News

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New update to antibiotic guidelines

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The final update to antibiotic guidelines for 2025 has been released by Therapeutic Guidelines has unveiled the latest updates to its antibiotic guidance, in what one expert says is a ’substantial revision’.
 
The December update was the third for 2025, following previous tranches released in March and September by the not-for-profit healthcare publisher.
 
Several key topics have been updated in the December release, including changes in the areas of:

• perinatal infections
• surgical prophylaxis
• skin and soft tissue infections
• traumatic wounds.

Several summary tables have also been updated, including information on antibiotic prescribing in primary care to reflect changes in guidance for lactational mastitis and bite wounds, including clenched-fist injuries.
 
 More specifically, the changes include:
 

• Metronidazole is now included in the first line regimen for intra-amniotic infection to target a broader range of anaerobic bacteria
• A cefazolin dose of 3 g is now recommended for surgical prophylaxis in adults who weigh 120 kg or more and have a glomerular filtration rate more than 40 mL/min
• Aminoglycoside dosing for surgical prophylaxis has been revised, with updated adult and paediatric gentamicin dosage regimens and tobramycin now recommended as an alternative
• Guidance on lactational mastitis has been expanded and includes clearer diagnostic criteria to distinguish it from localised breast inflammation and intravenous antibiotic regimens
• Trimethoprim+sulfamethoxazole is the oral antibiotic recommended for all water-immersed traumatic wound infections.

The guidelines were first published more than 40 years ago to address antibiotic resistance.
 
Back then, only 59 conditions were described, said Professor Mark Morgan, Chair of RACGP Expert Committee – Quality Care.
 
‘Now the count is about 200,’ he told newsGP.
 
He said the changes not only represent the increased number of conditions covered in the guidelines, but also ‘the steady march of antimicrobial resistance changing which antibiotic is likely to work’.
 
Professor Morgan said the updates to the management of perinatal infections, surgical and endocarditis prophylaxis were ‘major’, and that other ‘significant’ updates include management of lactational mastitis and wound infections associated with water.
 
However, he also notes that the Antibiotic Expert Group responsible for the reviews ‘identified many areas where research is lacking’.
 
‘There are evidence gaps around the optimal duration of antibiotic use and gaps around specific conditions such as the treatment for exacerbations of bronchiectasis and treatment of infection-associated lung effusions,’ he said.
 
Professor Morgan said it is ‘inevitable’ that guidelines become more complex over time.
 
‘Medical research changes the evidence base used for guidelines at an ever-increasing rate,’ he said.
 
‘We have far exceeded the point where mere humans can keep up and commit guidelines to memory. Instead, we are in a paradigm of rapidly looking up information quickly and in real time.’
 
He recommends GPs save the Therapeutic Guidelines’ summary table as a favourite site and refer to it regularly.
 
‘Changes to Therapeutic Guidelines are frequent as new evidence is appraised and incorporated,’ he said.
 
Professor Morgan said the speed at which new evidence emerges means that all clinical practice guidelines should ideally be ‘living’ guidelines, with mechanisms to enable swift updates of key recommendations.
 
‘The “live” nature of guidelines makes it hard for them to exist in print format or memorised,’ he said. ‘Frequent updates to guidelines make it hard to develop fixed protocols.’
 
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antibiotics antimicrobial resistance Therapeutic Guidelines

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