Summary Guidelines
Download / Print Section as PDFSummary Empiric Antimicrobial Guidelines
- Doses are for non-obese adults with normal renal and liver function.
- This is a brief summary guideline. See full guidelines for further sections and information.
- See footnotes at bottom of table.
Infection |
1 st Line Antibiotics |
Penicillin allergy: delayed onset non-severe reaction |
Penicillin allergy: immediate or severe delayed reaction |
Duration |
Abdomen |
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The regimens below may NOT cover Multi-drug Resistant Organisms (MRDO) in all cases. See note on MDRO |
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Intra-abdominal |
Mild Community Acquired Co-amoxiclav IV 1.2g q8h |
CefUROXime IV 1.5g q8h + Metronidazole** IV 500mg q8h |
Ciprofloxacin** IV 400mg q12h + Metronidazole** IV 500mg q8h |
4 to 7 days assuming adequate source control |
Moderate to Severe Community Acquired / All Hospital Acquired Piperacillin/tazobactam IV 4.5g q8h Add Gentamicin * IV one dose per GAPP App calculator IF haemodynamically unstable |
CefTRIAXone IV 2g q24h + Metronidazole** IV 500mg q8h Add Gentamicin * IV one dose per GAPP App calculator IF haemodynamically unstable |
Ciprofloxacin** IV 400mg q12h + Gentamicin * IV one dose per GAPP App calculator + Vancomycin * IV Infusion dose per GAPP App calculato r + Metronidazole** IV 500mg q8h |
Discuss with Micro/ID.
7 to 10 days assuming adequate source control |
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Bone & Joint |
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The regimens below may NOT cover Multi-drug Resistant Organisms (MRDO) in all cases. See note on MDRO |
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Septic Arthritis |
Flucloxacillin IV 2g q6h OR Ceftriaxone IV 2g every 24 hours IF high risk of Gram-negative organisms (e.g. elderly; nursing home resident; recurrent UTIs) or risk of gonococcus |
Vancomycin * IV Infusion dose per GAPP App calculator OR Ceftriaxone IV 2g every 24 hours IF high risk of Gram-negative organisms (e.g. elderly; nursing home resident; recurrent UTIs) or risk of gonococcus |
Discuss with Microbiology or Infectious Diseases |
Discuss with Microbiology or Infectious Diseases |
Osteomyelitis / Prosthetic Joint Infection |
Discuss with Microbiology or Infectious Diseases |
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Cardiovascular |
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Bacterial Endocarditis |
See full guideline |
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Central Nervous System |
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Suspected Bacterial Meningitis |
CefTRIAXone IV 2g q12h + Vancomycin * IV Infusion dose per GAPP App calculator
Consider adding Amoxicillin IV 2g q4h if risk of Listeria |
CefTRIAXone IV 2g q12h + Vancomycin * IV Infusion dose per GAPP App calculator
Consider adding Co-trimoxazole IV 60mg/kg q12h (round dose to nearest multiple of 480mg) if risk of Listeria |
Chloramphenicol IV 25mg/kg + Vancomycin * IV Infusion dose per GAPP App calculator. Give 1 st doses, THEN IMMEDIATELY discuss with Micro or ID Consider adding Co-trimoxazole IV 60mg/kg q12h (round dose to nearest multiple of 480mg) if risk of Listeria. |
Minimum 7 to 21 days |
Suspected Herpes Simplex Encephalitis |
Aciclovir IV 10mg/kg q8h (Refer to IV guide for dosing in obese patients) |
14 to 21 days |
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Eye |
See full guideline |
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Fungal |
See full guideline |
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Gastrointestinal |
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Clostridium difficile infection See full guideline |
Non-Severe Metronidazole PO/NG 400mg q8h |
10 to 14 days |
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Severe Vancomycin PO/NG 125mg q6h |
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Severe with ileus or toxic megacolon Vancomycin PO/NG 500mg every 6 hours + Metronidazole IV 500mg every 8 hours |
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Genital system |
See full guideline |
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IV Line |
See full guideline |
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Malaria |
See full guideline |
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Neutropenic Sepsis |
See full guideline |
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Obstetrics |
See full guideline |
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Respiratory System |
