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Overview
Antibiotics are used to treat infections caused by bacteria. Some can be used to treat a wide range of infections and are known as ‘broad-spectrum’ antibiotics (eg tetracyclines). Others antibiotics are only effective against a narrow range of bacteria and are called ‘narrow-spectrum’ antibiotics (eg macrolides). Antibiotics are also referred to as antimicrobials.
There are nine main types of antibiotics currently in use (Table 1).
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Table 1. Classes of antibiotics and examples |
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Class |
Examples |
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Penicillins |
Phenoxymethylpenicillin, flucloxacillin and amoxicillin. |
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Tetracyclines |
Tetracycline, doxycycline and lymecycline. |
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Cephalosporins |
Cephaclor, cefphadroxil and cephalexin. |
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Aminoglycosides |
Gentamicin and tobramycin |
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Macrolides |
Erythromycin, azithromycin and clarithromycin |
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Sulphonamides and trimethoprim |
Co-trimoxazole |
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Metronidazole |
Metronidazole and tinidazole |
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Quinolones |
Ciprofloxacin, levofloxacin and norfloxacin |
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Carbapenems |
Meropenem, ertapenem, imipenem |
Some antibiotics treat aerobic bacteria, and others target anaerobic bacteria. Aerobic bacteria require oxygen to survive, whereas anaerobic bacteria are bacteria that thrive in environments that lack oxygen. Infections such as gangrene are caused
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Indications
Summary guidance containing recommendations around antibiotics prescribing on antibiotic prescribing is updated at least every 3 months and is available on the British National Formulary (2023).
Infections of the mouth, teeth and soft tissues
These are generally treated with penicillin or amoxycillin. If the person is allergic to penicillin, clarithromycin is prescribed. If an anaerobic infection is present, metronidazole is prescribed.
Low-severity infections
People with low-severity infections are treated with amoxicillin or doxycycline. A loading dose of 200 mg of doxycycline is given, then 100 mg is given once daily. Once-daily dosage can be helpful if the person is forgetful or may be reluctant to take lots of medication. At-home caregivers can find it easier to give a once daily dose. If the person is allergic to penicillin, clarithromycin is prescribed.
Moderately severe infections
People with moderately severe infections are normally prescribed both amoxicillin
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Resistance
Antimicrobial resistance occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines, making infections harder to treat and increasing the risk of disease spread, severe illness and death (World Health Organisation, 2021). In England, 178 people are diagnosed every day with antibiotic-resistant infections (Public Health England, 2020).
The latest national surveillance data shows that an estimated 58 224 people in England had an antibiotic resistant infection in 2022 – a rise of 4% since 2021 (55 792). Deaths due to severe antibiotic-resistant infections increased from 2 110 in 2021 to 2 202 in 2022 (UK Health Security Agency, 2023).
Reducing the risks of antibiotic resistance
The key to reducing the risks of antibiotic resistance are reducing their use in humans and agriculture. This requires clinicians to diagnose accurately and to prescribe antibiotics only when necessary. People who are prescribed antibiotics should take them in
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NMC proficiencies
Nursing and Midwifery Council: standards of proficiency for registered nurses
Part 1: Procedures for assessing people’s needs for person-centred care
1. Use evidence-based, best practice approaches to take a history, observe, recognise and accurately assess people of all ages
Part 2: Procedures for the planning, provision and management of person-centred nursing care
11. Procedural competencies required for best practice, evidence-based medicines administration and optimisation
11.1 carry out initial and continued assessments of people receiving care and their ability to self-administer their own medications
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Resources
British National Formulary. Summary of antimicrobial prescribing guidance – managing common infections. 2023. https://www.bnf.org/news/2021/07/29/bnf-hosts-antimicrobial-summary-guidance-on-behalf-of-nice-and-phe/ (accessed 20 November 2023)
Butler CC, Hawking MK, Quigley A, McNulty CA. Incidence, severity, help seeking, and management of uncomplicated urinary tract infection: a population-based survey. Br J Gen Pract. 2015;65(639):e702-7. https://doi.org/10.3399/bjgp15X686965
Levell NJ, Wingfield CG, Garioch JJ. Severe lower limb cellulitis is best diagnosed by dermatologists and managed with shared care between primary and secondary care. Br J Dermatol. 2011;164(6):1326-1328. https://doi.org/10.1111/j.1365-2133.2011.10275.x
Little P, Moore M, Turner S et al. Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial. BMJ 2010;340:c199. https://doi.org/10.1136/bmj.c199
Medicines and Healthcare products Regulatory Agency. Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects. 2019a. https://www.gov.uk/drug-safety-update/fluoroquinolone-antibiotics-new-restrictions-and-precautions-for-use-due-to-very-rare-reports-of-disabling-and-potentially-long-lasting-or-irreversible-side-effects (accessed 20 November 2023)
Medicines and Healthcare products Regulatory Agency. Fluoroquinolone antibiotics (oxacins) what you need to know about side effects of tendons, muscles, joints, and nerves. 2019b.
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