Red Flags
- Sepsis with carbapenem-resistant Enterobacterales (CRE) or pan-drug-resistant organism on culture — narrow last-line agents (colistin, polymyxin B, ceftazidime-avibactam, cefiderocol) and infectious diseases consult[1]
- Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia — vancomycin or daptomycin; remove indwelling devices; echocardiography for endocarditis[1]
- Vancomycin-resistant Enterococcus (VRE) bacteraemia — linezolid or daptomycin; cohort isolate, contact precautions[1]
- C. difficile colitis with severe features (WBC ≥15, lactate ≥2.2, Cr rise) — fidaxomicin or vancomycin PO; surgical review if fulminant[1]
First-line treatment
Interventions
- Antimicrobial stewardship principles[1]Right drug, right dose, right route, right duration. Document indication and review at 48–72 h with culture results; de-escalate to narrowest effective agent; stop on resolution
- Watch / Reserve antibiotic gatekeeping[1]Restrict carbapenems, polymyxins, ceftazidime-avibactam, cefiderocol, linezolid, and daptomycin to documented indications with infectious disease or stewardship-team approval
- Infection prevention bundles[1]Hand hygiene, contact precautions for resistant organisms, central-line / catheter-associated infection bundles, environmental cleaning, vaccination
First-line drug therapy
| Drug | Class | Adult | Paediatric | Notes |
|---|---|---|---|---|
| Amoxicillin[1] | Beta-lactam (Access tier) | 500 mg PO TID for typical community infections | 25–50 mg/kg/day divided TID | WHO AWaRe Access tier — preferred first-line for sensitive organisms; preserves later-line agents |
| Doxycycline[1] | Tetracycline (Access tier) | 100 mg PO BD for 5–14 days depending on indication | — | Effective for atypical pneumonia, MRSA SSTI, rickettsial disease; limited resistance pressure |
Amoxicillin[1]
Beta-lactam (Access tier)
- Adult
- 500 mg PO TID for typical community infections
- Paediatric
- 25–50 mg/kg/day divided TID
WHO AWaRe Access tier — preferred first-line for sensitive organisms; preserves later-line agents
Doxycycline[1]
Tetracycline (Access tier)
- Adult
- 100 mg PO BD for 5–14 days depending on indication
- Paediatric
- —
Effective for atypical pneumonia, MRSA SSTI, rickettsial disease; limited resistance pressure
Safety-net
- Take antibiotics only as prescribed and complete the course only when your clinician advises — many infections need shorter courses than historically given[1]
- Do not share antibiotics or use leftover doses for new symptoms — wrong drug or wrong dose drives resistance[1]
- Worsening symptoms despite 48–72 h of treatment — return for review; may need a different agent or further investigation[1]
Referral criteria
- Sepsis with multi-drug-resistant or pan-drug-resistant organismInfectious diseases / clinical microbiology — narrow with susceptibility-driven last-line agent[1]
- Recurrent or refractory C. difficile colitisGastroenterology and infectious diseases for fidaxomicin, faecal microbiota transplant, or bezlotoxumab[1]
- Suspected outbreak of resistant organism on a wardInfection control team for cohorting, screening contacts, and root-cause analysis[1]
Clinical summary
National strategy and prescriber-level practices to limit antimicrobial resistance through stewardship, surveillance, and infection prevention.