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Community Acquired Pneumonia (including nursing home patients unless history of Multi-drug resistant organisms (MDRO). See note on MDRO )
Signs/symptoms of LRTI AND new consolidation on chest X-ray |
Mild CURB-65 Score 0 or 1 |
5 days (provided afebrile and clinically stable for 48 hours. Otherwise 7 days) |
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Amoxicillin PO 1g q8h. - In younger patient ADD Clarithromycin PO 500mg q12h |
Doxycycline PO 100mg every 12 hours Avoid doxycycline in pregnancy or breastfeeding. Discuss with Micro/ID. |
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Moderate CURB-65 Score 2 |
5 days (provided afebrile and clinically stable for 48 hours. Otherwise 7 days) |
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Amoxicillin PO/IV 1g q8h + Clarithromycin PO (IV if NPO) 500mg q12h |
Levofloxacin PO (IV if NPO) 500mg q12h
Avoid levofloxacin in pregnancy or breastfeeding. Discuss with Micro/ID. Caution if risks for prolonged QT interval |
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Severe CURB-65 Score ≥ 3 |
7 days (longer duration may be required; see full guideline )
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Co-amoxiclav IV 1.2g q8h + Clarithromycin PO (IV if NPO) 500mg q12h |
CefTRIAXone IV 2g q24h + Clarithromycin PO (IV if NPO) 500mg q12h |
Levofloxacin PO (IV if NPO) 500mg q12h + Consider adding Vancomycin * IV Infusion dose per GAPP App calculator IF risk of S. aureus
Avoid levofloxacin in pregnancy or breastfeeding. Discuss with Micro/ID. Caution if risks for prolonged QT interval |
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Aspiration Pneumonia (Community Acquired) NB: Antimicrobial therapy for patients with aspiration without clinical evidence of pneumonia (acute aspiration pneumonitis) does not offer clinical benefit |
Co-amoxiclav IV 1.2g q8h |
Discuss with Microbiology or Infectious Diseases
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5 days (provided afebrile and clinically stable for 48 hours. Otherwise 7 days) |
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COPD Exacerbation without infiltrate
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Amoxicillin PO 1g q8h OR If recent (<2/52) course of Amoxicillin: Co-amoxiclav PO 625mg q8h
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Clarithromycin PO 500mg q12h OR Doxycycline PO 100mg every 12 hours Avoid doxycycline in pregnancy or breastfeeding. Discuss with Micro/ID. |
5 days
(provided afebrile and clinically stable for 48 hours. Otherwise 7 days) |
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Hospital Acquired Pneumonia These regimens may NOT cover Multi-drug Resistant Organisms (MRDO) in all cases. See note on MDRO
Contact Micro/ ID for treatment of Pseudomonal infection |
Moderate Piperacillin/tazobactam IV 4.5g q6h
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Moderate or severe Vancomycin * IV Infusion dose per GAPP App calculator + Ciprofloxacin** IV 400mg q12h
If possible aspiration, Add Metronidazole** IV 500mg q8h.
If haemodynamically unstable, Add Gentamicin * IV one dose per GAPP App calculator. |
7 days (longer duration may be required; see full guideline ) |
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Severe (ICU assessment required) Piperacillin/tazobactam IV 4.5g q6h + Vancomycin IV infusion, dose per GAPP App calculator. See footnote* re review and monitoring. Review at 24 - 48 hours and stop if MRSA not detected
If haemodynamically unstable Add Gentamicin * IV one dose per GAPP App calculator |
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Sepsis - See full guideline |
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The regimens below may NOT cover Multi-drug Resistant Organisms (MRDO) in all cases. See note on MDRO |
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If haemodynamically unstable |
Antibiotics must be given as soon as possible, then discuss with Microbiology or Infectious Diseases. Meropenem should be considered in patients who are critically ill with sepsis or have a history of a Gram-negative Multi-drug Resistant Organism (MDRO). Discuss use of Meropenem with Microbiology or Infectious Diseases. If meropenem is essential in a patient with a history of severe penicillin allergy e.g. anaphylaxis, close monitoring is required for cross sensitivity e.g. in ICU. |
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Sepsis-Source Unclear If source is known or suspected e.g. meningitis, respiratory, urinary, skin and soft tissue, ensure antibiotics are appropriate for the source. Follow the antibiotic recommendations in the corresponding chapter.
