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Antibiotic Prescribing Chart

Here is a comprehensive antibiotic prescribing chart organized by common infection syndromes, with specific drug choices, dosing, and duration based on current guidelines.

Common Infection Syndromes

Skin and Soft Tissue Infections (SSTI)

Simple Abscess/Boils

• Treatment: Incision and drainage (primary intervention) 1

Outpatient SSTI (Uncomplicated)

Adults:

• TMP-SMX: 160-320/800-1600 mg PO q12h for 5-10 days 1
• Doxycycline: 100 mg PO q12h for 5-10 days 1
• Minocycline: 200 mg loading dose, then 100 mg PO q12h for 5-10 days 1
• Clindamycin: 300-450 mg PO q8h for 7 days 1

Pediatric:

• Doxycycline: <45 kg: 2 mg/kg/dose PO q12h; ≥45 kg: adult dose 1
• Minocycline: 4 mg/kg loading dose, then 2 mg/kg/dose PO q12h 1
• Clindamycin: 10-20 mg/kg/day in 3 divided doses PO 1

Inpatient SSTI (Complicated)

Adults:

• Vancomycin: 30-60 mg/kg/day IV divided q6-12h for 7-14 days 1
• Linezolid: 600 mg IV/PO q12h for 7-14 days 1
• Daptomycin: 4 mg/kg IV daily for 7-14 days 1

Pediatric:

• Vancomycin: 40 mg/kg/day IV divided q6-8h 1
• Linezolid: 10 mg/kg IV/PO q12h 1
• Teicoplanin: 10 mg/kg IV q12h for 3 doses, then 6-10 mg/kg daily 1

Respiratory Tract Infections

Pneumonia (Community-Acquired, Severe)

Adults:

• Ampicillin: 50 mg/kg q6h IV + Gentamicin: 7.5 mg/kg daily IV for at least 5 days 1
• Ceftriaxone (second-line): 80 mg/kg daily IV (max 4g) for at least 5 days 1
• If MRSA suspected: Vancomycin: 30-60 mg/kg/day IV divided doses for 7-21 days 1

Pediatric:

• Ampicillin: 50 mg/kg q6h IV + Gentamicin: 7.5 mg/kg daily IV for at least 5 days 1
• Ceftriaxone: 80 mg/kg daily IV for at least 5 days 1
• If staphylococcal: Cloxacillin: 50 mg/kg q6h IV for 7-10 days, then switch to oral (3 weeks total) 1

Pharyngitis (Group A Streptococcal)

First-Line (Non-Allergic):

• Penicillin V: Adults: 250 mg q6h or 500 mg q12h PO × 10 days; Children: 250 mg q8-12h PO × 10 days 1
• Amoxicillin: 50 mg/kg once daily (max 1000 mg) or 25 mg/kg q12h (max 500 mg) PO × 10 days 1
• Penicillin G benzathine: <27 kg: 600,000 U IM; ≥27 kg: 1,200,000 U IM (single dose) 1

Penicillin-Allergic:

• Cephalexin: 20 mg/kg q12h (max 500 mg/dose) PO × 10 days 1
• Clindamycin: 7 mg/kg q8h (max 300 mg/dose) PO × 10 days 1
• Azithromycin: 12 mg/kg daily (max 500 mg) PO × 5 days 1

Bacteremia/Sepsis

Uncomplicated Bacteremia (MRSA)

• Vancomycin: 30-60 mg/kg/day IV divided q6-12h for 2 weeks 1
• Teicoplanin: 6-12 mg/kg IV q12h × 3 doses, then daily for 2 weeks 1

Complicated Bacteremia (MRSA)

• Vancomycin: 30-60 mg/kg/day IV divided q6-12h for 4-6 weeks 1
• Daptomycin: 6-10 mg/kg IV daily for 4-6 weeks 1
• Note: Do NOT add gentamicin or rifampin to vancomycin 1

Pediatric Sepsis (Infant)

• Ampicillin: 50 mg/kg q6h IV + Gentamicin: 5-7.5 mg/kg daily IV for 7-10 days 1
• Ceftriaxone: 50 mg/kg daily IV for 7-10 days 1
• If staphylococcal: Flucloxacillin: 50 mg/kg q6h IV + Gentamicin: 5-7.5 mg/kg daily IV 1

Pediatric Sepsis (Older Child)

