Dr Mo Sobhy

Prescription writing

2023
 INDEX
General rules 2
How to fill out the drug chart 3
Palliative care 6
Atrial fibrillation 12
Pulmonary embolism 15
Diabetic foot 17
COPD 20
Infection and methotrexate 28
UTI 31
Lithium and Pain killer 34
Quinsy 37
Acute Pancreatitis 41
Venous thromboembolism 45
PROM 48
DVT 51
MRSA 53
Summary of antibiotic prescription 57

1
 General rules
 Only use a black pen.
 Prescription must include the patient's surname and given name, DOB, date of
admission.
 Where dosing is weight dependent e.g. pediatrics, low molecular weight heparins,
the weight should be documented
 Both positive and negative allergy histories and drug sensitivities MUST be
documented.
 Where allergy history is positive symptoms of the allergy should be described.
 For as required prescriptions the indication should be included.
 For all prescriptions for children (<12 years) the age and weight must be recorded.
 NO trailing zeroes (5mg NOT 5.0mg)
 Quantities less than 1g should be written in milligrams (500mg not 0.5g)
 Quantities less than 1mg should be written in micrograms (100micrograms not
0.1mg)
 When decimals are unavoidable the decimal point must be preceded by another
figure (0.5ml not .5ml)
 Dose units, the words micrograms, nanograms and units must not be abbreviated.
 The term milliliter is abbreviated to ml not cc or cm3
 For As Required prescriptions the minimum dose interval must be specified (6hours
NOT qds)
 Only the following abbreviations are to be used to describe the route of
administration:
IV – intravenous // SC – subcutaneous // IM – intramuscular // NEB – nebulised // PO –
oral // TOP – topical // PV – vaginal /// INH – inhalation /// PR – rectal
All other routes of administration must be written out in full, e.g. intrathecal, epidural,
sublingual, buccal.
 Prescribers must specify the precise location or area to be covered for topical drugs.
for example MUPIROCIN APPLY TO EACH NOSTRIL

2
 How to fill out the drug charts
Prescription chart is 4 sections
1. Once only

 Antibiotic loading dose, for example (doxycycline)

 PROM ( Dexamethason STAT)

2. Regular
 All sort of medications prescribed for long term conditions for example:
A patient with hypercholesterolemia has been prescribed atorvastatin 20mg, PO, OD

3
 3. Antibiotics

 Ensure the antibiotic is prescribed on the correct page

 confirm and check allergy status
 Always put a start date and an end date
 Always set time for daily doses
 Always write indication
 if you’ll write an antibiotic for more than 5 days use the subsequent drug table to add
extra 2 days and cross off the rest as demonstrated below. Or you can fill one box as
long as U state the start and end dates.

 Let’s practice:
A patient was admitted with breathlessness and cough. He was diagnosed with community
acquired pneumonia in the hospital. Consultant has reviewed the patient and planned to start
him on oral clarithromycin.

4
 4. As required (PRN)
 As required prescriptions must always state minimum dose interval and maximum dose
 the minimum dose interval MUST be specified (6 hours NOT qds)
 For as required prescriptions the indication should be included
 Drugs for continuous infusion should be written on an IV Fluid prescription, the drug and
quantity must be specified the name of the infusion solution (diluent) must be specified,
the duration or rate of administration must be specified in ml/min or ml/hr, as
demonstrated below.

5. Maintenance fluid

5
 PALLIATIVE CARE 1
You are FY2 in hospice care home
Who the patient is:
Mrs Victoria Yates, aged 80, is diagnosed with metastatic pancreatic cancer
Other information you have about the patient:
Patient is terminal. Palliative care has been prescribed. She has been referred from hospital to
hospice for the continuation of palliative care. She cannot eat or drink very well.
Special Note:
None
What you must do:
Write down the prescription of her palliative care medications
Hospital Handover Note:
Patient name: Victoria Yates Date of Birth: 25/03/1942 NHS Number: 123456 Hospital No: 1234
Allergy: Penicillin Reaction: Breathlessness
Dear Doctor,
Mrs Victoria Yates, aged 80, has been admitted in the medical department with pancreatic
cancer. She is terminally ill and on palliative care. She cannot eat or drink well.
Plan: she will be discharged to hospice for palliative care with the following medications:
• Morphine 5mg SC every 4 hours (max 6 doses) for pain
• Cyclizine 50mg TDS SC for nausea and vomiting
• Midazolam 2.5mg SC 4 hourly (max 6 doses) for agitation
• Hyoscine bromide 400 micrograms SC 4 hourly (max 2.4mg) for secretion
• Paracetamol 1g PO every 4 to 6 hours (max 4g/day) for pain
• Atorvastatin 10mg PO OD

