Respiratory tract (upper)

Antibiotics are not required in all cases. Refer to local paediatric guidelines.

PO penicillin V

If unable to swallow: IV benzylpenicillin, with switch to PO penicillin V

Acute sore throat (includes Group A/C/G streptococci): 5 days; consider up to 10 days if severely unwell / associated sepsis
Recurrent acute sore throat <2 weeks from previously treated infection: 10 days
Scarlet fever: 10 days

PO azithromycin

Acute sore throat (includes Group A/C/G streptococci): 3 days
Scarlet fever: 5 days

or

IV/PO clarithromycin

Acute sore throat (includes Group A/C/G streptococci): 5 days
Scarlet fever: 10 days

IV cefTRIAXone

Oral switch (no penicillin allergy): co-amoxiclav
Oral switch (mild penicillin allergy): clindamycin and ciprofloxacin

IV clindamycin 
and IV ciprofloxacin

Oral switch: clindamycin and ciprofloxacin

Children with acute otitis media do not usually require antibiotics, which typically shorten symptoms by 24 hours only.
Consider delayed antibiotic treatment.
Refer to BSAC Paediatric Pathways for further guidance.

PO/IV amoxicillin

PO azithromycin

or

PO/IV clarithromycin

IV cefTRIAXone
and IV/PO metronidazole

Oral switch: co-amoxiclav

IV clindamycin
and IV gentamicin

Oral switch: clindamycin

IV vancomycin
and IV/PO ciprofloxacin 
and IV/PO metronidazole  

A well child with few systemic symptoms or generalised lymphadenopathy does not require antibiotics.
Antibiotics should be reserved for systemically unwell children (i.e. those more likely to have an acute bacterial cause).

PO/IV co-amoxiclav

PO azithromycin

or

IV/PO clarithromycin

PO azithromycin

or

IV/PO clarithromycin 

Preferred option for children ≤1 month 

IV/PO co-trimoxazole

Not licensed for infants below 6 weeks