Can you provide a complete list of antibiotics with recommended doses and durations for common infectious diseases in India?

Antibiotic Guidelines for Common Infectious Diseases in India

Skin and Soft Tissue Infections

Uncomplicated Cellulitis (Community-Acquired, Methicillin-Susceptible)

First-line therapy for community-acquired skin infections should be cefazolin 1 g IV every 8 hours or oxacillin 1-2 g IV every 4 hours for adults, as 80-90% of community-acquired Staphylococcus aureus and streptococci remain susceptible to these agents. 1, 2

Adult Dosing:

• Cefazolin: 1 g IV every 8 hours 1
• Oxacillin/Nafcillin: 1-2 g IV every 4 hours 1
• Dicloxacillin (oral): 500 mg PO 4 times daily 1
• Cephalexin (oral): 500 mg PO 4 times daily 1
• Duration: Approximately 7 days depending on clinical response 1

Pediatric Dosing:

• Cefazolin: 50 mg/kg/day in 3 divided doses IV 1
• Oxacillin/Nafcillin: 100-150 mg/kg/day in 4 divided doses IV 1
• Dicloxacillin (oral): 25 mg/kg/day in 4 divided doses PO 1
• Cephalexin (oral): 25 mg/kg/day in 4 divided doses PO 1

For penicillin-allergic patients (non-immediate hypersensitivity):

• Clindamycin: 600 mg IV every 8 hours or 300-450 mg PO 3 times daily (adults); 25-40 mg/kg/day in 3 divided doses IV or 10-20 mg/kg/day in 3 divided doses PO (pediatric) 1

MRSA Skin and Soft Tissue Infections

For confirmed or suspected MRSA infections, vancomycin remains the parenteral drug of choice at 30 mg/kg/day in 2 divided doses for adults and 40 mg/kg/day in 4 divided doses for children. 1

Adult Treatment Options:

• Vancomycin: 15-20 mg/kg/dose IV every 8-12 hours 1
• Linezolid: 600 mg PO/IV twice daily 1
• Clindamycin: 600 mg PO/IV 3 times daily 1
• Doxycycline: 100 mg PO twice daily 1
• TMP-SMX: 1-2 double-strength tablets PO twice daily 1

Pediatric Treatment Options:

• Vancomycin: 15 mg/kg/dose IV every 6 hours 1
• Linezolid: 10 mg/kg/dose PO/IV every 8 hours (not to exceed 600 mg/dose) 1
• Clindamycin: 10-13 mg/kg/dose PO/IV every 6-8 hours (not to exceed 40 mg/kg/day) 1
• TMP-SMX: 4-6 mg/kg/dose (trimethoprim component) PO every 12 hours 1

Necrotizing Fasciitis and Severe Soft Tissue Infections

For necrotizing infections, immediate surgical debridement combined with broad-spectrum antibiotics covering mixed aerobic-anaerobic flora is mandatory, with piperacillin-tazobactam 3.37 g IV every 6-8 hours plus vancomycin as the preferred empiric regimen. 1

Adult Empiric Therapy for Mixed Infections:

• Piperacillin-tazobactam + Vancomycin: 3.37 g every 6-8 hours IV + 30 mg/kg/day in 2 divided doses IV 1
• Imipenem-cilastatin: 1 g every 6-8 hours IV 1
• Meropenem: 1 g every 8 hours IV 1
• Cefotaxime + Metronidazole + Clindamycin: 2 g every 6 hours IV + 500 mg every 6 hours IV 1

Pediatric Dosing:

• Piperacillin-tazobactam: 60-75 mg/kg/dose (piperacillin component) every 6 hours IV 1
• Vancomycin: 10-13 mg/kg/dose every 8 hours IV 1
• Meropenem: 20 mg/kg/dose every 8 hours IV 1
• Cefotaxime: 50 mg/kg/dose every 6 hours IV 1
• Metronidazole: 7.5 mg/kg/dose every 6 hours IV 1

