Severity
(classification)

1st line oral/iv antibiotics

Anaphylactic penicillin allergy
(see explanatory notes)

A
Minor to moderate infection

Review doses in renal impairment

DOXYCYCLINE 200mg po od
OR
CO-AMOXICLAV 625mg po tds

Treatment duration: typically 5 days

DOXYCYCLINE 200mg po od
OR
CLARITHROMYCIN 500mg po bd

Treatment duration: typically 5 days

 B/C 

Moderate to severe life threatening infection

Review doses in renal impairment

CO-AMOXICLAV 1.2g iv tds
plus
CLARITHROMYCIN 500mg bd iv/po

OR
If definite history of rash allergy but no anaphylactic penicillin allergy (see explanatory notes) use:
MEROPENEM 1g iv tds
plus
CLARITHROMYCIN 500mg bd iv/po

If suspected/confirmed MRSA add:
TEICOPLANIN 400mg iv every 12 hours for 3 doses then 600mg iv once daily and review with microbiologist
Maintain treatment pending pre-dose (trough) level on Day 5
Mild to moderate infection (10-20mg/l)
Severe(>20mg/l,<60mg/l)
Re-assay after 6 to 8 days

Total treatment duration (including oral step-down): typically 7-14 days

LEVOFLOXACIN 500mg po bd

(iv only if critically ill / NBM)

Total treatment duration (including oral step-down): typically 7-14 days

IV to Oral Switch

(explanatory notes)

CO-AMOXICLAV 625mg po tds
plus
CLARITHROMYCIN 500mg bd

Age ≤ 65 yrs
LEVOFLOXACIN 500mg po bd
Age > 65 yrs
DOXYCYCLINE 200mg po od

If MRSA positive: typically DOXYCYCLINE 200mg od, discuss with microbiologist if severe infection
Total antibiotic duration typically 7-14 days

[NB antiviral therapy, oseltamivir (Tamiflu®) or zanamivir (Relenza®) typically to complete 5 days]

• HPA guidance: antivirals for influenza