For full detailed guidance on the management of sepsis in a pregnant patient, see WAC Directorate Guideline on the Management of Suspected Sepsis and Sepsis in Obstetric Care (QPulse CLN-OGCP-218). Discuss with Obstetrics. |
Give antibiotics immediately |
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No risk factors for MRSA e.g. No CVC/No IV drug use |
Discuss with Microbiology or Infectious Diseases Ciprofloxacin^**IV 400mg q12h + Gentamicin ^* IV one dose per GAPP App calculator + Vancomycin * IV Infusion dose per GAPP App calculator
If pregnant or suspected intra-abdominal source Add Metronidazole IV 500mg q8h |
Duration is decided on a case by case basis |
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Piperacillin/tazobactam IV 4.5g q6h + Gentamicin ^* IV one dose per GAPP App calculator
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CefTRIAXone IV 2g q24h + Gentamicin ^* IV one dose per GAPP App calculator
If pregnant or suspected intra-abdominal source Add Metronidazole IV 500mg q8h |
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CVC/Inflammation at IV catheter site/IV drug use/Risk factors for MRSA |
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Piperacillin/tazobactam IV 4.5g q6h + Gentamicin ^* IV one dose per GAPP App calculator + Vancomycin * IV Infusion dose per GAPP App calculator |
CefTRIAXone IV 2g q24h + Gentamicin ^* IV one dose per GAPP App calculator + Vancomycin * IV Infusion dose per GAPP App calculator
If pregnant or suspected intra-abdominal source Add Metronidazole IV 500mg q8h |
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Suspected Meningococcaemia - See full guideline |
CefTRIAXone IV 2g q12h |
CefTRIAXone IV 2g q12h |
Chloramphenicol IV 25mg/kg. Give the first dose & discuss with Micro or ID immediately. |
7 days |
Skin & Soft Tissue |
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The regimens below may NOT cover Multi-drug Resistant Organisms (MDRO) in all cases. Vancomycin may be required in addition. See note on MDRO |
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Cellulitis/ Wound Infection
(Including initial treatment of Mastitis)
NB: If treating mastitis in the lactating woman , see full detailed guidance –including treatment duration - in WAC Directorate Guideline (QPulse CLN-OGCP-275) |
Mild Flucloxacillin PO 500mg - 1g q6h |
CefALEXin PO 500mg q6h |
Clindamycin PO 450mg q6h |
Duration for mild infection 5 days
Duration for moderate or severe infection 7 to 10 days |
Moderate to severe Flucloxacillin IV 2g q6h |
CeFAZolin (Unlicensed) IV 2g q8h |
Vancomycin * IV Infusion dose per GAPP App calculator |
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Severe with incipient necrotising fasciitis Flucloxacillin IV 2g q6h + Clindamycin** IV 600mg q8h |
Discuss with Microbiology or Infectious Diseases Vancomycin * * IV Infusion dose per GAPP App calculator + Clindamycin** IV 600mg q8h |
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For severe, if involving abdominal wall or groin or water exposure, consider adding Ciprofloxacin ** IV 400mg every 12 hours |
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Diabetic Foot Infection (without osteomyelitis )
Consider referral to Diabetic Foot Team (ENDF) |
Mild Co-amoxiclav PO 625mg q8h |
Clindamycin PO 450mg q6h |
Duration: Minimum 7 days for mild infection.
10 to 14 days in Moderate to Severe infection.
