Antimicrobial resistance — clinical roadmap

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]

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

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)

WHO AWaRe Access tier — preferred first-line for sensitive organisms; preserves later-line agents

Doxycycline^[1]

Tetracycline (Access tier)

Effective for atypical pneumonia, MRSA SSTI, rickettsial disease; limited resistance pressure

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]

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]

National strategy and prescriber-level practices to limit antimicrobial resistance through stewardship, surveillance, and infection prevention.

1.National Action Plan on Antimicrobial Resistance (NAP-AMR), MoHFW; NAP-AMR Module for Prescribers (NMC, 2024); WHO Global Action Plan on AMR (2024)