Management

Disease Common pathogens

First choice Alternatives
Respiratory
Respiratory viruses,
Doxycycline
Streptococcus pneumoniae, Amoxicillin
COPD 200mg loading dose, followed by
Haemophilus influenza, 500mg PO three times daily for 5 days
100mg once daily on days 2-5
Moraxella catarrhalis

Erythromycin, (for children over 1yo,

alternative for adults)
Child:
Azithromycin (for children, alternative
10mg/kg/PO four times daily for 14
for adults)
day
Pertussis <45kg: 10mg/kg/day on day one,
Adults:
(Whooping Bordetella pertussis followed by 5mg/kg/day on days 2-5
400mg four times daily for 14 days
cough) Adults & children>45kg: 500mg once
daily on day one, followed by 250mg
N.B:
once daily on days 2-5
Erythromycin estolate 7 days
treatment is as effective as 14 day
treatment of other erythromycin salts

Respiratory viruses,
Streptococcus pneumoniae,
Haemophilus influenza,
Pneumonia -
Mycoplasma pneumoniae,
Adults
Chlamydophilia pneumonia,
Legionella pneumophillia &
Staphylococcus aureus
Respiratory viruses,
Streptococcus pneumoniae,
Pneumonia -
Haemophilus influenza,
Children
Mycoplasma pneumoniae &
Staphylococcus aureus
Ear, nose and throat
Staphylococcus aureus,
Streptococcus pyogenes,
Otitis externa
pseudomonas aeruginosa,
polymicrobial infections
Amoxicillin
500mg - 1gm three times daily for 5-7
days
Monotherapy with Doxycycline is
If M.pneumoniae, C.pneumoniae or
acceptable for people with history of
L.pneumoniae are suspected or if the
penicillin allergy
patient has not improved after 48h,
add Doxycycline 200mg twice daily on
day one followed by 100mg twice
daily from day 2-7
Erythromycin
10-12.5mg/kg/dose four times daily
Amoxicillin
for 7 days
25-30mg/kg/dose three times daily
for 5-7 days (max. 500mg/dose age
Can be first line in school-aged
3m-5yo , 1000mg/dose age> 5yo
children where the likelihood of
atypical pathogens is higher
Clioquinol + Flumethasone Acetic acid 2% may be sufficient in
Adults & children>2: 2-3 drops twice mild cases
daily for 7 days
Ciprofloxacin + Hydrocortisone (if
Dexamethasone + Framycetin + pseudomonas suspeced)
Gramicidin
Adults & children: 2-3 drops three to Flucloxacillin (if there is spreading
four times daily for 7 days cellulitis or the patient is systemically
 Avoid excessive use, e.g. for longer
than one week as they may result in
fungal infection which can be difficult
to treat
Amoxicillin
Child: 15mg/kg/dose three times
daily, for 5 days (7-10 days if age<
Respiratory viruses, 2years, underlying medical condition
Streptococcus pneumoniae, or perforated ear drum)
Otitis media
Haemophilus influenza,
Moraxella catarrhalis Use 30mg/kg/dose three times daily,
for 5-7 days in severe or recurrent
infection (max. 500mg/dose age 3m-
5yo, 1000mg/dose age>5yo
Penicillin V
Child<20kg: 250mg two or three times
daily for 10 days
≥20kg and adults: 500mg two or three
Respiratory viruses, times daily for 10 days
Pharyngitis
Streptococcus pyogenes
Amoxicillin
Child<30kg: 750mg once daily OR
25mg/kg twice daily (max.
1000mg/day)
unwell, also consider referral to
hospital
Co-trimoxazole
Child >6weeks:
0.5mL/kg/dose oral liquid
(40+200mg/5mL) twice daily, for 5-7
days (max. 20mL/dose)
If child can swallow tablets, SS tablet
can be used (1 tablet is equivalent to
10mL of oral liquid)
N.B:
Co-trimoxazole should be avoided in
infants aged <6weeks, due to risk of
hyperbilirubinemia
Erythromycin
Child: 20mg/kg/dose twice daily OR
10mg/kg/dose four times daily for 10
days (max. 1gm/day)
Adult:
400mg twice daily for 10 days
N.B:
Co-trimoxazole doesn't have reliable
activity against S.pyogenes or