6
5 mg 30 mg

7
 Palliative Care 2
You are FY2 in hospice care home
Who the patient is:
Mrs Victoria Yates, aged 80, is diagnosed with metastatic pancreatic cancer
Other information you have about the patient:
Patient is terminal. Palliative care has been prescribed. She has been referred from hospital to
hospice for the continuation of palliative care. She cannot eat or drink very well. Her list of
medications can be found in the hospital handover inside the cubicle.
Special Note:
None
What you must do:
Write down the prescription of her palliative care medications
Hospital Handover Note:
Patient name: Victoria Yates
Date of Birth: 25/03/1942
NHS Number: 123456
Hospital No: 1234
Allergy: Penicillin, Reaction: Breathlessness
Plan: she will be discharged to hospice for palliative care with the following medications:
• Morphine for pain via syringe driver 30mg per 24 hours SC
• Morphine for breakthrough pain S/C
• Cyclizine 50mg TDS SC for nausea and vomiting
• Midazolam 2.5mg SC 4 hourly (max 6 doses) for agitation
• Hyoscine bromide 400 micrograms SC 4 hourly (max
2.4mg) for secretion
• Paracetamol 1g PO every 6 hours (max 4g/day) for pain
• Atorvastatin 10mg PO OD

8
9
10
 30 mg MORPHINE is given via pump (24 hour S/C infusion) For breakthrough pain
we divide total 24 hour dose by 6 30/6 gives you 5 mg ( Morphine breakthrough is
1/6 to 1/10 of the total dose)

 In this scenario you will stop oral medicines and Prescribe the rest as per given dose
in the as required section and write indication of each.

 If instead of morphine U R asked to prescribe diamorphine don’t panic, here are the
respective doses:

 If the patient is having acute pain due to a terminal condition then they should be
given oral morphine:

11
 If required to prescribe antiemetic for a preoperative patient you can safely prescribe
cyclizine

12
 Atrial Fibrillation
● Where Are you:
You are FY2 in Medicine
Who the patient is:
Mrs. Andrea Brighton, aged 81, was diagnosed with non-valvular atrial fibrillations
Other information you have about the
patient:
Patient had CABG 10 years ago
Sr. creatinine is 152 µmol/L
Patient was prescribed apixaban and atenolol 25 mg PO OD
Special Note:
None
What you must do:
Write down the prescription for the above medications

13
14
 Case discussion

 Apixaban for prophylaxis against blood clotting in AF

 Apixaban for long term ttt after a thromboembolic event

 NICE Guidlines
Antiplatelets, such as aspirin, clopidogrel, and ticagrelor — apixaban is predicted to increase the
risk of bleeding events when given with antiplatelet drugs. The manufacturer of apixaban
advises to avoid. If concurrent use is indicated, monitor for signs of bleeding and anaemia.

15
 Pulmonary Embolism

Where are you:

You are FY2 in Medicine
Who the patient is:
Miss Hannah Knowles, aged 60, has been admitted to the hospital because of breathlessness.
She was diagnosed with pulmonary embolism and was managed in the hospital
Other information you have about the patient:
She is a diagnosed case of hypercholesterolemia. She had a long-haul flight 10 days ago. She
was prescribed the following medications:
○ Apixaban for 6 months
○ Atorvastatin 20mg OD
○ Aspirin 75mg OD
eGFR is 87, D-dimer is increased
Special Note:
Patient is allergic to codeine. She gets itching after taking codeine
What you must do:
Write down the prescription for the above medications.

