Therapeutic Guidelines has released its latest updates to antibiotic guidance, marking a significant revision according to an expert. This December update is the third for 2025, following earlier releases in March and September.
Key Updates
Several areas have received updates:
- Perinatal Infections: Metronidazole is now included in the first-line regimen for intra-amniotic infection to target a broader range of anaerobic bacteria.
- Surgical Prophylaxis: A cefazolin dose of 3g is recommended for adults weighing 120kg or more with a glomerular filtration rate exceeding 40mL/min. Aminoglycoside dosing for surgical prophylaxis has been revised, including updated adult and paediatric gentamicin dosage regimens, with tobramycin now recommended as an alternative.
- Lactational Mastitis: Guidance has been expanded to include clearer diagnostic criteria to differentiate it from localized breast inflammation and outlines intravenous antibiotic regimens.
- Traumatic Wounds: Trimethoprim+sulfamethoxazole is the recommended oral antibiotic for all water-immersed traumatic wound infections.
Additionally, several summary tables have been updated, including information on antibiotic prescribing in primary care, reflecting changes for lactational mastitis and bite wounds, such as clenched-fist injuries.
Context and Challenges
The Antibiotic Guidelines were initially published over 40 years ago to address antibiotic resistance. Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care, noted that the number of conditions described has grown from 59 to approximately 200. He linked these changes to the ongoing challenge of antimicrobial resistance, which necessitates evolving antibiotic recommendations.
Professor Morgan highlighted the updates to perinatal infections, surgical, and endocarditis prophylaxis as major, and those for lactational mastitis and water-associated wound infections as significant. He also pointed out that the Antibiotic Expert Group identified research gaps, particularly regarding optimal antibiotic use duration and specific conditions like exacerbations of bronchiectasis and infection-associated lung effusions.
Professor Morgan stated that guidelines inevitably become more complex due to the accelerating pace of medical research. He emphasized that the volume of new evidence makes it impossible for individuals to memorize all guidelines, advocating for a paradigm of quickly looking up information in real-time. He recommended that general practitioners regularly consult the Therapeutic Guidelines’ summary table. He further suggested that all clinical practice guidelines should ideally be 'living' documents with mechanisms for swift updates, acknowledging that this makes fixed protocols or print formats challenging.