For Streptococcal Necrotizing Fasciitis:

• Penicillin + Clindamycin: 2-4 million units every 4-6 hours IV + 600-900 mg every 8 hours IV (adults) 1
• Pediatric: 60,000-100,000 units/kg/dose every 6 hours IV + 10-13 mg/kg/dose every 8 hours IV 1

Respiratory Tract Infections

Community-Acquired Pneumonia

For pediatric community-acquired pneumonia, high-dose amoxicillin at 90 mg/kg/day divided into 2 doses (maximum 4 g/day) is the first-line empiric therapy to ensure coverage of penicillin-resistant Streptococcus pneumoniae. 3

Pediatric Dosing:

• Mild-to-moderate CAP (≥3 months, <40 kg): 45 mg/kg/day in 2 doses PO 3
• Severe CAP or high pneumococcal resistance: 90 mg/kg/day in 2 doses PO (maximum 4 g/day) 3
• Duration: 10 days, continuing at least 48-72 hours after symptom resolution 3

High-dose indicated when ANY of these risk factors present:

• Age <2 years 3
• Daycare attendance 3
• Recent antibiotic use (within 30 days) 3
• Region with >10% penicillin-resistant S. pneumoniae 3
• Moderate-to-severe illness 3

For β-lactamase-producing organisms (H. influenzae, M. catarrhalis):

• Amoxicillin-clavulanate: 90 mg/kg/day (amoxicillin component) + 6.4 mg/kg/day (clavulanate) in 2 doses 3

Adult CAP (outpatient):

• Amoxicillin: 1 g PO 3 times daily for 7-10 days 3
• For high resistance or recent antibiotics: Consider amoxicillin-clavulanate 2 g/125 mg PO twice daily 3

Penicillin-Allergic Patients:

• Non-anaphylactic: Cefdinir, cefuroxime, or cephalexin 3
• Type I hypersensitivity: Azithromycin 500 mg day 1, then 250 mg days 2-5 (adults); 10 mg/kg day 1, then 5 mg/kg days 2-5 (pediatric) 3

Acute Bacterial Sinusitis

For acute bacterial sinusitis in children ≥2 years without risk factors, standard-dose amoxicillin 45 mg/kg/day in 2 doses for 10 days is appropriate; escalate to 80-90 mg/kg/day for children <2 years, daycare attendees, or those with recent antibiotic exposure. 3

Pediatric Dosing:

• Standard (≥2 years, no risk factors): 45 mg/kg/day in 2 doses 3
• High-dose (<2 years, daycare, recent antibiotics): 80-90 mg/kg/day in 2 doses 3
• Duration: Continue 7 days after symptom resolution, minimum 10 days total 3

Adult Dosing:

• Amoxicillin: 500 mg PO 3 times daily or 875 mg PO twice daily 3
• High-dose (risk factors): 1 g PO 3 times daily 3

Group A Streptococcal Pharyngitis

For Group A streptococcal pharyngitis, amoxicillin 50 mg/kg/day (maximum 1,000 mg per dose) in 2 doses for 10 days is the preferred first-line therapy, offering better adherence than penicillin V with equivalent efficacy. 3

Pediatric Dosing:

• Standard regimen: 50 mg/kg/day in 2 doses (maximum 1,000 mg per dose) for 10 days 3
• Alternative once-daily: 50 mg/kg once daily (maximum 1,000 mg) for 10 days 3

Adult Dosing:

• Amoxicillin: 500 mg PO twice daily for 10 days 3
• Alternative: 1,000 mg PO once daily for 10 days 3

Penicillin-Allergic Patients:

• Non-anaphylactic: Cephalexin 20 mg/kg/dose twice daily (max 500 mg/dose) for 10 days 3
• Type I allergy: Clindamycin 7 mg/kg/dose 3 times daily (max 300 mg/dose) for 10 days OR Azithromycin 12 mg/kg once daily (max 500 mg) for 5 days 3

