Therapeutic Guidelines Release Major Antibiotic Update
14 Jan 2026
The December release marks the third and final update for the year, following earlier updates in March and September. The not-for-profit publisher says the changes reflect evolving evidence and the ongoing impact of antimicrobial resistance on clinical practice.
Key Areas Updated
The latest guidance includes revisions to:
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Perinatal infections
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Surgical prophylaxis
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Skin and soft tissue infections
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Traumatic wound management
Several summary tables commonly used in primary care have also been updated, including guidance on lactational mastitis and bite wounds, such as clenched-fist injuries.
Notable Changes
Updates include:
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Metronidazole added to first-line treatment for intra-amniotic infection to broaden anaerobic coverage
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A higher 3 g dose of cefazolin for surgical prophylaxis in adults weighing 120 kg or more with adequate kidney function
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Revised aminoglycoside dosing, including updated gentamicin regimens and the addition of tobramycin as an alternative
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Expanded guidance on lactational mastitis, with clearer diagnostic criteria and intravenous treatment options
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Trimethoprim–sulfamethoxazole recommended as the oral antibiotic of choice for water-immersed traumatic wounds
Why the Changes Matter
The Antibiotic Guidelines were first published more than 40 years ago to address antibiotic resistance. According to Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care, the number of conditions covered has grown from 59 to around 200, reflecting both expanding knowledge and resistance patterns.
Professor Morgan described the updates to perinatal infections and surgical prophylaxis as major, while noting ongoing evidence gaps in areas such as antibiotic duration and treatment of some respiratory infections.
He said the increasing pace of medical research makes it unrealistic for clinicians to rely on memory alone, recommending that GPs regularly refer to the Therapeutic Guidelines online, which are frequently updated as new evidence emerges.
https://www1.racgp.org.au/
Source: Therapeutic Guidelines / RACGP / newsGP