• Ampicillin: 50 mg/kg q6h IV + Gentamicin: 7.5 mg/kg daily IV for 7-10 days 1
• Ceftriaxone: 50 mg/kg daily IV for 7-10 days 1

Endocarditis

Native Valve (Streptococcal, Penicillin-Susceptible)

• Penicillin G: 200,000-300,000 U/kg/day IV divided q4h (max 12-24 million U/day) for 4 weeks 1
• Ceftriaxone: 100 mg/kg/day IV divided q12h or 80 mg/kg/day IV daily (max 4g) for 4 weeks 1

Native Valve (MRSA)

• Vancomycin: 40 mg/kg/day IV divided q8-12h (max 2g/day) for 4-6 weeks 1
• Daptomycin (alternative): 6 mg/kg IV daily (<6 years: 10 mg/kg) for 4-6 weeks 1

Prosthetic Valve (MRSA)

• Vancomycin: 30-60 mg/kg/day IV + Rifampin: 300 mg PO q8h + Gentamicin: 1 mg/kg IV q8h for 6 weeks 1

Gastrointestinal Infections

Dysentery

• Ciprofloxacin: 15 mg/kg q12h PO × 3 days 1
• Ceftriaxone (second-line): 50-80 mg/kg daily IV × 3 days 1

Typhoid

• Ciprofloxacin: 15 mg/kg q12h PO × 7-10 days 1
• Ceftriaxone (second-line): 80 mg/kg daily IV × 5-7 days 1
• Azithromycin (alternative): 20 mg/kg daily PO × 5-7 days 1

Urinary Tract Infection

Pediatric:

• Co-trimoxazole: 10 mg/kg trimethoprim + 40 mg/kg sulfamethoxazole q12h PO × 5 days 1
• Ampicillin + Gentamicin (second-line): Same as sepsis dosing 1

Bone/Joint Infections

Osteomyelitis (>3 years old)

• Cloxacillin/Flucloxacillin: 50 mg/kg q6h IV × 10 days, then switch to oral 1
• Ceftriaxone (second-line): Standard dosing 1
• Clindamycin (alternative): Standard dosing 1

Mastoiditis

• Cloxacillin/Flucloxacillin: 50 mg/kg q6h IV × 10 days 1
• Ceftriaxone (second-line): Standard dosing 1

CNS Infections

Meningitis (Pediatric)

First-Line:

• Ceftriaxone: 50 mg/kg q12h IV × 7-10 days 1
• Cefotaxime: 50 mg/kg q6h IV × 7-10 days 1

Alternative (if no local resistance):

• Chloramphenicol: 25 mg/kg q6h IV + Ampicillin: 50 mg/kg q6h IV × 10 days 1
• Chloramphenicol: 25 mg/kg q6h IV + Benzylpenicillin: 60 mg/kg (100,000 U/kg) q6h IV × 10 days 1

Meningitis (Infant)

• Ampicillin: 50 mg/kg q6h IV + Gentamicin: 5-7.5 mg/kg daily IV × 3 weeks 1
• Ceftriaxone: 50 mg/kg daily IV × 3 weeks 1

Ear Infections

Acute Otitis Media

• Amoxicillin: 40 mg/kg q12h PO × 5 days 1
• Co-trimoxazole (where no resistance): 4 mg/kg trimethoprim + 20 mg/kg sulfamethoxazole q12h PO × 5 days 1

Key Prescribing Principles

Critical Dosing Considerations

• Loading doses for seriously ill patients: Vancomycin 25-30 mg/kg 1
• Maximum pediatric doses should not exceed adult doses on per-kg basis 1
• Renal adjustment required for vancomycin, aminoglycosides 1

Common Pitfalls to Avoid

• Do NOT add gentamicin or rifampin to vancomycin for MRSA bacteremia 1
• Do NOT use doxycycline/minocycline in children <8 years 1
• Do NOT transition to oral agents in complicated bacteremia 1
• Clindamycin resistance: Check susceptibility; inducible resistance possible in MRSA 1

Duration Adjustments

• Simple SSTI: 5-10 days 1
• Complicated SSTI: 7-14 days 1
• Uncomplicated bacteremia: 2 weeks 1
• Complicated bacteremia: 4-6 weeks 1
• Endocarditis: 4-6 weeks (native valve), 6 weeks (prosthetic valve) 1