Respiratory viruses,
Streptococcus pneumoniae,
Sinusitis
Haemophilus influenzae,
(acute)
Moraxella catarrhalis, anaerobic
bacteria
Viruses, Streptococcus
pneumoniae, Haemophilus
Conjunctivitis
influenzae, Staphylococcus
aureus
≥30kg and adults: 1000mg once daily eradicate pharyngeal carriage and
for 10 days should not be used
IM Benzathine pencillin
Child<30kg: 450mg (600,000IU), stat
≥30kg and adults: 900mg
(1,200,000IU) , stat
Doxycycline
Adult and child >12: 200mg on day
one followed by 100mg once daily on
Amoxicillin
days 2-7
Child: 15mg/kg/dose three times daily
for 7days
Amoxicillin-clavulanate (if symptoms
despite a treatment course of
Use 30mg/kg/dose three times daily
amoxicillin)
for 7 days in severe or recurrent
Child: 10mg/kg/dose (amoxicillin)
infection (max. 500mg/dose age 3m-
three times daily for 7 days (max.500
5yo, 1000mg/dose > 5yo
mg/dose)
Adult: 500+125 three times daily for 7
days
Eye
Chloramphenicol 0.5% eye drop Fusidic acid eye gel
Adult and child>2yo: 1-2 drops every 2 Adult and child:
hours for the first 24 hours, then 1 drop twice daily until 48 hours after
every 4 hours +/- chloramphenicol ete symptoms have cleared
 Less commonly: Chlamydia
trachomatis or Neisseria
gonorrheae
Can be viral, bacterial or allergic.
Bacterial usually associated with
mucopurulent discharge
Bacterial Neisseria meningitidis,
meningitis & Streptococcus pneumoniae
suspected Less common:
meningococcal Listeria monocytogenes,
Haemophilus influenzae
sepsis
Polymicrobial infections,
Pasteurella multocida,
Capnocytophaga canimorsus
Bites - human &
(cat & dog bites), Eikenella
animals corrodens (first injury),
Staphylococcus aureus,
Streptococci and anaerobes
ointment until 48 hours after
symptoms have cleared
CNS
Penicillin G
Ceftriaxone
Child< 1yo: 300mg IV or IM
Adult & child: 50-100mg/kg up to 2
Child 1-9yo: 600mg IV or IM
gm IV or IM
Adults & child>10: 1.2gm IV or IM
Skin
Adults & child>12: Metronidazole
400mg three times daily for 7 days +
Doxycycline 200mg on day one,
Amoxicillin-clavulanate
followed by 100mg once daily on days
Child: 10mg/kg/dose three times daily
2-7
for 7 days (max. 500mg/dose
Child<12: Metronidazole + Co-
Adult:
trimoxaxole (Doxycycline
500+126 three times daily for 7 days
contraindicated)

Staphylococcus aureus
Boils Consider MRSA if there is a lack
of response to flucloxacillin
Streptococcus pyogenes,
Cellulitis Staphylococcus aureus, Group C
or Group G Streptococci
Cephalexin
Adult: 500mg four times daily for 5-7
days
Flucloxacillin Erythromycin
Child: 12.5mg/kg/dose three times Child<12: 20mg/kg/dose twice daily,
daily for 7 days or 10mg/kg/dose four times daily for
Adult: 500mg four times daily for 5-7 5-7 days (max. 1gm/day)
days Adult: 800mg twice daily, or 400mg
four times daily for 5-7 days
Cephalexin
Child: 12.5-25mg/kg/dose twice daily Co-trimoxazole (if MRSA present)
for 5-7 days Child>6weeks: 0.5mL/kg oral liquid
(40+200mg/mL) twice daily for 5-7
days (max. 20mL/dose)
Adult & child>12yo: 160+800mg twice
daily for 5-7 days
Flucloxacillin Cephalexin
Child: 12.5mg/kg/dose four times Child: 12.5mg/kg/dose four times
daily for 7 days daily for 7 days
Adult: 500mg four times daily for 7 Adult: 500mg four times daily for 7
days days
OR (if flucloxacillin not tolerated)
Erythromycin
Cephalexin Child <12: 20mg/kg/dose twice daily,
Child: 12.5mg/kg/dose four times or 10mg/kg/dose four times daily for
daily for 7 days 5-7 days (max. 1gm/day)

