WHO AWaRe Classification of Antibiotics
Access
First choice for common infections. Low resistance potential.
- Amikacin
- Ampicillin/Sulbactam
- Amoxicillin/Clavulanate
- Cefazolin
- Clindamycin
- Gentamicin
- Metronidazole
- Nitrofurantoin
- Sulfamethoxazole/TMP
- Doxycycline
Watch
Higher resistance potential. Use for specific indications. Strict stewardship monitoring.
- Azithromycin
- Cefepime
- Cefotaxime
- Ceftriaxone
- Ertapenem
- Ceftazidime
- Ciprofloxacin
- Clarithromycin
- Meropenem
- Vancomycin
- Imipenem/Cilastatin
- Levofloxacin
- Moxifloxacin
- Pip/Tazobactam
Reserve
"Last Resort" options for multi-drug resistant organisms. Strict stewardship monitoring.
- Colistin
- Linezolid
- Tigecycline
- Daptomycin
- Ceftazidime/Avibactam
- Ceftolozane/Tazobactam
- Fosfomycin (IV)
- Minocycline (IV)
Preparation & Administration
| CEPHALOSPORINS | ||||||
|---|---|---|---|---|---|---|
| Drug | Reconstitution | Diluent | Dilution & Rate | RT Stability | Fridge | Notes |
| Ceftriaxone | 1g – 10mL 2g – 20mL |
NS / D5W | 0–1g in 50mL / 30min >1g in 100mL / 30min |
24h | 24h | Light protection NOT needed |
| Cefotaxime | 0.5–1g – 10mL 2g – 20mL |
NS / D5W | 0–2g in 50mL / 30min | — | 5 days | May darken; protect from heat |
| Ceftazidime | 0.5–1g – 10mL 2g – 20mL |
NS / D5W | 0–1g in 50mL / 30min >1g in 50–100mL / 30min Extended: 4h |
2h | 24h | Protect from light |
| Cefepime | 0.5g – 5mL 1–2g – 10mL |
NS / D5W | 0–2g in 50mL / 30min | 24h | 48h | Protect from light |
| Cefazolin | 0.5–1g – 5mL >1g – 10mL |
NS / D5W | 0–1g in 50mL / 30min >1g in 100mL / 30min |
— | 24h | SHAKE WELL; protect from light |
| Cefoxitin | 1g – 10mL 2g – 20mL |
NS / D5W | 0–1g in 50mL / 30min >1g in 100mL / 30–60min |
Immediate | 24h | Protect from light |
| Cefoperazone | 1g – 5mL >1g – 10mL |
NS / D5W | 0–1g in 50mL / 30min >1g in 100mL / 30min |
24h | 5 days | — |
| Cefoperazone/Sulbactam | 1g – 10mL | NS / D5W | 1g in 50mL / 30–60min | — | 24h | — |
| PENICILLINS | ||||||
|---|---|---|---|---|---|---|
| Drug | Reconstitution | Diluent | Dilution & Rate | RT Stability | Fridge | Notes |
| Ampicillin/Sulbactam | 0–1.5g – 5mL >1.5g – 10mL |
NS ONLY | 0–1.5g in 50mL / 30min >1.5g in 100mL / 30min |
8h | 48–72h | No D5W |
| Piperacillin/Tazobactam | 2.25g – 10mL 4.5g – 20mL |
NS / D5W | 2.25g in 50mL / 30min 4.5g in 100mL / 30min Extended: 4h |
— | 24h | — |
| CARBAPENEMS | ||||||
|---|---|---|---|---|---|---|
| Drug | Reconstitution | Diluent | Dilution & Rate | RT Stability | Fridge | Notes |
| Meropenem | 500mg – 10mL 1g – 20mL |
NS / D5W (NS preferred) |
Conc: 1–20 mg/mL 0.5–1g in 50mL / 15–30min Extended: 3h |
3h | 15h | NS preferred for stability |
| Imipenem/Cilastatin | 500mg – 10mL Shake well |
NS (preferred) / D5W | 0–500mg in 100mL / 30min >500mg in 250mL / 60min Extended: 3h |
— | 24h | Rinse vial with 10mL diluent |
| AMINOGLYCOSIDES & POLYMYXINS | ||||||
|---|---|---|---|---|---|---|
| Drug | Reconstitution | Diluent | Dilution & Rate | RT Stability | Fridge | Notes |
| Amikacin | Ready solution | NS / D5W | Conc: 0.25–5 mg/mL 0–1000mg in 100–200mL / 30–60min |
Immediate | — | — |
| Colistimethate Na | 1MU – 10mL Roll gently |
NS / D5W | In 50–100mL / 30–60min | Immediate | — | Avoid frothing |
| GLYCOPEPTIDES & OTHER ANTIBIOTICS | ||||||
|---|---|---|---|---|---|---|
| Drug | Reconstitution | Diluent | Dilution & Rate | RT Stability | Fridge | Notes |
| Vancomycin | 500mg – 10mL 1g – 20mL |
