Quick Reference: Antibiotic Guideline for Common

DISEASE PREFERRED AB ALTERNATIVE AB Indication for AB/ Remarks

Oral AB are indicated if + superficial
Internal & External Warm compresses &Cloxacillin Amoxycillin 500mg tds
cellulitis or abscess. No topical AB
Hordeolum 500mg qid 5/7 5/7

diseases in Primary Care

By Antimicrobial Stewardship Team FMS Penang 2018
are indicated
Health care workers, Pts : immune
compromise, uncontrolled DM,
contact lens use, dry eye, or recent Indication for
Condition Preferred AB Alternative AB
Chloramphenicol 0.5% eye drop ocular surgery ,Children going to AB/Remarks
Bacterial Conjunctivitis
EYE

q2-4h for 1/52 schools or day care centers Amoxycillin/Clavulanate 625 mg TDS 1/52 OR
(American Family Physician Trimethoprim/Sulfamethoxazole ( Bactrim) 320/1600 BD 1//52
www.aafp.org/afp Volume 81, Diverticular disease OR Ciprofloxacin 750 mg BD + Metronidazole 500 mg QID 7-10 IV Cefipime ( refer
Number 2 ◆ January 15, 2010) days hospital)

GASTROINTESTINAL SYSTEM
Amoxycillin/Clavulanat Pantoprazole 40 mg
Preseptal Cellulitis Cloxacillin 500mg -1gm qid for 5/7
e 625mg tds 1/52 Pantoprazole 40 mg BD + Clarithromycin 500 mg BD + BD+ tetracycline 500
Alternative to
Pantoprazole:
Amoxycillin/ Peptic ulcer disease Amoxycillin 1gm BD for 14/7 Or mg QID+
Omeprazole 20 mg BD,
Dacryocystitis Cefuroxime 250mg bd 1/52 Clavulanate 625mg tds secondary to H. Pylori Metronidazole 400
Lansoprazole 30 mg BD,
1/52 infection for penicillin allergy: Pantoprazole 40 mg BD + Clarithromycin mg TDS+Bismuth
Esomeprazole 20 mg BD,
AB For severe disease or when risk 500 mg BD + Metronidazole 400 mg BD for 14 days Subcitrate 420 mg
Rabeprazole 20 mg BD
NOSE EAR

Amoxicillin 500mg tds OR QID 14 days

Acute otitis media
Acute Rhinosinusitis (ABRS)
mild oral candidiasis
1)Topical Acyclovir 5% cream q4h
Herpes simplex virus I & 2
ORAL
Cefuroxime 500mg bd
of complications. should not be
routinely Bacterial diarrhoea
Purulent drainage that worsens Trimethoprim/Sulpha
after 5/7 or persists beyond 10 days Shigela/E-Coli/ metaxazole ( Bactrim) AB Treatment required
Amoxicillin 500mg tds OR
Β-lactam allergy: / symptoms Klebsiella/Aeromonas/Yersi Ciprofloxacin 500 mg BD for 5 days 160/800 BD for 5 for: (1) Severe illness
Amoxicillin/Clavulanate 625mg
Doxycycline 100mg bd out of proportion to those typically nia/non Typhy Salmonella days (2) Age < 6/12 or > 50
tds 5-7/7
associated Campylobacter Azithromycin 500 mg OD 3 days years (3) Gross blood in
with viral infection stool (4) Fever > 38◦ C
EES 800 mg BD for 3
(5) Worsening or relapse
Nystatin (oral suspension) Vibrio Cholera Azithromycin 1 gm STAT OR Doxycycline 300 mg STAT days
/persistent symptoms >
T.Itraconazole 100mg
500,000-1,000,000U tds-qid (till
od 2/52 Giardia/Amoebiasis/Clostri 1/52
2/7 after symptoms disappeared dium Metronidazole 750 mg TDS 10 days (6)
Trimethoprim/Sulphametaxazole ( Bactrim) 160/800 BD for 10 Immunocompromised
for 5-10/7 in prodromal phase Isospora /Cyclospora days host
(recurrent herpes labialis ) 2) T. Azithromycin 1 gm

