What are the common antibiotics prescribed for urinary tract infections (UTIs), respiratory tract infections (RTIs), and skin infections in general practice, including drug names, doses, and durations?

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Common Antibiotics for General Practice in India

For safe and effective antibiotic prescribing in general practice, amoxicillin-clavulanate is the most versatile first-line option for respiratory, skin, and urinary tract infections, with specific alternatives based on infection type, severity, and patient factors. 1

Urinary Tract Infections (UTIs)

Uncomplicated UTIs/Cystitis

  • First-line:

    • Nitrofurantoin 100 mg PO four times daily for 5 days
    • Fosfomycin 3 g single dose
    • Amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days

  • Second-line (if resistance concerns or allergies):

    • Cephalexin 500 mg four times daily for 5-7 days
    • Cefuroxime 500 mg twice daily for 5-7 days

Complicated UTIs/Pyelonephritis

  • Outpatient treatment:

    • Ciprofloxacin 500 mg twice daily for 7-14 days 2
    • Amoxicillin-clavulanate 875/125 mg twice daily for 10-14 days

  • Inpatient treatment:

    • Piperacillin-tazobactam 3.375 g IV every 6 hours
    • Ceftriaxone 1-2 g IV daily

Respiratory Tract Infections

Acute Bacterial Sinusitis

  • First-line:

    • Amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days 3

  • Alternatives (penicillin allergy):

    • Doxycycline 100 mg twice daily for 5-7 days
    • Cefuroxime 500 mg twice daily for 5-7 days

Community-Acquired Pneumonia

  • Outpatient (mild):

    • Amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days
    • Azithromycin 500 mg on day 1, then 250 mg daily for 4 days 4

  • Inpatient (moderate-severe):

    • Ceftriaxone 1-2 g IV daily plus Azithromycin 500 mg IV/PO daily
    • Piperacillin-tazobactam 3.375 g IV every 6 hours for severe cases

Skin and Soft Tissue Infections

Impetigo

  • First-line:

    • Mupirocin ointment applied to lesions twice daily for 5-7 days
    • Retapamulin ointment applied to lesions twice daily for 5 days 1

  • Oral therapy (extensive lesions):

    • Cephalexin 250-500 mg four times daily for 7 days
    • Amoxicillin-clavulanate 875/125 mg twice daily for 7 days

Cellulitis (non-purulent)

  • Outpatient (mild):

    • Cephalexin 500 mg four times daily for 5-10 days
    • Amoxicillin-clavulanate 875/125 mg twice daily for 5-10 days

  • Inpatient (moderate-severe):

    • Cefazolin 1 g IV every 8 hours
    • Clindamycin 600-900 mg IV every 8 hours (for penicillin allergy)

Abscess/Purulent SSTI (MRSA concern)

  • Outpatient:

    • Trimethoprim-sulfamethoxazole 1-2 double-strength tablets twice daily for 7-10 days
    • Clindamycin 300-450 mg four times daily for 7-10 days

  • Inpatient:

    • Vancomycin 15-20 mg/kg IV every 12 hours
    • Linezolid 600 mg IV/PO every 12 hours

Animal/Human Bite Infections

  • First-line:

    • Amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days 1

  • Alternative (penicillin allergy):

    • Doxycycline 100 mg twice daily plus metronidazole 500 mg three times daily

Practical Prescribing Considerations

Dosage Adjustments

  • Renal impairment:
    • CrCl 30-50 mL/min: Use standard doses with increased interval
    • CrCl 5-29 mL/min: Reduce dose by 50% or increase interval
    • Hemodialysis: Dose after dialysis

Duration of Therapy

  • Most uncomplicated infections: 5-7 days
  • Complicated infections: 10-14 days
  • Bone/joint infections: 4-6 weeks minimum

Common Pitfalls to Avoid

  1. Overuse of fluoroquinolones: Reserve for specific indications due to resistance concerns and adverse effects
  2. Inappropriate use of broad-spectrum antibiotics: Start narrow when possible
  3. Inadequate dosing: Ensure optimal dosing especially in critically ill patients 5
  4. Failure to adjust for local resistance patterns: Consider regional resistance data when selecting empiric therapy 6

Special Populations

  • Pregnant women: Avoid tetracyclines, fluoroquinolones, and trimethoprim in first trimester
  • Children under 8: Avoid tetracyclines due to dental staining
  • Elderly: Consider reduced dosing based on renal function and drug interactions

Regional Resistance Considerations

In areas with high antibiotic resistance (common in India):

  • Avoid empiric use of trimethoprim-sulfamethoxazole for UTIs (high resistance rates) 6
  • Consider higher doses of amoxicillin-clavulanate for respiratory infections
  • For suspected ESBL infections, consider carbapenems or newer agents like ceftazidime-avibactam 1

By following these evidence-based guidelines, general practitioners can provide safe and effective antibiotic therapy while minimizing the risk of treatment failure and antibiotic resistance.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Guideline

Acute Bacterial Sinusitis Treatment Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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