Take swabs prior to antibiotic therapy. Check previous microbiology results, allergies and drug interactions.Penicillin Allergy:
• Penicillin allergy is documented in over10% of patients but the nature of allergy is often uncertain (not a true allergy).
• True allergy (anaphylaxis) occurs in under 1% of patients and is a barrier to all beta-lactam antibiotics.
• History of a rash or mild symptoms could still allow the use of cephalosporins or carbapenem antibiotics.

Consider delayed antibiotic prescriptions.

Pharyngitis / sore throat / tonsillitis

  • Self limiting illness lasting around 1 week
  • Check FeverPAIN score (Fever, Purulent tonsils, Attending rapidly, Inflamed tonsils, No cough/coryza)
    • 0-1 = No antibiotics.
    • 2-3 = delayed
    • 4 or greater = delayed/immediate

Phenoxymethylpenicillin 500mg QDS (or 1g BD) for 5 days (10 if high risk group A strep)

If penicillin allergic:Clarithromycin 500mg BD

Duration: 5 days

Otitis externa

  • It is important to exclude underlying chronic otitis media prior to treatment.
  • Good aural hygiene will often resolve the problem.

1st line: Betamethasone 0.1% drops 2 drops 3-4 hourly until pain improves then reduce.
2nd line: Neomycin sulphate with steroid 3 drops TID

Duration: 7 days

Otitis media

  • Self limiting illness lasting around 3-7 days
  • Consider 2-3 day delayed prescribing or immediate antibiotics if patient has ottorhoea

Amoxicillin 500mg TDS (1g if severe)

If penicillin allergic:Clarithromycin 500mg BD

Duration: 5 days

Sinusitis

  • Self limiting illness lasting around 2-3 weeks
  • Optimise analgesia ± xylometazoline 0.1% nasal spray
  • Consider delayed by 7 days or immediate antibiotics when purulent nasal discharge

Doxycycline 200mg STAT then 100mg OD or

Amoxicillin 500mg TDS

Duration: 5 days

Community acquired pneumonia (CAP)

  • Generally treat in the community unless severe or of clinical concern.
  • Use CRB65 to assess.
    Score 1 for each of the following:
    • Confusion (4AT below 4)
    • Respiratory rate over 30
    • BP systolic under 90 or diastolic under 60
    • Age over 65


• Score 0: suitable for home treatment
• Score 1-2: hospital assessment advised
• Score 3-4: urgent admission


PO Amoxicillin 500mg TDS

If penicillin allergic:
PO Doxycycline 200mg STAT then 100mg OD OR PO Clarithromycin 500 mg BD

Duration: 5 days

Infective exacerbation of COPD

Treat exacerbations promptly with antibiotics if purulent sputum and increases shortness of breath and/or increased sputum production.


PO Doxycycline OR PO Amoxicillin OR PO Clarithromycin

Duration: 5 days

Acute bronchitis/cough

  • Self limiting illness lasting around 3 weeks.
  • Antibiotics not shown to benefit in absence of co-morbidity.
  • Consider 7 day delayed antibiotics prescribing as per Community acquired pneumonia.

Oral candidiasis

Miconazole gel 4 times daily or Nystatin 1ml 4 times daily.

Duration: 7 days

Note: Miconazole should not be used concurrently with Warfarin

Suspected COVID-19/viral pneumonia

  • Antibiotics not routinely required
  • If evidence of bacterial infection on chest X-ray/purulent sputum then treat as per community acquired pneumonia.
  • Consider stopping antibiotics once viral pneumonia confirmed.

Editorial Information

Last reviewed: 18/12/2023

Next review date: 18/12/2024

Reviewer name(s): J Van Aartsen.