| Indication, drug | Dosage | Remarks | |||
|---|---|---|---|---|---|
| Tonsillitis (streptococcal) Pharyngitis and Tonsillitis in Children. Treatment duration 10 days if not otherwise mentioned | |||||
| 1. | Penicillin V | 50 000-100 000 IU/kg/day divided into 3 doses, treatment duration 10 days | |||
| 2. | Amoxicillin | 50 mg/kg/day divided into 3 doses | Especially in small children who refuse to take penicillin. | ||
| 3. | Cephalexin | 40-50 mg/kg/day divided into 3 doses | In penicillin allergy without anaphylaxis. Shorter duration of treatment (3-6 days) can be considered, if e.g. the child has difficulties with the intake of a long drug course. | ||
| 4. | Macrolides | Azithromycin | 10-20 mg/kg/day as a single dose, treatment duration 3 days | If the alternatives 1, 2 and 3 are not suitable, macrolides can be used as allowed by the local resistance situation or if sensitivity testing has been performed. | |
| Roxithromycin | Available as tablets only | ||||
| Clarithromycin | 15 mg/kg/day divided into 2 doses | ||||
| Sinusitis Sinusitis in Children. Treatment duration 7 days if not otherwise mentioned. Antimicrobial treatment is considered if sinusitis symptoms remain similar for more than 10 days, become worse after 5 days from onset or are severe. | |||||
| 1. | Amoxicillin | 40-80 mg/kg/day divided into 2 or 3 doses | |||
| 2. | Amoxicillin-clavulanic acid | 40/5.7-80/11.4 mg/kg/day divided into 2 doses | |||
| 3 | Doxycycline | 200 mg in a single dose on the first day, thereafter 100 mg once daily | Only for children over 8 years old, weighing over 50 kg | ||
| 4. | Sulpha-trimethoprim | 25 + 8 mg/kg/day divided into 2 doses | |||
| Macrolides | As in tonsillitis | ||||
| Otitis media Acute Otitis Media in Children: Treatment and Follow-Up. Treatment duration 5-7 days. Otitis media often heals without antimicrobial treatment. | |||||
| 1. | Amoxicillin | 40 mg/kg/day divided into 2 doses | |||
| 2. | Amoxicillin-clavulanic acid | 40/5.7 mg/kg/day divided into 2 doses | |||
| 3. | Sulpha-trimethoprim | As in sinusitis | |||
| Pneumonia Pneumonia in Children. Treatment duration 7 days. | |||||
| 1. | Amoxicillin | 50-80 mg/kg/day divided into 3 doses | |||
| 2 | Doxycycline | First day 4 mg/kg twice, then 2-4 mg/kg once daily | For over 8-year-olds when Chlamydia pneumoniae or mycoplasma infection is suspected. The dose is rounded off to 100 and 150 mg tablet sizes. | ||
| 3. | Cephalexin | 50 mg/kg/day divided into 3 doses | In penicillin allergy | ||
| 4. | Macrolides | Azithromycin | As in tonsillitis | If, based on the clinical picture, mycoplasma is suspected, combining amoxicillin with macrolide may be considered, but macrolide should not be used as sole antimicrobial. | |
| Clarithromycin | |||||
| Urinary tract infection Urinary Tract Infection in a Child in outpatient care. Treatment duration in infants 10 days, for cystitis in older children 5 days. | |||||
| 1. | Nitrofurantoin | 5 mg/kg/day divided into 2 doses | Infection at bladder level | ||
| 2. | Trimethoprim | 8 mg/kg/day divided into 2 doses | |||
| 3. | Pivmecillinam, cephalosporins, sulpha-trimethoprim or amoxicillin-clavulanic acid | ||||
| 4. | Sulpha-trimethoprim | 25 + 8 mg/kg/day divided into 2 doses | Infection at kidney level | ||
| 5. | Cephalexin | 50 mg/kg/day divided into 2-3 doses | |||
| Impetigo Impetigo and other Pyoderma. Treatment duration 7 to 10 days. | |||||
