asymptomatic after treatment).
As co-infection with chlamydia is very common, azithromycin
is also routinely given.
Common pathogens Neisseria gonorrhoeae
Antibiotic treatment
First choice Ceftriaxone 250 mg IM stat
and
Azithromycin 1 g stat
(including in pregnancy and breastfeeding)
14
Trichomoniasis
Management Sexual partners of a person who has tested positive for
trichomoniasis should also be treated, even if asymptomatic.
N.B. culture is seldom positive in males even if infection
present.
Common pathogens Trichomonas vaginalis
Antibiotic treatment
First choice Metronidazole 400 mg, twice daily, for seven days
or
Metronidazole 2 g stat
The single dose has the advantage of improved compliance
but there is some evidence to suggest that the failure rate is
higher.
Bacterial vaginosis
GENITO-URINARY
15
Genito-urinary (continued)
Acute non-specific urethritis
Management Non-specific urethritis is a diagnosis of exclusion. A urethral
swab and first void urine sample should be taken to exclude
gonorrhoea and chlamydia. Treat sexual contacts.
Common pathogens Urethritis not attributable to Neisseria gonorrhoeae or
Chlamydia trachomatis is termed non-specific urethritis
and there may be a number of organisms responsible, e.g.
Ureaplasma urealyticum, Mycoplasma genitalium, Trichomonas
vaginalis
Antibiotic treatment
First choice Azithromycin 1 g stat
GENITO-URINARY
16
Epidiymo-orchitis
Management Test for chlamydia, gonorrhoea and UTI
Bed rest, analgesics and scrotal elevation are recommended
Antibiotic treatment
First choice If STI pathogens suspected:
Ceftriaxone 250 mg IM stat
and
Doxycycline 100 mg, twice daily, for at least two weeks
GENITO-URINARY
CNS
Bacterial meningitis
CNS
17
Notes
Erythromycin
Cefaclor
Doxycycline
Avoid alcohol
Flucloxacillin or
Phenoxymethylpenicillin
Take at least one hour before meals and at
least two hours after meals.
NOTES
Metronidazole
18
Bibliography
1. Australian Medicines Handbook. Adelaide; Australian Medicines Handbook Pty Ltd, 2006.
2. British Medical Association and the Royal Pharmaceutical Society. BNF 61. London: Royal
Pharmaceutical Society, 2011.
3. Ellis-Pegler R, Thomas M. Approaches to the management of common infections in general
practice. Auckland; Diagnostic Medlab, 2003.
4. Everts R. Antibiotic guidelines for primary care, Nelson and Marlborough Districts 2007-2008.
5. Lang S, editor. Guide to pathogens and antibiotic treatment. 7th ed, Auckland; Diagnostic
Medlab 2004.
6. Lang S, Morris A, Taylor S, Arroll B. Management of common infections in general practice: Part
1. NZ Fam Phys 2004;31(3):176-8.
7. Lang S, Morris A, Taylor S, Arroll B. Management of common infections in general practice: Part
2. NZ Fam Phys 2004;31(4):258-60.
NOTES
The information in this publication is specifically designed to address conditions and requirements in
New Zealand and no other country. BPAC NZ Limited assumes no responsibility for action or inaction
by any other party based on the information found in this publication and readers are urged to seek
appropriate professional advice before taking any steps in reliance on this information.
19
Respiratory
3
Pharyngitis
Acute sinusitis
Eyes
7
Conjunctivitis
Skin
8
Gastrointestinal
10
Campylobacteriosis
Clostridium difficile toxin disease
Giardiasis
Salmonellosis
Genito-urinary
13
17
Cystitis
Acute pyelonephritis
Chlamydia
Gonorrhoea
Trichomoniasis
CNS
Bacterial meningitis