5. Infections

First line drugs Second line drugs Specialist drugs Secondary care drugs
Recommended in both primary and secondary care Alternatives (often in specific conditions) in both primary and secondary care; Where a specialist input is needed (see introduction for definition) Prescribing principally within secondary care only

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only
  • Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.


Useful Sources of information:

1) Primary Care Antimicrobial Guidelines 

2) Management of Infections in Primary Care – 1 st line choices (To be read in conjunction with the full guidance in the link above)

3) Secondary Care Adult Antimicrobial Guidelines (Milton Keynes University Hospital NHS Foundation Trust)


1) Wherever possible antibiotics should be prescribed orally.

2) Antibiotics should be:
            ? Administered only for as long as necessary to treat the infection
            ? Changed from IV to oral as soon as possible

3) Sugar free liquids are preferred where available, and SF identifies where a sugar free product is available.

4) For young children requiring doses of less than 5ml an oral syringe will be dispensed


Suspected Meningitis

Pre-admission management for suspected meningitis can be found here: http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1194947389261


1) All GPs should carry benzylpenicillin for injection and administer it whilst arranging the transfer of the case to hospital, unless there is a history of immediate allergic reactions after previous penicillin administration.

2) GPs do not need to carry an alternative antibiotic. However, if other antibiotics are available, a 3rd generation cephalosporin may be used. If there is a history of immediate allergic reactions to penicillin or cephalosporins, chloramphenicol may be used.

3) Immediate dose of IV/IM benzylpenicillin for suspected meningococcal infection

            ?  Adults and children aged 10 years or over - 1.2g

            ?  Children aged 1 to 9 years - 600mg 

            ?  Children aged under 1 year - 300mg                 



Prevention of Endocarditis

NICE CG64: Antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures (March 2008)



5.1    Antibacterial drugs  


 5.2    Antifungal drugs          

           For local treatment of fungal infections see section:       

                                        7.2.2 – genital

                                        7.4.4 – bladder

                                        11.3.2 – eye

                                        12.1.1 – ear

                                        12.3.2 – oropharynx

                                        13.10.2 – skin 



5.3    Antiviral drugs     


5.4    Antiprotozoal drugs 

5.5    Anthelmintics   




Last updated by: Annie Bolton on 13-08-2018 15:07