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17
 Diabetic foot

Cellulitis
Where Are you:
You are FY2 in Surgery
Who the patient is:
Mr. Rio Fernandes, aged 50, has been admitted due to cellulitis (Diabetic Foot)
Other information you have about the patient:
Patient has been diagnosed with Diabetes 5 years ago. He is on Metformin 500mg TDS
Special Note:
Patient is allergic to Penicillin. Patient had itching
What you must do:
Consultant had requested you to start him on Co-trimoxazole with Gentamicin or metronidazole

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 8/1/22

With meals

19
 Case discussion

 Metronidazole:

 Co-trimoxazole

 Metformin

 Caution for metformin

Risk factors for lactic acidosis
caution in chronic stable heart failure (monitor cardiac function), and concomitant use of drugs
that can acutely impair renal function; interrupt treatment if dehydration occurs, and avoid in
conditions that can acutely worsen renal function and avoid in patients with sepsis In adults:
Prescription potentially inappropriate (STOPP criteria) if eGFR less than
30 mL/minute/1.73 m2 (risk of lactic acidosis)
20
Community Acquired Pneumonia
Where Are you:
You are FY2 in A&E
Who the patient is:
Mr. Jamie Strauss, aged 55, was admitted with breathlessness and cough . He was diagnosed
with community acquired pneumonia in the hospital. Consultant has reviewed the patient and
planned to start him on clarithromycin 500mg PO BD for 5 days
Other information you have about the patient:
Other regular medications:
○ Salbutamol 200 microgram (1-2 puff PRN) up to 4 times a day
○ Seretide 250 evohaler 1 puff BD
○ Ipratropium bromide 40 microgram (1-2 puffs BD)
○ Prednisolone 30mg PO OD 7 days
○ Aspirin 75mg PO OD
○ Ramipril 2.5mg PO OD
○ Levothyroxine 50 microgram PO OD
○ Atorvastatin 20mg PO OD
Special Note:
None
What you must do
Write down the prescription for the above medications

21
Community acquired pneumonia

22
6/1/22

23
NICE Guidlines
Statins (atorvastatin, simvastatin) — these are extensively metabolised by CYP3A4.
Concomitant administration with clarithromycin increases the plasma levels and the risk
ofmyopathy. do not prescribe clarithromycin to a person taking simvastatin. If treatment
with clarithromycin cannot be avoided, stop treatment with simvastatin temporarily— avoid
concurrent use of Atorvastatin with clarithromycin. If concurrent use cannot be avoided,
prescribe the lowest dose of atorvastatin.

COPD 2
● Where Are you:
You are FY2 in Medicine
Who the patient is:
Miss Hannah Knowles, aged 60, has been admitted to the hospital because of breathlessness.
She was diagnosed with acute bronchitis.
Other information you have about the patient:
Pt admitted to the ward for acute exacerbation of COPD Prescribe Clarythromycin and regular
medications.
OTHER MEDICATION:
Seretide 250 EVOHALER one puff BD
SALBUTAMOL 100 mg 1-2 puff PRN
Special Note:
Patient is allergic to PENICILLIN AND CLARITHYROMYCIN. She gets itching.
What you must do:
Write down the prescription for the above medications.

24
25
 COPD3
Where Are you:
- You are FY2 in A&E

Who the patient is:

- Mr. Jamie Strauss, aged 55, was admitted with breathlessness and cough. He was diagnosed
with community acquired pneumonia in the hospital. Consultant has reviewed the patient and
planned to start him on IV Co-Amoxiclav 1000mg PO BD for 7 days. With low flow oxygen
(Venturi Mask).

Other information you have about the patient:

- Other regular medications :
- Salbutamol 200 microgram (1-2 puff PRN) up to 4 times a day.
- Seretide 250 evohaler 1 puff BD.
- Ipratropium bromide 40 microgram (1-2 puffs BD).
- Prednisolone 30mg PO OD 7 days.
- Aspirin 75mg PO OD.

Special Note:
- The patient is allergic to penicillin and codeine.
- Has HTN, CHL, and COPD.

What you must do

- Write down the prescription for the above medications.

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 VENTURI MASK 24%

Date of your exam

IV

Community acquired Pneumonia

27
 COPD Cases discussion

 COPD, acute exacerbation.