| 1. | Cephalexin | 50 mg/kg/day divided into 3 doses | Topical treatment (fusidic acid or combination of neomycin and bacitracin) is sufficient in infections limited to a small area. | ||
| 2. | Amoxicillin-clavulanic acid | 40/5.7 mg/kg/day divided into 2 doses | |||
| 3. | Flucloxacillin | 30-50 mg/kg/day divided into 3 doses | Tablets only, not for children weighing less than 40 kg | ||
| 4. | Clindamycin | 8 mg/kg/day divided into 3 doses | In cephalosporin allergy | ||
| Purulent skin infection caused by staphylococci | |||||
| 1. | Cephalexin | 50 mg/kg/day divided into 3 doses | Note! MRSA strains Multidrug-Resistant Bacteria in Hospitals are also encountered in outpatient care, cephalosporins are ineffective; medication is chosen according to sensitivity testing. | ||
| 2. | Flucloxacillin | 30-50 mg/kg/day divided into 3 doses | Tablets only, not for children weighing less than 40 kg | ||
| Indication, drug | Dosage | Remarks | ||
|---|---|---|---|---|
| Tonsillitis (streptococcal) Sore Throat and Tonsillitis. Treatment duration 10 days if not otherwise mentioned. | ||||
| 1. | Penicillin V | 2-3 million IU divided into 3 doses | ||
| 2. | Cephalexin | 500 mg 3 times daily | In penicillin allergy without anaphylaxis | |
| 3. | Macrolides | Azithromycin | 500 mg once daily, treatment duration 3 days | If the alternatives 1 and 2 are not suitable, macrolides can be used as allowed by the local resistance situation or if sensitivity testing has been performed. |
| Roxithromycin | 150 mg twice daily | |||
| Clarithromycin | 250-500 mg twice daily | |||
| 4. | Clindamycin | 300 mg 3 times daily | For recurrent tonsillitis First-line drug for patients with anaphylactic penicillin allergy | |
| Sinusitis Acute Maxillary Sinusitis or otitis media Acute Otitis Media in Adults. Treatment duration 7 days if not otherwise mentioned. Antimicrobial treatment is considered in patients with sinusitis symptoms for more than 10 days and with verified discharge in the sinuses. | ||||
| 1. | Amoxicillin | 500 mg 3 times daily or 750 mg 2-3 times daily | ||
| 2. | Doxycycline | Initial dose 150-200 mg, thereafter 100-150 mg once daily | ||
| 3. | Amoxicillin-clavulanic acid | 500/125 mg 3 times daily or 875/125 mg 2-3 times daily | ||
| 4. | Sulpha-trimethoprim | 500 mg/160 mg twice daily | ||
| 5. | Macrolides | As in tonsillitis | Only if allergy to other drugs | |
| Pneumonia Pneumonia, community-acquired, in outpatient care. Treatment duration at least 5-7 days. Usually the treatment can be discontinued after 10 days. | ||||
| 1. | Amoxicillin | 1 g 3 times daily or 750 mg 3-4 times daily | Does not cover Chlamydia pneumoniae or mycoplasma | |
| + roxithromycin or | 300 mg once daily | In combination with amoxicillin if the aim is to cover Chlamydia pneumoniae and mycoplasma; not to be used as the sole drug | ||
| + azithromycin or | 500 mg once daily for 3 days | |||
| + clarithromycin or | 500 mg once daily | |||
| + doxycycline | 100 mg twice daily | |||
| 2. | Moxifloxacin | 400 mg once daily for 10 days | To be considered if there is a history of treatment with some other antimicrobial drug in the past 3 months or a travel abroad, or the patient has a severe underlying disease | |
| Levofloxacin | 500 mg 1-2 times daily or 750 mg once daily for 10 days | |||
| Secondary drug for patients with penicillin allergy and alternative in mild pneumonia when the aim is to cover also Chlamydia pneumoniae and mycoplasma | ||||
