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Antibiotic Guideline for Respiratory Tract Infections

Antibiotic Guideline for Respiratory Tract Infections

In 2016, National Centre For Disease Control, Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India came out with National Treatment Guidelines for Antimicrobial Use in Infectious Diseases.

Following are major recommendation for respiratory tract infections

Respiratory Tract Infections:

 Condition  Likely Causative Organisms  Empiric (presumptive) antibiotics/First Line  Alternative antibiotics/Second Line  Comments



 S. pneumoniae, H.influenzae, Legionella,

E.coli, Klebsiella sp., S.aureu

 Mild to moderate cases


500mg-1 g TDS oral.

If IV indicated, amoxycillin-clavulanate 1.2 g IV TDS or

Ceftriaxone 2g IV OD For

Severe cases Amoxycillin-clavulanate 1.2 g IV TDS

OrCeftriaxone 2g IV OD Duration 5-8 days

 Piperacillin-Tazobactam 4.5gm IV 6 hourly


Imipenem 1g IV 6hourly


Cefoperazone-Sulbactam 3gm IV 12 hourly

 If MRSA is a concern, add Linezolid 600mg IV/Oral BD

If atypical pneumonia suspected, Doxycycline 100mg bd


Azithromycin 500 mg oral/IV OD

 Lung abscess, Empyema  S. pneumoniae, E.coli, Klebsiella sp., Pseudomonas aeruginosa,

S.aureus, anaerobes

 Piperacillin-Tazobactam 4.5gm IV 6hourly

or Cefoperazone-Sulbactam 3gm IV 12 hourly

 ADD Clindamycin 600-900mg IV 8hourly  3-4 weeks treatment required
 Acute pharyngitis   Viral  None required  As most cases are viral no antimicrobial therapy required
   Group A ß-hemolytic Streptococci (GABHS),

Group C, G Streptococcus,

 Oral Penicillin v 500mg BD


Amoxicillin 500 mg Oral TDS for 10 days

 In case of penicillin allergy:


500mg OD for 5 days or

Benzathine penicillin 12 lac units IM stat

 Antibiotics are recommended to reduce transmission rates and prevention of long term sequaelae such as rheumatic fever
 Ludwig’s angina Vincent’s angina  Polymicrobial

(Cover oral anaerobes)

 Clindamycin 600 mg IV 8 hourly

or Amoxicillin-Clavulanate 1.2gm IV

 Piperacillin-Tazobactam 4.5gm IV 6 hourly  Duration based on improvement
 Acute bacterial rhinosinusitis  Viral,

S. pneumoniae, H.influenzae,

M. catarrhalis

 Amoxicillin-clavulanate 1gm

oral BD for 7 days

 Moxifloxacin 400mg OD for 5- 7days
 Acute bronchitis   Viral  Antibiotics not required
 Acute bacterial exacerbation of COPD  S. pneumoniae

H. influenzae

M. catarrhalis

 Amoxicillin-clavulanate 1gm oral BD for 7 days  Azithromycin 500 mg oral OD × 3 days

You can read the full Guideline by clicking on the following link :

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