The recommended total duration of treatment is 5 days. guided by the most recent sputum
culture and susceptibility results when available.
Oral first line:
 Amoxicillin, clarithromycin, or doxycycline.

 Doxycycline in acute exacerbation of COPD: By mouth, Adult

Initially 200 mg daily for 1 dose, then maintenance 100 mg once daily for 5 days in total,
increased if necessary to 200 mg once daily, increased dose used in severe infections.

 Patient is allergic to penicillin and has been prescribed co amoxiclav. You ll change it to
clarithromycin
CLARITHROMYCIN 500 mg PO BD for 5 days.

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 METHOTREXATE AND INFECTION
Where are you:
You are FY2 in Medicine
Who the patient is:
Miss Sally Rude, aged 80, has been diagnosed with acute Pyelonephritis. She has a history
of Rheumatoid Arthritis. She has Hypertension. Weight of the patient is 65 kg
Other information you have about the patient:
eGFR is 40. Regular medications are
○ Amlodipine 10mg OD
○ Methotrexate 7.5mg once weekly every Tuesday
○ Folic acid 5mg once weekly
Special Note:
Patient is allergic to Clarithromycin. Patient had itching
What you must do:
Consultant had requested you to start her on Cefalexin

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31
 Case discussion

 Methotrexate: contraindicated in active infection that’s why the dose was omitted in the
first week.

 Folic acid: Prevention of methotrexate-induced side-effects in rheumatic disease

By mouth Adult: 5 mg once weekly, dose to be taken on a different day to methotrexate
dose.

UTI (Nitrofurantoin)
Where are you:
You are FY2 in medicine
Who the patient is:
Miss Rachel Trunk, aged 30, has come to you with burning micturation
Other information you have about the patient:
She was prescribed nitrofurantoin for suspected UTI
Other medications:
○ Amlodipine 10mg OD
○ Paracetamol PRN max 4 grams
Special Note:
Patient is allergic to penicillin. After taking penicillin patient developed rash.
What you must do :
Write down the prescription for the above medications, check dose and write down the
antibiotic.

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33
 Case discussion

 Nitrofurantoin: Lower urinary-tract infections :By mouth

Adult 100 mg twice daily for 3 days (7 days in males and pregnant women)

 Pregnancy For nitrofurantoin: Avoid near term — may produce neonatal

haemolysis.

 Avoid if eGFR less than 45 ml/min, may be used with caution if eGFR 30–44 ml/min
as a short-course only (3 to 7 days)

 If eGFR less than 30 ml/ min then shift to Trimethoprim:

 Lower urinary-tract infections By mouth: Adult 200 mg twice daily for 3 days (7
days in males)
As Dr Mo said Trimethoprim like Triceps is strong and can handle low eGFR.

 Dose adjustments In adults:

Dose reduction to half normal dose after 3 days if eGFR 15–30 mL/minute/1.73 m2.
Dose reduction to half normal dose if eGFR less than 15 mL/minute/1.73 m2.

34
 Lithium and Pain killer
Where are you:
You are FY2 in psychiatry ward
Who the patient is:
Mr. Robert Washington, aged 50, has hurt his ankle and is in severe pain
Other information you have about the patient:
He has been diagnosed with COPD Regular medications:
○ Ipratropium bromide 20 microgram (1-2 puffs BD)
○ ○ Atorvastatin 20mg PO OD
○ Lithium 300 mg PO OD
Special Note:
Patient is allergic to penicillin. After taking penicillin patient developed rash.
What you must do:
Write down the prescription for Ibuprofen

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V
36
 Case discussion
 Ibuprofen increases the concentration of Lithium and could lead to lithium toxicity.
Manufacturer advises monitor and adjust dose.
 Diclofenac: is contraindicated in patients with the following:
 Ischaemic heart disease
 Peripheral arterial disease
 Cerebrovascular accidents
 Congestive heart failure
Patients with the above mentioned conditions should switch to other NSAID such as
Naproxen or Ibuprofen.
 Both Lithium and NSAIDs in Renal impairment: the MHRA advises to avoid where
possible; if necessary, use with caution.
 Lithium salts have a narrow therapeutic/toxic ratio and should therefore not be
prescribed unless facilities for monitoring serum-lithium concentrations are available, so
write in additional info: dose adjusted according to serum-lithium concentration