May require up to 3 weeks for severe infection. |
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Moderate Co-amoxiclav IV 1.2g q8h |
Clindamycin** IV 600mg q8h + Ciprofloxacin** IV 400mg q12h Monitor for diarrhoea |
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Severe Piperacillin/tazobactam IV 4.5g q8h Discuss with Microbiology or Infectious Diseases. See full guideline. |
Vancomycin * IV Infusion dose per GAPP App calculator + Clindamycin** IV 600mg q8h + Ciprofloxacin** IV 400mg q12h Discuss with Micro or ID. Monitor for diarrhoea. |
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If risk factors for MRSA in moderate to severe infection consider adding Vancomycin * * IV Infusion dose per GAPP App calculator |
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Bites, Animal & Human, Prophylaxis &Treatment |
Co-amoxiclav PO 625mg q8h |
Metronidazole PO 400mg q8h + Doxycycline PO 100mg every 12 hours Avoid doxycycline in pregnancy or breastfeeding. Discuss with Micro/ID |
Duration: Prophylaxis - 5 days Treatment - 7 days |
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Consider need for IV therapy or longer duration if severe infection | ||||
Throat |
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Acute Pharyngitis/ Tonsillitis |
Benzylpenicillin IV 1.2g q4h |
Clarithromycin** IV 500mg q12h
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10 days |
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Peritonsillar Abscess |
Co-amoxiclav IV 1.2g q8h |
Ceftriaxone IV 2g q24h + Metronidazole** IV 500mg q8h |
Clindamycin** IV 600-900mg q8h
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7 days
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Severe Acute Epiglottitis |
CefTRIAXone IV 2g q24h
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CefTRIAXone IV 2g q24h
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Vancomycin * IV Infusion dose per GAPP App calculator + Ciprofloxacin** IV 400mg q12h |
7 to 10 days |
Urinary Tract |
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The regimens below may NOT cover Multi-drug Resistant Organisms (MDRO) in all cases. See note on MDRO |
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Cystitis/Lower UTI |
1 st line antibiotic Nitrofurantoin PO 50mg q6h Avoid nitrofurantoin if eGFR <45 ml/min/1.73 m2. When potential benefit outweighs risk, it may be used with caution if the eGFR is 30–44 ml/min/1.73 m2 for a short course only (3–7 days) |
Adjust initial treatment based on culture & sensitivity results.
If eGFR<30ml/ min/1.73m 2 , discuss patients with Microbiology or ID
If pregnant, see WAC Directorate Management of Urinary Tract Infections in Pregnancy (QPulse CLN-OGCP-227) |
Duration for non-pregnant women :
3 days for nitrofurantoin (7 days in males ) |
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Pyelonephritis or complicated UTI Non-pregnancy |
Co-amoxiclav IV 1.2g q8h + Gentamicin * IV one dose per GAPP App calculator
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CefTRIAXone IV 2g q24h Add Gentamicin * IV one dose per GAPP App calculator IF haemodynamically unstable |
Ciprofloxacin** IV 400mg (or PO 500mg) q12h Add Gentamicin * IV one dose per GAPP App calculator IF haemodynamically unstable |
Minimum 10 days
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Acute Pyelonephritis in Pregnancy |
CefTRIAXone IV 2g q24h IF haemodynamically unstable, Add Gentamicin ^* IV one dose per GAPP App calculator (use booking weight) See full guideline + full detailed guidance in WAC Directorate Management of Urinary Tract Infections in Pregnancy (QPulse CLN-OGCP-227) |
See full guideline
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See full guideline
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Viral |
See full guideline |
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* Gentamicin & Vancomycin : Reduce dose in renal impairment. Therapeutic drug monitoring required. Review need for ongoing Gentamicin and Vancomycin on a daily basis.Continue with once daily Gentamicin dosing ONLY if Consultant/Specialist Registrar recommended. ** Ciprofloxacin/Clarithromycin/Clindamycin/Metronidazole IV: Consider oral switch after 24 to 48 hours. ^Gentamicin & Ciprofloxacin are recommended in pregnancy when benefit outweighs risk. |