Critical considerations:

• Antibiotic therapy may be started up to 9 days after symptom onset and still prevent acute rheumatic fever 3
• Fever typically resolves within 3-4 days, but complete the full 10-day course 3
• Obtain rapid antigen test or throat culture before prescribing; approximately 70% of sore throats are not streptococcal 3

Acute Otitis Media

For children <2 years with confirmed acute otitis media, immediate antibiotic therapy with amoxicillin 80-90 mg/kg/day in 2 doses should be initiated; children ≥2 years with mild symptoms may be observed for 48-72 hours before starting antibiotics. 3

Pediatric Dosing:

• Standard: 80-90 mg/kg/day in 2 doses for 10 days 3
• Recent antibiotic use (within 4-6 weeks): Amoxicillin-clavulanate 90 mg/kg/day (amoxicillin component) + 6.4 mg/kg/day (clavulanate) 3

Treatment Duration:

• <2 years or severe symptoms: 10 days 3
• ≥2 years with mild symptoms: 5-7 days may be adequate 3

Urinary Tract Infections

For pediatric uncomplicated UTI, amoxicillin-clavulanate 20-40 mg/kg/day (amoxicillin component) in 3 divided doses for 7-10 days is appropriate, with higher dosing reserved for recent antibiotic exposure or daycare attendance. 3

Pediatric Dosing:

• Standard (no risk factors): 20 mg/kg/day in 3 doses 3
• High-dose (recent antibiotics, daycare): 40 mg/kg/day in 3 doses 3
• Duration: 7-10 days; favor 10 days for febrile UTIs 3

Adult Dosing:

• Amoxicillin-clavulanate: 500 mg/125 mg PO 3 times daily for 7 days 3

Critical considerations:

• Do NOT use nitrofurantoin for febrile UTIs or pyelonephritis, as it achieves only urinary concentrations 3
• Review local resistance patterns before prescribing 3

Bone and Joint Infections

Osteomyelitis

For MRSA osteomyelitis, vancomycin 15-20 mg/kg/dose IV every 8-12 hours (adults) or 15 mg/kg/dose every 6 hours (pediatric) combined with surgical debridement is the mainstay of therapy. 1

Adult Treatment Options:

• Vancomycin: 15-20 mg/kg/dose IV every 8-12 hours 1
• Daptomycin: 6 mg/kg/day IV once daily 1
• Linezolid: 600 mg PO/IV twice daily 1
• Clindamycin: 600 mg PO/IV 3 times daily 1

Pediatric Treatment Options:

• Vancomycin: 15 mg/kg/dose IV every 6 hours 1
• Daptomycin: 6-10 mg/kg/dose IV once daily 1
• Linezolid: 10 mg/kg/dose PO/IV every 8 hours (not to exceed 600 mg/dose) 1
• Clindamycin: 10-13 mg/kg/dose PO/IV every 6-8 hours (not to exceed 40 mg/kg/day) 1

Some experts recommend adding rifampin 600 mg once daily (adults) to the chosen antibiotic for enhanced bone penetration. 1

Septic Arthritis

For septic arthritis, drainage or debridement of the joint space should always be performed in addition to systemic antibiotics, with vancomycin as first-line for suspected MRSA. 1

Adult Dosing:

• Vancomycin: 15-20 mg/kg/dose IV every 8-12 hours 1
• Daptomycin: 6 mg/kg/day IV once daily 1
• Linezolid: 600 mg PO/IV twice daily 1

Pediatric Dosing:

• Vancomycin: 15 mg/kg/dose IV every 6 hours 1
• Daptomycin: 6-10 mg/kg/dose IV once daily 1
• Linezolid: 10 mg/kg/dose PO/IV every 8 hours (not to exceed 600 mg/dose) 1