37
 Peritonsillar Abscess “Quinsy”
Where are you:
You are FY2 in Medicine
Who the patient is:
Tracy Yates, aged 6 years, has been diagnosed with peritonsillar abscess (quinsy). She
was managed in the ER. There are no signs of dehydration. Patient has difficulty
swallowing, Weight of the child is 23 kg.
Other information you have about the patient:
Consultant has advised the following medications:
○ Phenoxymethylpenicillin
○ Metronidazole
○ IV fluids maintenance
Special Note:
Patient is allergic to clarithromycin. Patient had itching
What you must do:
Write down the prescription for the above medications. Check
doses with BNF. Calculate the fluid dose

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39
40
 Case discussion
 if patient has difficulty swallowing:

 IV Benzylpenicillin sodium:
by slow intravenous injection, or by intravenous infusion, 25 mg/kg every
6 hours; increased if necessary to 50 mg/kg every 4–6 hours (max. per dose
2.4 g every 4 hours) in severe infection, intravenous route recommended in
infants.

 IV Metranidazole For Child 2 months–17 years

By intravenous infusion, 7.5 mg/kg every 8 hours (max. per dose 500 mg).
 IV to oral switch when:
 Clinically improving +- improving inflammatory markers
 Apyrexial
 If source control (I+D) of peritonsillar abscess, then early IV to oral switch
recommended, PHENOXYMETHYLPENICILLIN is first line:

41
  Maintenance fluid calculation in Pediatric:
100ml/kg for the first 10 KG
50ml/kg for the next 10 KG
20ml/kg for each extra KG
For this child, it is 1000+500+60= 1560 ml, to calculate the rate divide the total amount/24= 65
ml/h

42
 ACUTE PANCREATITIS
● Where Are you:
You are FY2 in Medicine
Who the patient is:
Miss Hannah Knowles, aged 60, has been diagnosed with acute pancreatitis.
Other information you have about the patient:
Prescribe MEROPENAM 500 mg TDS and Fluids.
OTHER MEDICATION:
Seretide 250 EVOHALER one puff BD
AMLODIPINE 10 mg
Special Note:
Patient is allergic to PENICILLIN. She gets RASH. Patient weight is 70 kg
What you must do:
Write down the prescription for the above medications.

43
 IV

Start when patient can tolerate oral

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45
 Allergy and cross-sensitivity For meropenem
Avoid if history of immediate hypersensitivity reaction to beta-lactam Antibacterials,
Use with caution in patients with sensitivity to beta-lactam antibacterials.

 Maintenance fluids For adults, it is 30 ml/kg.

You can either write the rate or the duration of the infusion.

46
 VTE Risk Assessment

Where are you:

You are FY2 in obstetrics & gynecology

Who the patient is:

Miss Daniella Halifax, aged 42, had her 4th delivery yesterday

Other information you have about the patient:

No known allergy
She has not been diagnosed with any past medical history
Her weight is 60 kg

Special Note:
None

What you must do:

Do DVT risk assessment and write down the anticoagulant according to the weight

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48
 VTE prophylaxis for surgical patients

 All patients should undergo a risk assessment to identify their risk of venous
thromboembolism (VTE) and bleeding on admission to hospital. Commonly used risk
assessment tools can be found at: https://www.nice.org.uk/guidance/ng89/resources.

 VTE prophylaxis to people undergoing elective hip replacement surgery whose risk of VTE
outweighs their risk of bleeding. Choose any one of:

 LMWH for 10 days followed by aspirin (75 mg or 150 mg) for a further 28 days.
 LMWH for 28 days combined with anti-embolism stockings (until discharge).

 Offer VTE prophylaxis to people undergoing elective knee replacement surgery whose
VTE risk outweighs their risk of bleeding. Choose any one of:

 Aspirin (75 mg or 150 mg) for 14 days.

 LMWH for 14 days combined with anti-embolism stockings until discharge.

 Offer mechanical VTE prophylaxis on admission to people undergoing elective spinal or

cranial surgery. Choose either:

 anti-embolism stockings or intermittent pneumatic compression.

