The doses below are taken from the recommendations of Strama Stockholm for the empirical antibiotic treatment of adults in hospital and in residential care homes (SÄBO) 2025/2026. They are Swedish regional recommendations and reflect Swedish resistance patterns and formulary availability; check what applies where you work. They assume normal renal and hepatic function, a non-pregnant adult of normal weight, and individual assessment. See the separate quick reference for dosing in impaired renal function.
Respiratory tract
| Diagnosis | Agent | Dose | Duration |
|---|---|---|---|
| Pneumonia, non-severe (DS-CRB65 0–1) | phenoxymethylpenicillin | 1 g × 3 PO | 5–7 days |
| or benzylpenicillin | 3 g × 3 IV | ||
| Pneumonia, in chronic lung disease | amoxicillin | 750 mg × 3 PO | 5–7 days |
| or benzylpenicillin | 3 g × 4 IV | ||
| Pneumonia, suspected atypical pathogen | erythromycin | 500 mg × 4 PO | 5–7 days |
| or doxycycline | 200 mg × 1 (day 1), then 100 mg × 1 | ||
| Pneumonia, severe (DS-CRB65 2–3) | benzylpenicillin | 3 g × 3 IV | 7 days |
| plus erythromycin | 1 g × 3 IV | if an atypical pathogen is suspected | |
| Pneumonia, critically ill (DS-CRB65 4–6) | cefotaxime plus erythromycin | 2 g × 3 IV plus 1 g × 3 IV | 7 days |
| Hospital-acquired pneumonia, non-severe | cefotaxime | 1–2 g × 3 IV | 8 days including oral step-down |
| Hospital-acquired pneumonia, severe | piperacillin–tazobactam | 4 g × 4 IV | |
| Exacerbation of COPD with an indication for antibiotics | amoxicillin | 750 mg × 3 PO | 5–7 days |
| or doxycycline | 200 mg × 1 on day 1, then 100 mg × 1 | 5–7 days | |
| Epiglottitis and other severe upper airway infection | cefotaxime | 1–2 g × 3 IV | Depends on the diagnosis |
Always assess the severity clinically, whatever the DS-CRB65 score.
Urinary tract
| Diagnosis | Agent | Dose | Duration |
|---|---|---|---|
| Afebrile UTI, women | nitrofurantoin | 50 mg × 3 | 5 days |
| or pivmecillinam | 400 mg × 2–3 | 3 days (< 50 years) | |
| or pivmecillinam | 200 mg × 3 | 5 days | |
| Afebrile UTI, men | nitrofurantoin | 50 mg × 3 | 7 days |
| or pivmecillinam | 200 mg × 3 | 7 days | |
| Febrile UTI, pyelonephritis | ciprofloxacin | 500 mg × 2 PO | Women 7 days, men 10–14 days |
| or cefotaxime | 1 g × 3 IV | 10–14 days including oral step-down | |
| or gentamicin | 4.5 mg/kg IV as a single dose | ||
| Urosepsis with complicating factors | cefotaxime | 1 g × 3 IV | 10–14 days including oral step-down |
| or piperacillin–tazobactam | 4 g × 3 IV | ||
| Urosepsis with shock | cefotaxime | 2 g × 3 IV | Standard dose after stabilisation |
| or piperacillin–tazobactam | 4 g × 4 IV | ||
| plus gentamicin | 5–7 mg/kg IV as a single dose | ||
| Urosepsis with shock and suspected ESBL | meropenem | 1 g × 3 IV |
Do not treat asymptomatic bacteriuria. The exceptions are pregnancy and the period before a urological procedure. A positive urine dipstick in an older patient is difficult to interpret.
Skin and soft tissue
| Diagnosis | Agent | Dose | Duration |
|---|---|---|---|
| Erysipelas | phenoxymethylpenicillin | 1 g × 3 (2 g × 3 if weight > 90 kg) | 10 days |
| or benzylpenicillin | 1–3 g × 3 IV | ||
| Extensive furunculosis | flucloxacillin | 1 g × 3 | 10 days |
| Wound infection | flucloxacillin | 1 g × 3 | 7 days |
| Cat bite within 2 days | phenoxymethylpenicillin | 1 g × 3 | 10 days |
| Cat bite after 2 days, close to a joint or on the face | amoxicillin–clavulanic acid | 500/125 mg × 3 | 10 days |
| Dog or human bite | amoxicillin–clavulanic acid | 500/125 mg × 3 | 10 days |
Abdomen
| Diagnosis | Agent | Dose | Duration |
|---|---|---|---|
| Peritonitis | piperacillin–tazobactam | 4 g × 3 IV | 4 days if source control has been achieved, 7 days in bacteraemia |
| or cefotaxime plus metronidazole | 1 g × 3 IV plus 1.5 g for the first dose, then 1 g × 1 IV | ||
| Clostridioides difficile, primary infection, low risk of recurrence | vancomycin | 125 mg × 4 PO | 10 days |
| Clostridioides difficile, high risk of recurrence | fidaxomicin | 200 mg × 2 PO | 10 days |
In appendicitis, cholecystitis, diverticulitis and pancreatitis, antibiotics are given only in certain more severe cases.
CNS and other
| Diagnosis | Agent | Dose | Duration |
|---|---|---|---|
| Bacterial meningitis, initial therapy (after corticosteroid) | cefotaxime plus ampicillin | 3 g × 4 IV plus 3 g × 4 IV | 7–21 days depending on the pathogen |
| or meropenem | 2 g × 3 IV | ||
| Erythema migrans, solitary | phenoxymethylpenicillin | 1 g × 3 | 10 days |
| Erythema migrans, multiple or with fever | doxycycline | 200 mg × 1 | 10 days |
| Neuroborreliosis | doxycycline | 200 mg × 1 | 14 days |
| or ceftriaxone | 2 g × 1 IV | 14 days | |
| Septic arthritis, native joint | cloxacillin | 2 g × 4 IV | 4 weeks in total |
| Osteomyelitis | cloxacillin | 2 g × 4 IV | 6 weeks in total |
Penicillin allergy
| Type of reaction | Implication |
|---|---|
| An immediate reaction (usually within 1 hour, up to 6 hours) with urticaria, mucosal swelling, respiratory difficulty or anaphylaxis | Penicillins must not be given again. Cephalosporins (other than cefadroxil), carbapenems and monobactams may be given |
| A severe delayed reaction (Stevens–Johnson syndrome, toxic epidermal necrolysis) | All beta-lactam antibiotics are avoided |
| Gastrointestinal symptoms alone, or a limited skin rash without mucosal involvement | Harmless, not a contraindication |
Red flags and pitfalls
- Take cultures before the first dose. Blood cultures before all intravenous treatment.
- Do not give antibiotics for asymptomatic bacteriuria, acute bronchitis in a patient without lung disease, or chronic leg ulcers without clear signs of infection.
- Source control. An abscess, an empyema or an obstructed infected kidney will not resolve on antibiotics alone.
- Record a provisional duration of treatment in the notes when the drug is started, and review it daily.
- Nitrofurantoin is as a general rule contraindicated at an eGFR < 45 mL/min.
- Narrow the spectrum according to the culture result and switch to oral treatment as soon as possible.
Sources
- Strama Stockholm. Empirical antibiotic treatment of adults in hospital and in residential care homes 2025/2026, the drug and therapeutics committee of Region Stockholm.
- strama.se and the Strama Nationell app.
- infektion.net, the Swedish national clinical care programmes.
