What are the commonly prescribed antibiotics for various infections in general practice?

Commonly Prescribed Antibiotics for Various Infections in General Practice in India

For respiratory tract infections, skin infections, and urinary tract infections, the most appropriate antibiotics should be selected based on the specific infection type, with treatment durations of 5-7 days for most common infections to reduce antimicrobial resistance while maintaining efficacy. 1

Respiratory Tract Infections

Community-Acquired Pneumonia

• First-line treatment:

  • Adults: Amoxicillin 500-1000 mg three times daily for 5 days 1
  • Children <5 years: Amoxicillin 90 mg/kg/day in 2 divided doses 2
  • Assess response after 5 days using clinical stability markers (resolution of vital signs abnormalities, ability to eat, normal mentation) 1

• Alternative options:

  • Macrolides (for atypical pathogens):
    • Azithromycin 500 mg once daily for 3 days or 500 mg on day 1, then 250 mg daily for 4 days 1, 3
    • Clarithromycin 250-500 mg twice daily for at least 5 days 1
  • Doxycycline 100 mg twice daily for 5 days 1, 4
  • Respiratory fluoroquinolones for patients with comorbidities 1

COPD Exacerbations and Acute Bronchitis

• First-line treatment (when bacterial infection is suspected):

  • Amoxicillin 500-1000 mg three times daily for 5 days 1
  • Amoxicillin-clavulanate 875/125 mg twice daily for 5 days in areas with high beta-lactamase producing pathogens 5

• Alternative options:

  • Macrolides: Azithromycin 500 mg once daily for 3 days 6, 7
  • Doxycycline 100 mg twice daily for 5 days 1, 4
  • Cefuroxime axetil 750 mg twice daily (in areas with low beta-lactamase producing H. influenzae) 1

Streptococcal Pharyngitis/Tonsillitis

• First-line treatment:
  • Children: Amoxicillin 90 mg/kg/day in 2 doses for 10 days 2
  • Alternative for penicillin allergy: Azithromycin 12 mg/kg/day for 5 days 8

Skin and Soft Tissue Infections

Impetigo

• First-line treatment:
  • Dicloxacillin 250 mg four times daily (adults) or 12 mg/kg/day in 4 divided doses (children) 1
  • Cephalexin 250 mg four times daily (adults) or 25 mg/kg/day in 4 divided doses (children) 1
  • Mupirocin ointment for limited lesions, applied three times daily 1

Cellulitis (Non-purulent)

• First-line treatment:
  • 5-6 day course of antibiotics active against streptococci 1
  • Dicloxacillin 500 mg four times daily 1
  • Cephalexin 500 mg four times daily 1

MRSA Skin Infections

• Treatment options:
  • Clindamycin 300-450 mg three times daily (adults) or 10-20 mg/kg/day in 3 divided doses (children) 1
  • Trimethoprim-sulfamethoxazole 1-2 double-strength tablets twice daily 1
  • Doxycycline 100 mg twice daily (not for children <8 years) 1, 4

Urinary Tract Infections

Uncomplicated Cystitis in Women

• First-line treatment:
  • Nitrofurantoin for 5 days 1
  • Trimethoprim-sulfamethoxazole for 3 days 1
  • Fosfomycin as a single dose 1

Uncomplicated Pyelonephritis

• Treatment options:
  • Fluoroquinolones for 5-7 days 1
  • Trimethoprim-sulfamethoxazole for 14 days (based on susceptibility) 1

Special Considerations

Pediatric Infections

• Respiratory infections:
  • Amoxicillin is first-line for most pediatric respiratory infections 2
  • Azithromycin for mycoplasma pneumonia: 10 mg/kg on day 1 (maximum 500 mg) and 5 mg/kg on days 2-5 (maximum 250 mg) 2, 3

Immunodeficiency

• Prophylactic antibiotics for recurrent respiratory infections:
  • Amoxicillin 10-20 mg/kg daily or twice daily (children); 500-1000 mg daily or twice daily (adults) 1
  • Azithromycin 10 mg/kg weekly or 5 mg/kg every other day (children); 500 mg weekly or 250 mg every other day (adults) 1
  • Trimethoprim-sulfamethoxazole 5 mg/kg daily or twice daily (children); 160 mg daily or twice daily (adults) 1

Antibiotic Stewardship Principles

• Limit treatment duration to 5 days for most respiratory infections and cellulitis 1
• Reassess if no improvement after 48-72 hours rather than extending duration 1
• Avoid unnecessary broad-spectrum antibiotics when narrow-spectrum options are effective 1
• Consider local resistance patterns when selecting empiric therapy 2

Common Pitfalls to Avoid

• Using macrolides as first-line therapy for typical pneumonia in young children 2
• Inadequate dosing of amoxicillin for respiratory infections 2
• Defaulting to 10-day courses regardless of the condition 1
• Failing to adjust therapy based on clinical response 1

By following these evidence-based recommendations, practitioners can effectively treat common infections while minimizing antimicrobial resistance and adverse effects.