 Continue for 30 days or until the person is mobile or discharged, whichever is sooner

 For Obstetric VTE prophylaxis (please look at the table above).

 Consider pharmacological VTE prophylaxis for people with serious or major trauma as
soon as possible after the risk assessment when the risk of VTE outweighs the risk of
bleeding. Continue for a minimum of 7 days.

 Pharmacological prophylaxis in general surgery should usually continue for at least 7 days
post-surgery

 Acutely ill medical patients who are at high risk of VTE should be offered pharmacological
prophylaxis. Patients should be given a low molecular weight heparin as a first-line option,
for a minimum of 7 days

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50
 PROM

Where are you:

You are FY2 in Obstetric & gynecology

Who the patient is:

Miss Maria Adam 34 week pregnant presented with premature rupture of membranes.

Other information you have about the patient:

No past medical history

Regular medications
Calcichew

Special Note:
Patient allergic to Penicillin. Reaction - Rash

What you must do:

Prescribe Dexamethasone
Erythromycin 250mg QDS PO for 10 days

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52
 Case discussion

Premature rupture of membranes treatment and management

- Antibiotic administration:

In the UK, both the National Institute for Health and Care Excellence (NICE) and the Royal
College of Obstetricians and Gynecologists (RCOG) recommend the use of
ERYTHROMYCIN 250 mg qds for 10 days (or until labour is established if this is sooner)

- Corticosteroid prophylaxis:

Between 24+0 and 33+6 weeks of gestation women should be offered a single course of
antenatal corticosteroids i.e. Dexamethasone 12mg intramuscular. Two bolus doses 24
hours apart.

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 DVT-Rivaroxaban

Where you are

You are an FY2 in A&E.

Who the patient is

Mr Harry Warrington, aged 47, has been diagnosed with DVT.

Other information you have about the patient

Regular medication:
Amlodipine 10mg OD PO
Aspirin 75 OD PO
Paracetamol 1g QID

What you must do

Prescribe: Rivaroxaban

Special note:
None

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55
 MRSA

Where are you:

You are FY2 in MRSA Ward

Who the patient is:

Mr. David Halifax, Aged 82, has been diagnosed with MRSA skin infection

Other information you have about the patient:

Patient was on the following medications:-
● Amlodipine 10mg OD
● Paracetamol PRN (max 4 gram)
● Mupirocin ointment BD 5 Days
● Vancomycin
Weight is 80 kg
eGFR - normal
Consultant has decided to give …. ml of fluid

Special Note:
Patient is allergic to penicillin. After taking penicillin patient developed a rash.

What you must do:

Write down the prescription for the above medications, Check dose and write down
vancomycin

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N.B:
Vancomycin drug chart should be provided in the exam, if it’s not then use the BNF
Directions of usage according to the relevant indication.

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 I

1.25 g 2/1/22

IV infusion in 250 ml 0.9 NaCl

59
Let’s say U were not given a guideline for vancomycin prescription:

60
 GP prescription

 State the name and address of the patient

 Have an appropriate date (usually the date of signing)
 Each medication item should be separated by a solid or hashed horizontal
line or similar separator.
 Details of the medicine to include:
 Name of medicine (generic name unless a specific brand must be
given)
 Form (e.g. tablets, oral suspension)
 Strength (e.g. 5mg for tablets or 125mg/5ml for an oral suspension):
units and acceptable abbreviations are shown in Table 6.
 Directions: should include quantity and frequency and for liquid
preparations, it is best practice to write directions using the mass of
active ingredient rather than volume so the pharmacist is clear on
the dosage (especially for oral suspensions i.e. 125mg rather than
5ml).
 Quantity to be supplied (e.g. 56 tablets)

 For each controlled drug item in schedule 2 or 3, the text „CD‟ shall be
printed after the dm+d product name e.g. Tramadol 50mg capsules CD.
 Dosage/Frequency should be expressed in words without numerical figures
e.g. One capsule to be taken three times a day
 For controlled drugs only the quantity must be printed in both figures and
words in that order ; e.g. 56 (Fifty-six) capsule

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62
 - Miss Laura Brown 04/06/1995 of Flat D 22 University Road, Woodland
Town WD12 1MN presents with an itchy left eye with yellow discharge that
stuck her eye closed this morning. She denies pain and does not use
contact lenses.