Acyclovir 400-800mg 5 X/Day for
1-2/52
Amoxycillin 500mg tds PLUS
Periodontitis Metronidazole 400mg tds
Systemic antibiotic use not
Localised Pericoronitis
recommended
Phenoxymethylpenicillin 500mg
Amoxicillin 500mg bd-
Tonsillitis / Pharyngitis tds 10/7 or IM Benzathine
Penicillin 1.2MU 1 dose
Condition Preferred AB
Burns Antibiotic not recommended
Travellers diarrhoea Ciprofloxacin 500 mg BD 3 days STAT
Azithromycin 500mg
odfor 3 days
AB for aggressive case ONLY Condition Preferred AB Alternative AB Indication for AB/ Remarks
Nitrofurantoin caution in elderly.
1st line treatment-Mechanical and
Amoxycillin/Clavulananic acid 625mg tds for Contraindicated in eGFR
chemical plaque control . UTI (adult) Nitrofurantoin 50mg QID for 3/7 3/7 Cefuroxime 250mg bd for 3/7 <40ml/min Treatment for 7days
in male
tds 10/7 Nitrofurantoin 50mg QID for 1/52 Asymptomatic bacteriuria
Amoxycillin/Clavulanic acid 625mg tds for
UTI (pregnant) Cephalexin 500mg bd for 1/52 1/52
(positive culture) in pregnancy
Cefuroxime 250mg bd for 1/52 should be treated as per guideline.
Indication for AB/ Nitrofurantoin 50mg ON for 3 to Trimethoprim/ sulphamethoxazole
Alternative AB
Remarks UTI (recurrent) 12/12 Trimethoprim 80/400mg ON for 3 to 12/12 >3 episodes/year
ProphylaticABs are not 100mg ON for 3 to 12/12 Cephalexin 250mg ON for 3 to 12/12
routinely given to burn Oral Metronidazole 2 gm stat dose or
Vaginitis Oral Metronidazole 400 mg bd for High dose metronidazole (2g) not
patients as they do not Tinidazole recommended in pregnancy and breast
reduce the risk of (Trichomonas vaginalis) 5/7 2 g stat feeding ( metallic taste in breast milk)

infection Intravaginal metronidazole 0.75% gel once

UROGENITAL SYSTEM
Oral Metronidazole 400 mg bd for daily for 5/7 or Intravaginal clindamycin 2%
Chickenpox (V.
Acyclovir 800mg PO 5 times daily for 7 days Start early < 48 hours
Bacterial Vaginosis 5/7 or Metronidazole 2 gm stat cream once daily for 1/52 or Clindamycin
Zoster) 300 mg b.d. P.O. 1/52
Advisable to start Clotrimazole vaginal pessary 200mg
Herpes Zoster Acyclovir 800mg PO 5x/day for 7-10 days. Longer duration if slow Nystatin pessary100,000 units ON for 2
treatment early within 48 Vaginal Candidiasis ON for 3 nights or Clotrimazole weeks Tioconazole pessaries 200mg od for
(Shingles) to resolve lesions
hours 3 /7
vaginal pessary 500mg ON stat
Cephalexin 500mg PO qid for 5-7/7 OR Ceftriaxone 500mg IM + Cefixime 400 PO STAT OR Cefotaxime
Start for swab with gram neg
Localised: Topical 2% fusidic acid q8-12h for 7 /7 Amoxycillin/Clavulanate625mgPOtds7-10/7 Gonorrhea Azithromycin 1g stat or doxycycllin 500mg I/M STAT OR Spectinomycin 2G I/M
diplococci (if negative refer to
Generalised: Cloxacillin 500mg PO qid for 5-7/7 Paediatrics: 100mg bd 1/52 STAT
Impetigo Penicillin Allergy : EES 800mg PO bd for 5-7/7 Amoxycillin /Clavulanate 25-30mg/kg/24h PO bd 7/7
NGU)
Erythromycin 500mg PO QID 1/52 OR
Paediatrics: Cloxacillin50-100mg/kg/24hPOqid 7/7 or Azithromycin 1g Po Stat Or EES 800mg PO bd 1/52 or
Cephalexin 50-75 mg/kg/24h PO q6-8h for 7/7 NSU/Chamydia Doxycycline 100mg Po Bd 1/52 Ofloxacin 200mg BD 1/52 OR
EES 800mg PO bd for 7-10/7 OR Surgical drainage is Levofloxacin 500mg OD 1/52
Boils/ Carbuncles Cloxacillin 500mg PO qid for 7-10/7 Cefuroxime 500mg PO bd 7-10/7 OR important in the Primary, secondary and Early latent For patients allergic to penicillin:
Amoxycillin/Clavulanate 625mg PO tds 7-10/7 management syphilis (<12 months): Doxycycline 100 mg oral tds for 14/7
Penicillin PO 500mg q6h >2 weeks OR Benzathine Penicillin 2.4 million early syphilis, 28/7
Erysipelas EES 800mg PO bd for 10/7 OR Cephalexin 500mg PO q6h Syphillis
units IM once a week single dose late syphilis Azithromycin 2g single dose
Cloxacillin 500mg PO qid for 10/7 Late Latent Syphilis EES 800 mg oral qid for 14 days(early), 28
Penicillin 500mg PO q12h OR Erythromycin Ethylsuccinate 800mg PO q12h Inj. Benzathine Penicillin 2.4 million days (late syphilis)
Parenteral route for IM once a week for 3 weeks i.e. 3 Ceftriaxone 500mg IM daily for 10
Cellulitis Amoxicillin 500mg PO tds OR Cephalexin 500mg PO tds Paediatrics: Amoxicillin 25-30mg/kg/24h PO tds 7 /7
extensive lesions days( early)
Paediatrics: Cloxacillin 100-200mg/ kg/24h PO/IVqid 7-10/7 OR Cephalexin 50-75mg/kg/24h PO q6-8h for 7/7 doses
Oral Acyclovir 200 mg 5x/daily for Start within first 3 days of onset
Tinea capitis/ Tinea
Griseofulvin 500mg bd or od 6 to 12/52 or longer AND Genital Herpes 5/7 of lesion
2.5% Selenium sulphide shampoo OR Itraconazole 200mg PO od
barbae 2% ketoconazole shampoo 2 – 3 times/wk x 2/52 Refer to Skin clinic for: 1) podophyllin 10-25% 1-2 times per week OR
Mild infections: Clotrimazole 1% OR Miconazole 2% till clinical Genital Warts (2)imiquimod 5% cream 3 x week for 16 week or (3) Cryotherapy with
Tinea corporis/ Tinea Itraconazole 200mg od for 2 weeks OR liquid nitrogen, trichloroacetic acid 40-100%
clearance with additional 2 weeks, Extensive infections:
SKIN

