An unprecedented major update to antibiotic prescribing in primary care has been released by Therapeutic Guidelines.
In the first of a three-stage release, the update focuses on common infections treated by GPs and treatment of serious infections managed in hospitals.
In response to a changing clinical environment, Therapeutic Guidelines conducted the comprehensive multidisciplinary review of more than 200 existing or new clinical topics.
Six expert groups worked on the update including a primary care group which included infectious diseases physicians, microbiologists, four GPs, a geriatrician and a range of other clinicians.
The newly released updates include new patient information, images and diagrams, as well as an aminoglycoside-dosing calculator.
Key Changes
- Nitrofurantoin now recommended as the first-line treatment of acute cystitis in nonpregnant adults because of high trimethoprim resistance among Escherichia coli (E. coli). It is also recommended first for children who can swallow tablets and capsules and weigh 29 kg or more
- Increased dosages of beta lactams for pyelonephritis to ensure adequate antimicrobial exposure and activity against enterobacterales such as E. coli
- Increased dosage of amoxicillin+clavulanate for pyelonpehritis and diabetic foot, rising to 875+125 mg orally, eight-hourly to ensure adequate drug exposure
- An option to allow eight-hourly dosing of cefalexin for some cefalexin recommendations (such as for treating cellulitis and pyelonephritis) using a higher dose, due to the challenges of giving medicines every six hours to children.
With a range of topics still being revised, a further update to the Antibiotic Guidelines is due to be released later this year, followed by a third in 2026.
For further details on changes to the Antibiotic Guidelines, see the Therapeutic Guidelines website.
Information is correct as of 3 April 2025.