What does this patient likely have?

Please write a prescription for an appropriate eye drop to treat this problem using
a blank FP10 prescription form.

63
Mr Alex Johnson 12/09/2011 of Home Farm, Woodland Town WD10 1FA has
been seen by the Child and Adolescent Psychiatry Team who have diagnosed
him with ADHD. You are to issue a prescription for his Concerta XL under
shared care arrangements. He is currently taking 18mg in the morning.
Please write a prescription using a blank FP10 prescription form

64
 Summary of antibiotics prescription

Lower urinary tract infections

 Non-pregnant women

 local antibiotic guidelines should be followed if available

 NICE Clinical Knowledge Summaries recommend trimethoprim or nitrofurantoin
for 3 days

 Pregnant women

- if the pregnant woman is symptomatic:

 first-line: nitrofurantoin (should be avoided near term)

 second-line: amoxicillin or cefalexin
 trimethoprim is teratogenic in the first trimester and should be avoided during
pregnancy

- asymptomatic bacteriuria in pregnant women:

 Immediate antibiotic prescription of either nitrofurantoin (should be avoided near
term), amoxicillin or cefalexin. This should be a 7-day course

 Men

 an immediate antibiotic prescription should be offered for 7 days, trimethoprim or

nitrofurantoin should be offered first-line unless prostatitis is suspected

 Catheterised patients

do not treat asymptomatic bacteria in catheterised patients, if the patient is symptomatic they
should be treated with an antibiotic a 7-day course should be given.

 Acute pyelonephritis

For patients with sign of acute pyelonephritis hospital admission should be considered

 local antibiotic guidelines should be followed if available

 the BNF currently recommends a broad-spectrum cephalosporin or a quinolone (for non-

pregnant women) for 10-14 days.

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Respiratory system

Condition Recommended treatment

Exacerbations of chronic bronchitis Amoxicillin or tetracycline or clarithromycin

Uncomplicated community- Amoxicillin (Doxycycline or clarithromycin in penicillin

acquired pneumonia allergic, add flucloxacillin if staphylococci suspected
e.g. In influenza)

Pneumonia possibly caused by Clarithromycin

atypical pathogens

Hospital-acquired pneumonia Within 5 days of admission: co-amoxiclav or cefuroxime

More than 5 days after admission: piperacillin with
tazobactam OR a broad-spectrum cephalosporin (e.g.
ceftazidime) OR a quinolone (e.g. ciprofloxacin)

Skin

Condition Recommended treatment

Impetigo Topical hydrogen peroxide, oral flucloxacillin

or erythromycin if widespread
Cellulitis Flucloxacillin (clarithromycin, erythromycin or
doxycycline if penicillin- allergic)
Cellulitis (near the eyes or nose) Co-amoxiclav (clarithromycin,+ metronidazole
if penicillin-allergic)

Erysipelas Flucloxacillin (clarithromycin, erythromycin or

doxycycline if penicillin-allergic)
Animal or human bite Co-amoxiclav (doxycycline + metronidazole if
penicillin-allergic)
Mastitis during breast-feeding Flucloxacillin

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ENT

Condition Recommended treatment

Throat infections Phenoxymethylpenicillin (erythromycin alone

if penicillin-
allergic)

Sinusitis Phenoxymethylpenicillin

Otitis media Amoxicillin (erythromycin if penicillin-allergic)

Otitis externa Flucloxacillin (erythromycin if penicillin-

allergic)

Periapical or periodontal abscess Amoxicillin

Gingivitis: acute necrotising Metronidazole

ulcerative

Genital system

Condition Recommended treatment

Gonorrhoea Intramuscular ceftriaxone

Chlamydia Doxycycline or azithromycin

Pelvic inflammatory Oral ofloxacin + oral metronidazole or intramuscular

ceftriaxone + oral doxycycline+ oral metronidazole

Syphilis disease Benzathine benzylpenicillin or doxycycline or erythromycin

Bacterial vaginosis Oral or topical metronidazole

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