What are the top 5 antibiotics prescribed in general practice, their doses, brand names (e.g. Amoxil (amoxicillin)), indications, and usage based on symptoms?

Top 5 Antibiotics Prescribed in General Practice: Dosage, Brand Names, Indications, and Symptom-Based Usage

The top 5 most commonly prescribed antibiotics in general practice are amoxicillin-clavulanate, azithromycin, ceftriaxone, ciprofloxacin, and doxycycline, each with specific indications, dosages, and symptom-based usage patterns.

1. Amoxicillin-Clavulanate (Augmentin)

Dosage:

• Adults: 875/125 mg PO twice daily or 500/125 mg PO three times daily
• Children: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours

Brand Names in India:

• Augmentin, Moxclav, Clavam, Augpen

Indications:

• Skin and soft tissue infections
• Respiratory tract infections (sinusitis, bronchitis)
• Otitis media
• Animal and human bites 1, 2

When to Use (Symptoms):

• Purulent sputum with fever and cough
• Skin infections with purulent discharge
• Ear pain with fever and discharge
• Wounds from animal or human bites with redness and swelling 1

Contraindications:

• Penicillin allergy
• History of amoxicillin-clavulanate associated hepatic dysfunction
• Mononucleosis (increased risk of rash)

2. Azithromycin (Zithromax)

Dosage:

• Adults: 500 mg on day 1, followed by 250 mg once daily for 4 days
• Children: 10 mg/kg on day 1 (max 500 mg), then 5 mg/kg (max 250 mg) once daily for 4 days 1

Brand Names in India:

• Azithral, Zithromax, Azee, Aziwin

Indications:

• Cat scratch disease
• Atypical pneumonia
• Pharyngitis
• Sinusitis
• Otitis media

When to Use (Symptoms):

• Dry cough with minimal sputum
• Gradual onset respiratory symptoms
• Lymphadenopathy with history of cat scratch
• Pharyngitis when penicillin allergic 1

Contraindications:

• Known hypersensitivity
• History of QT prolongation
• Concurrent use of drugs that prolong QT interval
• Severe hepatic impairment

3. Ceftriaxone (Rocephin)

Dosage:

• Adults: 1-2 g IV/IM once daily
• Children: 50-100 mg/kg/day IV/IM divided every 12-24 hours (max 4 g/day) 2

Brand Names in India:

• Rocephin, Monocef, Cefaxone, Oframax

Indications:

• Severe community-acquired pneumonia
• Meningitis
• Complicated urinary tract infections
• Gonorrhea
• Severe skin and soft tissue infections 1

When to Use (Symptoms):

• High fever with respiratory distress
• Altered mental status with fever
• Severe skin infections with systemic symptoms
• Pelvic pain with purulent discharge (gonorrhea)
• Severe urinary symptoms unresponsive to oral therapy 1

Contraindications:

• Hypersensitivity to cephalosporins
• History of anaphylactic reaction to penicillins
• Neonatal hyperbilirubinemia

4. Ciprofloxacin (Cipro)

Dosage:

• Adults: 500-750 mg PO twice daily or 400 mg IV every 12 hours
• Children: Not generally recommended; when necessary, 10-15 mg/kg every 12 hours (not to exceed 1 g/day) 1, 2

Brand Names in India:

• Ciprobid, Ciplox, Ciprinol, Ciprobay

Indications:

• Urinary tract infections
• Prostatitis
• Gastrointestinal infections
• Respiratory infections (in specific circumstances)
• Skin and soft tissue infections 1

When to Use (Symptoms):

• Dysuria, frequency, urgency in adults
• Diarrhea with suspected bacterial etiology
• Prostate tenderness with urinary symptoms
• Skin infections when first-line agents contraindicated 3

Contraindications:

• Children under 18 years (except in specific circumstances)
• Pregnancy
• History of tendon disorders with fluoroquinolone use
• Myasthenia gravis
• Concurrent use of tizanidine

5. Doxycycline (Vibramycin)

Dosage:

• Adults: 100 mg PO twice daily or 100 mg PO once daily
• Children >8 years: 2-4 mg/kg/day divided twice daily (max 200 mg/day) 1, 2

Brand Names in India:

• Doxy, Doxytet, Microdox, Doxycin

Indications:

• Respiratory tract infections
• Skin and soft tissue infections
• Malaria prophylaxis
• Acne
• Sexually transmitted infections 1

When to Use (Symptoms):

• Atypical pneumonia symptoms
• Skin infections with slow progression
• Acne with inflammatory papules and pustules
• Malaria prophylaxis for travelers
• Tick bite with rash suggestive of rickettsial disease 1

Contraindications:

• Children under 8 years
• Pregnancy
• Severe hepatic impairment
• Hypersensitivity to tetracyclines

Important Considerations

Antibiotic Resistance:

• Local resistance patterns should guide empiric therapy
• Consider narrowing spectrum once culture results are available
• Avoid using antibiotics for viral infections 4

Duration of Therapy:

• Most respiratory infections: 5-7 days
• Skin and soft tissue infections: 7-10 days
• Urinary tract infections: 3-7 days depending on gender and complication status 2

Special Populations:

• Adjust doses in renal impairment, especially for amoxicillin-clavulanate and ciprofloxacin
• Avoid tetracyclines in children under 8 years and pregnant women
• Fluoroquinolones should be avoided in children under 18 years except in specific circumstances 1, 2

Common Pitfalls:

1. Prescribing amoxicillin for otitis externa (inappropriate in 67.3% of cases) 4
2. Using broad-spectrum antibiotics for viral upper respiratory infections
3. Not adjusting doses for renal impairment
4. Inadequate duration of therapy leading to treatment failure
5. Not considering local resistance patterns when selecting empiric therapy

By following these guidelines and considering patient-specific factors, clinicians can optimize antibiotic selection for common infections in general practice.