Doses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC). See guidance on dosing in children for quick reference dosage/weight guide. Refer to drug interactions table for detailed drug interactions for all antimicrobials. Note extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.
Note additional warnings for clarithromycin and fluoroquinolones
Comments from Expert Advisory Committee
- Many are viral. Illness resolves over 4 days in 80% without antibiotics. A+
- Antibiotics do not reduce pain in first 24 hours, subsequent attacks or deafness. A+
- Need to treat 20 children >2y and seven 6-24m old to get pain relief in one at 2-7 days. A+ B+
- Children with otorrhoea, or <2years with bilateral acute otitis media, have greater benefit but are still eligible for delayed prescribing. A+
- Haemophilus is an extracellular pathogen, thus macrolides, which concentrate intracellularly, are less effective treatment.
- Antibiotics to prevent mastoiditis NNT>4000.B
Use NSAID or paracetamol. A-
Consider a no or delayed antibiotic strategy. A+
If antibiotics deemed clinically indicated:
Amoxicillin preferred antibiotic. Recommended duration 5 days
See guidance on Amoxicillin dosing in children
Please note: various strengths of Amoxicillin powder for suspension available:
- 125mg/ 1.25ml
- 250mg /5ml
Clarithromycin if penicillin allergic. Recommended duration 5 days
See guidance on Clarithromycin dosing in children
Preparations available for children: Clarithromycin Granules for Oral Solution: 125mg/5mls and 250mg/5mls, 250mg tablets. Prolonged release tablets not recommended in children.
The HSE Health A-Z website provides patient information on many hundreds of conditions and treatments.
We recommend patients use the website developed by HSE/ICGP/IPU partnership www.undertheweather.ie for tips on how to get better from common infections without using antibiotics, what you can do for yourself or a loved one and when to seek help.
Reviewed Dec 2019