Therapeutic Guidelines has released the first part of what it is calling an “unprecedented” antibiotic guidelines update.
Part one of a major update to the Therapeutic Guidelines’ antibiotics guide has dropped, featuring new dosage options for children and updates to first-line medicines for common infections.
According to Therapeutic Guidelines, which published its first set of antibiotic guidelines in 1978, the 2025 updates follow a comprehensive review of over 200 clinical topics by more than 100 Australian clinicians.
One of the bigger updates for GPs is that nitrofurantoin is now recommended as first-line treatment for urinary tract infections in women and some children, given the growing trimethoprim resistance among E. coli.
“There has been a move away from trimethoprim – which has been recommended for many years as the first line treatment for cystitis – because resistance … reached a point at which the [expert advisory] group didn’t feel comfortable recommending it as first line anymore,” Therapeutic Guidelines managing editor Jessica Gibney told The Medical Republic.
According to Ms Gibney, this round of updates is the biggest in the history of the antibiotic guidelines.
Among the updates are 20 entirely new topics, including vancomycin use in young infants and children, managing suspected infections with multidrug-resistant gram-negative bacteria and doxycycline for postexposure prophylaxis against sexually transmitted infections.
All antibiotic recommendations now contain a link to the table of dosing adjustments for people with kidney impairments, unless the drug is hepatically cleared.
For Staphylococcus aureus infections, cefazolin is now an equal first-line alternative to flucloxacillin, and for directed therapy of Pseudomonas aeruginosa, cefepime is now recommended alongside ceftazidime or piperacillin and tazobactam.
“In this update, ceftriaxone is usually preferred to cefotaxime in adults because ceftriaxone requires less frequent dosing,” the non-profit health publisher said.
“If Staphylococcus aureus is a likely pathogen, cefotaxime monotherapy may be recommended as an alternative to ceftriaxone in combination with flucloxacillin because it has superior intrinsic activity against staphylococci.”
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Therapeutic Guidelines also acknowledged that rates of resistance to clindamycin were rising in methicillin-resistant Staphylococcus aureus (MRSA), making vancomycin the preferred drug for intravenous therapy in cases of a serious MRSA infections in most regions.
For oral therapy of MRSA infections, trimethoprim and sulfamethoxazole are preferred to clindamycin.
Antibiotic therapies are no longer recommended as first-line therapy for mild or moderate travellers’ diarrhoea and the initial management of acute infectious diarrhoea now prioritises supportive care and follow-up.
Several topics are still under revision, including lyme disease, melioidosis, parasitic infections and opportunistic co-infections in adults with HIV, to be updated in late 2025 or early 2026.
There were no updates to topics that had recently undergone a complete review, such as pre-exposure prophylaxis against HIV, sore throat and acute rheumatic fever.
This story was updated on April 2 to clarify recommendations around cefepime