| Doxycycline | 100 mg twice daily | Not to be used as the sole drug in pneumonia with severe symptoms. Increased resistance in pneumococcal strains limit the use of the drug. | ||
| Pneumonia Pneumonia, community-acquired, treated in the hospital | ||||
| 1. | Cefuroxime* | 1.5 g 3-4 times daily i.v. | Especially if the pneumonia diagnosis is uncertain | |
| Penicillin G* | 2 million IU 6 times daily or 2.5-5 mill. IU 4 times daily i.v. | Young fit patient with lobar pneumonia | ||
| 2. | Moxifloxacin | 400 mg once daily i.v. or p.o. | Change over to peroral administration as soon as possible | |
| Levofloxacin | 500 mg twice daily or 750 mg once daily i.v. or p.o. | Change over to peroral administration as soon as possible | ||
| * May be combined with an oral macrolide or doxycycline to cover Chlamydia pneumoniae and mycoplasma | ||||
| Urinary tract infection (cystitis) Urinary Tract Infections in outpatient care. Treatment duration 3 days. The local resistance pattern should guide the choice of drug. | ||||
| Trimethoprim | 160 mg twice daily or 300 mg once daily | Varying resistance | ||
| Nitrofurantoin | 75 mg twice daily | Not in renal insufficiency Effective against multiresistant strains of E. coli and Klebsiella | ||
| Pivmecillinam | 200 mg 3 times daily or 400 mg twice daily | Not effective against Staphylococcus saprophyticus | ||
| Fosfomycin | 3 g single dose | Special permit may be required | ||
| Urinary tract infection (cystitis): special situations | ||||
| Renal insufficiency: cephalexin, amoxicillin, pivmecillinam; note decreased dosage | ||||
| Pregnancy: pivmecillinam (not repeatedly), nitrofurantoin (not to be used close to labour, pregnancy weeks 38-42), cephalexin, amoxicillin according to the antibiogram; duration of treatment 5 days | ||||
| Men: duration of treatment 7 days, in febrile cystitis 10-14 days. Drugs: trimethoprim, sulpha-trimethoprim, nitrofurantoin or fosfomycin. An urinary tract infection in a male patient necessitates further urological investigations. | ||||
| Urinary tract infection with fever (pyelonephritis). Treatment duration in women 5-7 days and in men 10-14 days. | ||||
| 1. | Fluoroquinolone orally | Ciprofloxacin 500 mg twice daily Levofloxacin 500-750 mg once daily | Note! Oral norfloxacin should not be used in the treatment of complicated pyelonephritis. The number of pathogens resistant to fluoroquinolones is on the increase and consequently checking the urinary culture result is particularly important. | |
| 2. | Cefuroxime | 750-1 500 mg 3 times daily i.v. | When oral treatment is not feasible. Further treatment with a fluoroquinolone, with a first generation cephalosporin or with sulpha-trimethoprim p.o. | |
| 3. | Sulpha-trimethoprim | 500-800 mg + 160 mg twice daily | If the strain is known to be sensitive | |
| Mastitis Lactational Mastitis. Treatment duration 10-14 days. In non-breastfeeding women, a mammography should always be performed after the treatment, in order to rule out possible carcinoma. | ||||
| 1. | Cephalexin | 500 mg 3 times daily | ||
| Flucloxacillin | 750 mg 3 times daily | |||
| 2. | Roxithromycin | 150 mg twice daily | Or some other macrolide | |
| Erysipelas Erysipelas. Total treatment duration of 7-14 days is usually sufficient. If erysipelas frequently recurs, long-term prophylactic medication should be considered. | ||||
| 1. | Penicillin G; in a mild case treatment may be started directly with oral penicillin V | 1-3 mill. IU 4 times daily i.v. | Further treatment p.o.:
| |
| Procaine penicillin | 1.5-3 mill. IU once daily | Further treatment: see penicillin G | ||