Early infections is usually due to
Staphylococcus aureus and/or
Streptococci.
Diabetic foot
Later infection may be
infections polymicrobial with a mixture of
gram-positive cocci, gram-
negative bacilli and anaerobes
Streptococcus pyogenes,
Impetigo
Staphylococcus aureus
Adult: 500mg four times daily for 7
days
Amoxicillin-clavulanate
Adult: 500+125mg three times daily
for 5-7 days
Topical: (localized area of infection)
Hydrogen peroxide 1% cream: apply
2-3 times daily for 5 days
Povidone iodine 10% ointment: apply
three times daily for 5 days
Oral: (extensive/multiple lesions)
Adult: 800mg twice daily, or 400mg
four times daily for 5-7 days
Co-trimoxazole (if MRSA present)
Child<6 weeks: 0.5mL/kg oral liquid
(40+200mg/5mL) twice daily for 5-7
days (max. 20mL/dose)
Adult & child>12yo: 160+800mg twice
daily for 5-7 days
Cephalexin
500mg four times daily +
Metronidazole 400mg 2-3 times daily
for 5-7 days
Co-trimoxazole (if patient with
penicillin hypersensitivity)
160+800 twice daily + Clindamycin
300mg three times daily for 5-7 days
Topical: (localized area of infection)
Fusidic acid 2% cream or ointment:
apply three times daily for 5 days
If topical treatment fails, use oral
treatment as before
Oral:
Cephalexin (if Flucloxacillin not
tolerated)
 Flucloxacillin
Child: 12-25mg/kg/dose four times
daily for 5 days (max. 500mg/dose)
Adult: 500mg four times daily for 5
days
Staphylococcus aureus in
lactating women, Flucloxacillin
Mastitis Staphylococcus aureus & Adult: 500mg four times daily for 7
anaerobes in non-lactating days
females or in males
Child: 12-25mg/kg/dose twice daily
for 5 days
Adult: 500mg four times daily, or 1gm
twice daily for 5 days
Erythromycin (if allergy to
flucloxacillin)
Child<12yo: 20mg/kg/dose twice daily
or 10mg/kg/dose four times daily for
5 days (max. 1.6gm/day)
Adult: 800mg twice daily, or 400mg
four times daily for 5 days
Co-trimoxazole (if MRSA present)
Child >6weeks: 24mg/kg/dose oral
liquid (40+200) twice daily for 5 days
(max. 20mL/dose)
Child>12yo & adult: 960mg (160+800)
twice daily for 5 days
Cephalexin
Adult: 500mg four times daily for 7
days
Erythromycin
Adult: 400mg four times daily for 7
days
In males or non-lactating females
 Amoxicillin-clavulanate:
500+125mg three times daily for 7
days
Fusidic acid 2% cream or ointment (if
isolate sensitive to fusidic acid)

Mupirocin 2% ointment (if isolate

Recurrent skin resistant to fusidic acid and sensitive
Staphylococcus aureus Nil
infections to mupirocin)
If isolate is resistant to both fusidic
acid and mupirocin, topical treatment
is not indicated, discuss with an
infectious diseases specialist
Gastrointestinal
Erythromycin
Child: 10mg/kg/dose four times daily Ciprofloxacin
Campylobacter
Campylobacter jejuni for 5 days Adult: 500mg twice daily for 5 days
enterocolitis Adult: 400mg four times daily for 5 (not recommended for children)
days
Clostridium Vancomycin
Metronidazole If patient has not responded to two
difficile colitis
Clostridium difficile Adult: 400mg three times daily for 10 courses of metronidazole; discuss
(Pseudomembranous days with an infectious diseases physician
colitis) or clinical microbioligist. Oral
 vancomycin (using the injection
product) may be required
For treatment failure with ornidazole:
Ornidazole
exclude re-infection from
Child <35kg: 225mg/3kg/dose once
asymptomatic family contacts e.g.
daily for 1-2 days
children
Adults & child>35: 1.5g once daily for
Metronidazole
1-2 days
Child: 10mg/kg/dose three times daily
N.B: ornidazole is only available in
Giardiasis Giardia lamblia for 7 days (max. 400mg/dose)
tablet form, tablets may be crushed
Adult: 400mg three times daily for 7
days
Metronidazole
Child: 30mg/kg/dose once daily for 3
N.B. Nitazoxanide (hospital
days (max. 2g/dose)
treatment) may be considered for
Adult: 2g once daily for three days
recurrent treatment failure
Co-trimoxazole
Salmonella Salmonella enteritidis and Ciprofloxacin
Adult: 160+800mg twice daily for
enterocolitis Salmonella typhimurium Adult: 500mg twice daily for 3 days
three days
Genito-urinary
Ornidazole
Metronidazole
500mg twice daily for 5 days, or 1.5g,
Gardenerella vaginalis, Adult: 400mg twice daily for 7 days, or
Bacterial stat may be used instead of
Bacteroides, Peptostreptococci, 2g, stat, if adherence to treatment is a
vaginosis metronidazole, but is not
Mobilunculus and others concern, however, this is associated
recommended in women who are
with a higher relapse rate
pregnant as no study data is available
Azithromycin
Chlamydia Chlamydia trachomatis Amoxicillin
Adult: 1g, stat