Bacteremia and Endocarditis

MRSA Bacteremia

For MRSA bacteremia, vancomycin 15-20 mg/kg/dose IV every 8-12 hours or daptomycin 6 mg/kg/day IV once daily are the recommended first-line agents. 1

Adult Dosing:

• Vancomycin: 15-20 mg/kg/dose IV every 8-12 hours 1
• Daptomycin: 6 mg/kg/dose IV once daily 1

Pediatric Dosing:

• Vancomycin: 15 mg/kg/dose IV every 6 hours 1
• Daptomycin: 6-10 mg/kg/dose IV once daily 1

MRSA Prosthetic Valve Endocarditis

For MRSA prosthetic valve endocarditis, triple therapy with vancomycin plus gentamicin plus rifampin is recommended. 1

Adult Dosing:

• Vancomycin: 15-20 mg/kg/dose IV every 8-12 hours 1
• Gentamicin: 1 mg/kg/dose IV every 8 hours 1
• Rifampin: 300 mg PO/IV every 8 hours 1

Pediatric Dosing:

• Vancomycin: 15 mg/kg/dose IV every 6 hours 1
• Gentamicin: 1 mg/kg/dose IV every 8 hours 1
• Rifampin: 5 mg/kg/dose PO/IV every 8 hours 1

Cutaneous Anthrax

Community-Acquired Anthrax

For community-acquired cutaneous anthrax, penicillin V 200-500 mg PO 4 times daily (adults) or 25-50 mg/kg/day in divided doses (pediatric) is the treatment of choice. 1

Adult Treatment Options:

• Penicillin V: 200-500 mg PO 4 times daily 1
• Amoxicillin: 500 mg PO every 8 hours 1
• Erythromycin: 250 mg PO every 6 hours 1
• Doxycycline: 100 mg PO twice daily 1

Pediatric Treatment Options:

• Penicillin V: 25-50 mg/kg/day in divided doses 2 or 4 times per day 1
• Amoxicillin: 40 mg/kg PO in divided doses every 8 hours (for children <20 kg); 500 mg every 8 hours (for children ≥20 kg) 1

Bioterrorism-Related Anthrax

For bioterrorism or suspected bioterrorism-related cutaneous anthrax, doxycycline 100 mg PO/IV twice daily (adults) or ciprofloxacin 500 mg PO twice daily are the preferred agents. 1

Adult Dosing:

• Doxycycline: 100 mg PO/IV twice daily 1
• Ciprofloxacin: 500 mg PO twice daily or 400 mg IV every 12 hours 1

Pediatric Dosing:

• Doxycycline: 2.2 mg/kg every 12 hours (for children <45 kg); 100 mg twice daily (for children ≥45 kg) 1
• Ciprofloxacin: 10-15 mg/kg every 12 hours PO or IV (not to exceed 1 g in 24 hours) 1

Context-Specific Considerations for India

In India, quinolones (particularly ciprofloxacin) and third-generation cephalosporins (ceftriaxone and ceftriaxone/sulbactam) are heavily prescribed, but surveillance data shows increasing resistance patterns requiring adherence to first-line guideline-recommended agents. 4, 5, 6

Common prescribing pitfalls identified in Indian hospitals include:

• Overuse of quinolones for pneumonia instead of amoxicillin 5
• Irrational antibiotic prescribing in gastroenteritis 5
• Longer than recommended duration of surgical prophylaxis 5
• Overreliance on antibiotics for skin and soft tissue infections without adequate drainage 5
• Increasing use of "watch" category antibiotics and fixed-dose combinations 6

To optimize antibiotic prescribing in India:

• Use local surveillance data when available to guide empiric therapy 4
• Implement diagnostic routines (rapid antigen tests, cultures) before prescribing 4
• Adhere to standardized local guidelines based on current resistance patterns 4
• Reserve broad-spectrum agents (carbapenems, linezolid) for documented resistant organisms or life-threatening situations 2