| 2. | Cefuroxime | 1 500 mg 3 times daily i.v. | For patients with allergy for penicillin, further treatment with cephalexin 500-1 000 mg orally 3-4 times daily | |
| Clindamycin | 300-600 mg 4 times daily i.v. | For patients with allergy for penicillin, further treatment with 600-1 800 mg/day orally divided into 3-4 doses | ||
| Prophylactic medication: penicillin V 1-2 mill. IU/day p.o. or benzatine penicillin 1.2-2.4 mill. IU i.m. every 4 weeks (the interval of the injections is adjusted according to response) | ||||
| Purulent skin infection caused by staphylococci. Treatment duration 7-10 days. | ||||
| 1. | Cephalexin | 500-750 mg × 2-3 | Note! MRSA strains Multidrug-Resistant Bacteria in Hospitals are also encountered in outpatient care, cephalosporins are ineffective; medication is chosen according to sensitivity testing, | |
| Flucloxacillin | 750 mg 3 times daily | |||
| 2. | Amoxicillin-clavulanic acid | 500/125 mg 3 times daily or 875/125 mg 2-3 times daily | In the case of hypersensitivity, other antimicrobial drugs effective against staphylococci can be used as an alternative, for example clindamycin or a combination of sulfamethoxazole and trimethoprim. | |
| Primary eradication of Helicobacter pylori Peptic Ulcer Disease, Helicobacter Pylori Infection and Chronic Gastritis. Treatment duration 7 days. | ||||
| Amoxicillinor | 1 000 mg twice daily | Recurrent infection, see Peptic Ulcer Disease, Helicobacter Pylori Infection and Chronic Gastritis. | ||
| metronidazoleand | 400 mg 3 times daily | In penicillin allergy | ||
| clarithromycinand | 500 mg twice daily | Recurrent treatment after one failed treatment: amoxicillin 1 g twice daily + levofloxacin 500 mg once daily + PPI, all for 10 days. In patients with penicillin hypersensitivity, amoxicillin can be replaced by tetracycline 500 mg 4 times daily. | ||
| proton pump inhibitor | Normal dose twice daily | |||
| Campylobacter infection Diarrhoeal Diseases Caused by Microbes. Treatment duration with azithromycin 3 days, with roxithromycin and clarithromycin 10 days. | ||||
| Azithromycin | 500 mg once daily | In strains brought from abroad, resistance to fluoroquinolones is common. | ||
| Roxithromycin | 150 mg twice daily | |||
| Clarithromycin | 500 mg twice daily | |||
| Salmonella gastroenteritis Diarrhoeal Diseases Caused by Microbes, caused by some other agent than S. Typhi or S. Paratyphi* | ||||
| Ciprofloxacin | 500 mg twice daily for 3 days (if the symptoms are moderate to severe) | Always assess the need for antimicrobial treatment individually; strains resistant to fluoroquinolones are common; see Diarrhoeal Diseases Caused by Microbes | ||
| * In a suspected S. Typhi or S. Paratyphi infection: ceftriaxone i.v., in a confirmed case combine it with azithromycin or ciprofloxacin | ||||
| Gonorrhoea Gonorrhoea | ||||
| 1. | Ceftriaxone | 500 mg i.m. single dose Complicated disease: 1 g once daily i.m. for 3-5 days | In combination with lidocain.In addition oral azithromycin 2 g, if antibiotic sensitivity is not known. | |
| 2. | Spectinomycin | 2 g i.m. as a single dose | In cephalosporin allergy (special permit may be required) | |
| Chlamydial urethritis or cervicitis Chlamydial Urethritis and Cervicitis | ||||
| 1. | Azithromycin | 1 g as a single dose | Also during pregnancy | |
| 2. | Doxycycline | 100 mg twice daily for 7-10 days | ||
| Lymecycline | 300 mg twice daily for 7-10 days | |||
Primary/Secondary Keywords