Summary of antimicrobial guidance

Acute Sore Throat 

Advise paracetamol, or if preferred and suitable, ibuprofen for pain. Medicated lozenges may help pain in adults.

Use FeverPAIN or Centor to assess symptoms:

• FeverPAIN 0-1 or Centor 0-2: no antibiotic;
• FeverPAIN 2-3: no or back-up antibiotic;
• FeverPAIN 4-5 or Centor 3-4: immediate or back-up antibiotic.

Systemically very unwell or high risk of complications: immediate antibiotic.

5 days of phenoxymethylpenicillin may be enough for symptomatic cure; but a 10-daycourse may increase the chance of microbiological cure.

First choice adult: 

phenoxymethylpenicillin 500mg QDS or 1000mg BD for 5 to 10 days*

Penicillin allergy adult: 

clarithromycin 250mg to 500mg BD for 5 days

OR

erythromycin (if macrolide needed in pregnancy; consider benefit/harm) 250mg to 500mg QDS or 500mg to 1000mg BD for 5 days

For information on children’s dosage or for detailed information see the guidance visual summary or https://www.nice.org.uk/guidance/ng84

NICE

Last updated: Feb 2023

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Acute Otitis Media

Regular paracetamol or ibuprofen for pain (right dose for age or weight at the right time and maximum doses for severe pain).

Consider ear drops containing an anaesthetic and an analgesic for pain if an immediate antibiotic is not given and there is no ear drum perforation or otorrhoea.

• Otorrhoea or under 2 years with infection in both ears: no, back-up or immediate antibiotic.
• Otherwise: no or back-up antibiotic.
• Systemically very unwell or high risk of complications: immediate antibiotic.

First choice adult:          

amoxicillin for 5 to 7 days

Penicillin allergy adult:   

clarithromycin for 5 to 7 days

OR

erythromycin (if macrolide needed in pregnancy: consider benefit/harm) for 5 to 7 days

Second choice adult:     

co-amoxiclav for 5 to 7 days

For information on children’s dosage or for detailed information see the guidance visual summary or https://www.nice.org.uk/guidance/ng91

NICE

Section last updated: Oct 2023

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Sinusitis

Advise paracetamol or ibuprofen for pain. Little evidence that nasal saline or nasal decongestants help, but people may want to try them.

• Symptoms for 10 days or less: no antibiotic.
• Symptoms with no improvement for more than 10 days: no antibiotic or back-up antibiotic depending on likelihood of bacterial cause. Consider high-dose nasal corticosteroid (if over 12 years).
• Systemically very unwell or high risk of complications: immediate antibiotic.

First choice adult:          

phenoxymethylpenicillin 500mg QDS for 5 days

Penicillin allergy adult:   

doxycycline (not in under 12s) 200mg on day 1, then 100mg OD for 5 days

OR

clarithromycin 500mg BD for 5 days

OR

erythromycin (if macrolide needed in pregnancy: consider benefit/harm) 250 to 500mg QDS or 500 to 1000mg BD for 5 days

Second choice or first choice if systemically very unwell or high risk of complications: 

co-amoxiclav 500/125mg TDS for 5 days

For information on children’s dosage or for detailed information see the guidance visual summary or  https://www.nice.org.uk/guidance/ng79

Section last updated: Oct 2017

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