NS / D5W | Conc ≤5 mg/mL: 0–500mg / 100mL / 30min 501–1250mg / 250mL / 60min 1251–1750mg / 500mL / ≥90min 1751–2250mg / 500mL / ≥120min |
24h | 96h | Red Man Syndrome — infuse slowly |
| Teicoplanin | 200–400mg – 5mL Roll gently |
NS / D5W | Over 30 minutes If foaming: wait 15min |
Immediate | 24h | Only if clear yellow to dark yellow |
| Linezolid | Premix: 100mL / 200mg 200mL / 400mg 300mL / 600mg |
NS / D5W | Over 30–120 minutes | RT | — | Protect from light; yellow color OK |
| Daptomycin | 500mg – 10mL | NS ONLY | 500mg in 50mL / 30min | 12h | 48h | Store reconstituted vial in fridge |
| Tigecycline | 50mg – 5mL | NS / D5W | 50–100mg in 100mL / 30–60min Max: 1 mg/mL |
24h | 48h | Normal: yellow-orange Discard if green/black |
| Clindamycin | Ready solution | NS / D5W | Conc ≤18 mg/mL; Rate ≤30 mg/min: 300mg / 50mL / 10min 600mg / 50mL / 20min 900mg / 50–100mL / 30min 1200mg / 100mL / 40min |
— | 24 days | Max 1200 mg/hr |
| FLUOROQUINOLONES | ||||||
|---|---|---|---|---|---|---|
| Drug | Reconstitution | Diluent | Dilution & Rate | RT Stability | Fridge | Notes |
| Moxifloxacin | Premix: 250mL / 400mg | — | 400mg over 1 hour | Store at RT | Do NOT Refrigerate! Precipitates if refrigerated |
Store at RT — Do NOT Refrigerate! |
| Levofloxacin | Premix: 100mL / 500mg 150mL / 750mg |
NS / D5W | 500mg / 60min 750mg / 90min |
3 days (diluted) | — | Protect from light |
Duration of Antibiotic Therapy
↑ Respiratory Tract Infections
| Community-Acquired Pneumonia | 5 days | |
| Aspiration Pneumonia | 5 days | |
| Hospital-Acquired Pneumonia | 7 days | |
| Ventilator-Associated Pneumonia | 7 days | Longer if slow response, abscess, empyema |
↑ Urinary Tract Infections
| Complicated UTI | 5–7 days | |
| Prostatitis | 2–4 weeks |
↑ Skin & Soft Tissue Infections
| Skin Abscess | 7–14 days | |
| Necrotizing Fasciitis | 7–14 days | |
| Cellulitis / Erysipelas | 7–14 days | |
| Diabetic Foot Infection | 1–2 weeks |
✓ Bone & Joint Infections
| Osteomyelitis | 6 weeks | |
| Prosthetic Joint (PJI) | 4–6 weeks | 6 weeks if joint involved; 3–4 weeks if extensive |
| Depends on Organism & Antibiotic | ||
⊕ CNS Infections
| Bacterial Meningitis | 7–21 days | |
| Encephalitis | 14–21 days |
↑ Infective Endocarditis
| Bacterial Endocarditis | 2–6 weeks | Depends on Organism & Antibiotic |
↑ Intra-abdominal Infections
| Spontaneous Bacterial Peritonitis | 7 days | |
| IAI / Cholangitis / Cholecystitis | 4–7 days | |
| Necrotizing Pancreatitis | 7–10 days |
✓ CRBSI (Catheter-related Bloodstream Infections)
| Central Line-Associated Bloodstream Infection (CLABSI) | 10–14 days | |
| CRBSI (Catheter-related Bloodstream Infection) | 4–7 days |
UTI — Duration by Drug & Patient Sex
| Drug | Nitrofurantoin | TMP-SMX | Fosfomycin | Beta-Lactams | Fluoroquinolones |
|---|---|---|---|---|---|
| Male / Female | Male / Female | Single (PO) | Male / Female | Male / Female | |
| Duration | 7 Days / 5 Days | 7 Days / 3 Days | Single Dose | 7 Days / 5 Days | 5 Days / 3 Days |
Quick Reference: Critical Reminders
Do NOT Use D5WAmpicillin/Sulbactam (short stability)
NS OnlyDaptomycin
No RefrigerationMoxifloxacin (precipitates if refrigerated)
Protect from LightCeftazidime, Cefepime, Cefazolin, Cefoxitin, Linezolid, Levofloxacin
Extended InfusionPip/Tazo (4h) | Meropenem (3h) | Imipenem (3h)
Shake WellCefazolin, Imipenem/Cilastatin
Discard if Wrong ColorTigecycline: discard if green/black (normal: yellow-orange)
Infusion ReactionsVancomycin — Red Man Syndrome (infuse slowly)