cruris/ Tinea faciei Griseofulvin 500mg PO bd or od for 4-6 weeks

Terbinafine 250mg od for 2 weeks Ceftriaxone 250 mg. i.m single dose or Bactrim 2 tab. b.d. for 1 - 2/52 or
Chancroid Erythromycin 500 mg orally qid for 7-14/7 or Azithromycin 1g stat
Tinea manuum/ Tinea Griseofulvin 500mg PO bd 6-12/52 OR
Terbinafine 250mg PO od 2/52
pedis Itraconazole 200mg PO od for 2-4 weeks If contraindications to
Griseofulvin 500mg PO bd 6/12(finger systemic agents may
Pulse Itraconazole 200mg PO bd for 1/52 per mthFor 2/12 (finger
nails),12/12(toe nails) OR Fluconazole 150mg PO once consider topical Condition Preferred Alternative Remarks
Tinea unguium nails) For 3 /12 (toe nails) OR Terbinafine 250mg PO od for
weekly 6-12 months for toenail, ≥3 months for antifungal agents
6/52(finger nails) for 12/52(toe nails) Mild Infection:
fingernail Diabetic Foot Cephalexin 500mg qid OR Clindamycin 300-450mg PO tds OR
(1) Local infection involving skin & SC tissues

DM FOOT
Amoxycillin/Clavulanate 625mg tds 1- Trimethoprim/Sulphametoxazole 5-
Selenium Sulphide 2% shampoo apply to affected areas 10 Mild Infection 2/52 10mg/kg PO bd 1-2/52
(2)Erythema, less than 2 cm around the
minutes before bathing OR Dilute to 1:1 with water, apply and ulcer (3) No systemic signs
Tinea versicolor leave overnight (treat for 1-2 weeks) Itraconazole 200mg PO od for 1/52 (recurrent cases)
Refer to hospital. Need IV AB AB should not be used unless there are local
Face: Topical Miconazole 2% cream, Clotrimazole 1% cream 4- Diabetic Foot or systemic symptoms of infection. Local
6/52 treatment including surgical debridement is
Moderate & Severe important. AB selection should be based on
Mild: Miconazole 2% cream, Clotrimazole 1% cream bd till clear Fluconazole 100mg PO od 1/52(in severe and
Candidiasis Infections: the most recent culture and sensitivity
Extensive: Itraconazole 200mg PO od for 1/52 immunocompromised patients) report.
Benzyl Benzoate emulsion 25% (EBB) apply from neck down and
Gamma Benzene Hexachloride 1% (Lindane) apply
leave for 24 hours for 2/7
and leave for 8 hours (not to be repeated in less than REFERENCES:
In pregnancy: Permethrin 5% lotion/cream apply and leave for 8
a week) OR Permethrin 5% cream apply and leave for
hours
8 hours Paediatrics: For children > 2 years and <12:
Scabies Paediatrics: Permethrin 5% cream apply and leave for 8 hours
Benzyl Benzoate Emulsion (EBB) , 12.5% apply from
(not for babies less than 2 months) - two or more applications,
neck down and leave for 24 hours for 2 days, Gamma ₠ The Modified Centor Score
each a week apart
Benzene Hexachloride 0.5% (Lindane) apply and leave Criteria Score Criteria Score
Babies less than 2 month : Sulphur 6% in calamine lotion q12h
for 8 hours (not to be repeated in less than a week)
OR Crotamiton (Eurax) cream q12h for 2-3 weeks Absence of cough 1 Age 3- 14 years 1 Temperature <36°C or >38°C
Gamma Benzene Hexachloride 0.1% (Lindane) apply and leave Swollen & tender 1 Age 15 - 44 0 Heart rate >90/min
Head lice for 8 hours OR Malathion 1% shampoo Ant. Cervical LN years Respiratory rate >20/min or PaCO2<32mmHg
T > 38 ◦ C 1 Age >44 years -1
<4x10⁹/L ; >12x10⁹/L or 10% immature band
Amoxycillin/Clavulanate 625mg PO q8h 5/7 In the hands or proximity Tonsillar exudates 1 WBC
Doxycycline 100mg PO bd AND Clindamycin 300mg to a joint -Associated forms
Animal bite IM ATT 0.5ml is recommended if it has been > 5 years since last PO qid 5/7 edema If infected: cover
or swelling
immunization. for 10 days
Adapted from Malaysia National Antibiotic Guideline (NAG), 2nd Edition 2014 ABBREVIATION: AB : Antibiotic