Antibiotic Guide: choices for common infections – 2023

Last updated: 1 November, 2024

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bpacnz Primary Care Antibiotic Guide

Antibiotics: choices for common infections

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The following information is a guide. It is intended to aid selection of an appropriate antibiotic for typical patients with infections commonly seen in general practice. Individual patient circumstances and local resistance patterns may alter treatment choices.

Antibiotic use in New Zealand is higher per head of population than in many similar developed countries. Increased antibiotic use (and misuse) leads to the development of resistance by eliminating antibiotic-susceptible bacteria and leaving antibiotic-resistant bacteria to multiply. Antimicrobial stewardship aims to limit the use of antibiotics to situations where they deliver the greatest clinical benefit. Along with infection control, this is the key strategy to counter the emerging threat of antimicrobial resistance.

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General principles of antimicrobial stewardship:

  1. In most cases, only prescribe antibiotics for bacterial infections if:
    • Symptoms are significant or severe
    • There is a high risk of complications
    • The infection is not resolving or is unlikely to resolve
  2. Select the first-line indicated antibiotic at the recommended dose and duration
  3. Reserve broad spectrum antibiotics for indicated conditions only
  4. Educate patients about responsible use of antibiotics, including when an antibiotic is not indicated, and the importance of adhering to the advised regimen (dose and duration); discuss ways that palatability issues or minor adverse effects can be minimised and tips for remembering to take doses on time

For further reading, see: Antibiotics: the future is short

Notes for using this guide

Disclaimer: The following information is a “living document”; information is updated as new evidence or recommendations emerge. It is intended to aid selection of an appropriate antibiotic for typical patients with infections commonly seen in primary care. Local resistance patterns may mean that there will be regional variation in first-line choices.

  • Information on national antimicrobial resistance patterns is available from the Institute of Environmental Science and Research Ltd (ESR), Public Health Surveillance
  • Regional resistance patterns may vary; check with your local laboratory
  • To check the funding status of a medicine and any supply issues, refer to the New Zealand Formulary or the Pharmaceutical Schedule
  • This guideline distinguishes child and adult dosing where appropriate. ‘Child’ for the purpose of this guideline refers to those aged > 1 month and < 12 years, unless otherwise specified. For dosing relating to neonates aged < 1 month, refer to the New Zealand Formulary for Children
  • Further information relating to isolation periods and reporting of patients with Notifiable Diseases (and their contacts) can be found in the Communicable Diseases Control Manual or alternatively discuss with Public Health
  • Infectious diseases medicine is a dynamic and evolving discipline; this guide is a “living document” and any major changes in antibiotic choice, dose or management will be updated online as required. If you would like to suggest any changes to the guide or the addition of topics, email: editor@bpac.org.nz
  • The information in this publication is specifically designed to address conditions and requirements in New Zealand and no other country. bpacnz assumes no responsibility for action or inaction by any other party based on the information found in this publication and readers are urged to seek appropriate professional advice before taking any steps in reliance on this information.
  • This resource is the subject of copyright which is owned by bpacnz. You may access it, but you may not reproduce it or any part of it except in the limited situations described in the terms of use on our website.

The following main resources were used in the development of this guide:

  1. bpacnz. Online resources. Available from: https://bpac.org.nz/
  2. Dermnet NZ. Available from: https://dermnetnz.org/
  3. National Heart Foundation of New Zealand. Group A Streptococcal Sore Throat Management Guideline 2019 Update. Available from: https://www.heartfoundation.org.nz/professionals/health-professionals
  4. New Zealand Formulary and New Zealand Formulary for Children. Available from: https://nzf.org.nz/
  5. New Zealand Sexual Health Society (NZSHS). STI management guidelines for use in primary care. Available from: http://sti.guidelines.org.nz/
  6. Starship Children’s Health. Clinical guidelines. Available from: www.adhb.govt.nz/starshipclinicalguidelines
  7. Te Whatu Ora Te Toka Tumai Auckland. Antimicrobial Stewardship. Adult empirical antimicrobial treatment guideline. Available from: https://www.adhb.health.nz/health-professionals/resources/ams/

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