Majoriry due to Chlamydia
trachomatis or Neisseria
gonorrhea. Also E.coli,
Bacteroides species, Gadenella
Epididiymo-
vaginalis, Mycoplasma hominis,
orchitis
Ureaplasma urealyticum,
Trichomonas vaginalis,
Streptococcus agalactiae and
others
Gonorrheae Neisseria gonorrhea
Pelvic
inflammatory Chlamydia trachomatis, Neisseria daily for 14 days + Metronidazole
disease gonorrhea and others
(PID)
500mg three times daily for 7 days
Doxycycline (only in women who are pregnant
Adult: 100mg twice daily for 7 days. who are unable to take azithromycin)
Do not use in pregnancy or breast
feeding
If STI pathogens suspected:
Ceftriaxone 500mg IM + Doxycycline
Amoxicillin-clavulanate
100mg twice daily for 14 days
500+125mg three times daily for 10
days (if UTI pathogens suspected and
If UTI pathogens suspected:
contraindicated to Quinolones
Ciprofloxacin
500mg twice daily for 10 days
If STI suspected Ciprofloxacin 500mg + Azithromycin
Ceftriaxone 500mg IM + 1g, stat, only if the isolate is known to
Azithromycin 1g, stat (including in be ciprofloxacin sensitive.
pregnancy and breastfeeding) Resistance rates vary by location.
Ceftriaxone
Ceftriaxone
500mg IM + Azithromycin 1g on day
500mg IM + Doxycycline 100mg twice
one 1 and day eight 8 (if compliance is
likely to be poor)
400mg twice daily for 14 days
(metronidazole may discontinued if
Ornidazole
not tolerated)
(If metronidazole is not tolerated)
 Amoxicillin-clavulanate
500+125mg three times daily for 10
days
Escherichia coli, Proteus spp., Co-trimoxazole
Pyelonephritis -
Klebsiella spp. and Enterococcus Adult: 160+800 twice times daily for Ciprofloxacin
acute spp. 10 days 500mg twice daily for 7 days (but
should be reserved for isolates
resistant to initial empiric choices and
avoided during pregnancy)
For those intolerant of the stat dose,
use

Metronidazole
Metronidazole 400mg twice daily for
Adult: 2g, stat
7 days
Can be used in women who are
Trichomoniasis Trichomonas vaginalis
pregnant or breastfeeding, but advise
Ornidazole 1.5g, stat or 500mg twice
to avoid breastfeeding for 12-24 hours
daily for 5 days may be used instead
after dose)
of metronidazole, but it is not
recommended in women who are
pregnant as no study data is available
Urethritis not attributable to
Azithromycin
Neisseria gonorrhea or
Adult: 2g, stat
Chlamydia trachomatis is
Urethritis termed non-specific urethritis Nil
Doxycycline
and there may be a number of
Adult :100mg twice daily for 7 days
organisms responsible, e.g.
Ureaplasma urealyticum,
 Mycoplasma genitalium and
Trichomonas vaginalis
Escherichia coli, Staphylococcus
Urinary tract
saprophyricus, Proteus spp.,
infection (UTI) -
Klebsiella spp. and Enterococcus
adult spp.
Urinary tract
Escherichia coli, Proteus spp.,
infection (UTI) -
Klebsiella spp., Enterococcus spp.
child
If purulent discharge, treat as for
gonorrhea, i.e.
Ceftriaxone: 500mg IM + Azithromycin
1g, stat
Trimethoprim
Adult: 300mg once daily for 3 days
(avoid during the first trimester of
pregnancy)
Norfloxacin 400mg twice daily for 3
Nitrofurantoin days (but should be reserved for
Adult: 50mg four times daily for 5
isolates resistant to initial empiric
days (avoid at 36+ weeks in choices and avoided during pregnancy
pregnancy, and in patients with CrCl
<60mL/min
Treat for 7 days in pregnant women
and in males
Cefaclor 8-10mg/kg/dose three times
daily for 3 days (max. 500mg/dose)
Co-trimoxazole 0.5mL/kg/dose
Amoxicillin-clavulanate
(40+200mg/5mL) twice daily for 3
10mg/kg/dose (amoxicillin
days (max. 20mL/dose)
component) three times daily for 3
days (max. 500mg/dose amoxicillin
component)
References:
- Lang S, editor. Guide to pathogens and antibiotic treatment. 7th ed, Auckland; Diagnostic Medlab 2004
- 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.
- 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.
- Antibiotics: Choices for Common Infection 2013 Edition (Updated October, 2015)
- British Infection Association and Health Protection Agency. Management of infection guidance for primary care for consultation and local adaptation,
2012. Public Health England. Available from: www.hpa.org.uk
- Ellis-Pegler R, Thomas M. Approaches to the management of common infections in general practice. Auckland; Diagnostic Medlab, 2003.