First line antibiotics

If local measures have proved ineffective or there is evidence of cellulitis, spreading infection or systemic involvement or a high risk of complications, one of the following first-line antibiotics can be used.
Phenoxymethylpenicillin is the drug of first choice due to its narrower spectrum of activity, which is less likely to drive antimicrobial resistance. However, amoxicillin may be more appropriate for those patients where compliance is likely to be more challenging.^14,15
Metronidazole is appropriate for patients with penicillin allergy.²
Before prescribing antibiotics, refer to the BNF or BNFC for drug interactions.
Advise patients to space out doses as much as possible throughout the day.
Review patients who have been prescribed antibiotics at 3 days (see Bacterial infections 3-day review tool), and if there is resolution of symptoms, advise the patient to stop taking the antibiotic.²
If the patient has not responded to the prescribed antibiotic within 48-72 hours, as identified via self-reporting or at 3-day review, check patient compliance and the effectiveness of local measures, review pain management and confirm the diagnosis before considering whether to prescribe an alternative or adjunctive antibiotic.³

Phenoxymethylpenicillin