Antibiotic Counselling Sheet

Foreword about using this tool:

This Antibiotic Counselling sheet is a supporting tool to help inform the information provided to patients, including how to take antibiotics, their common side
effects, and interactions. This was a collaboration between Public Health England’s TARGET Antibiotics toolkit and Public Health Wales and is suitable to be
used by healthcare professionals across England and Wales. This sheet summarises information from the British National Formulary (BNF) and Electronic
Medicines Compendium (EMC). These tables can be used when providing antibiotic adherence advice to patients and support shared decision making in
healthcare settings, in line with NICE Guideline [NG197].
This tool is designed to support healthcare professionals and may not account for individual circumstances of patients, nor is it a complete replication of the
information. It should not be used as sole basis for decision making, nor replace healthcare professional consultations. Please ensure you are using the most
up to date version of this tool published on the TARGET website. Please consider using the TARGET patient information leaflets on common infections, and the
Antibiotic Checklist for community pharmacy (available at: www.RCGP.org.uk/TARGET-patient-lealets) to support Antimicrobial Stewardship.

General advice:
• Take doses at regular intervals throughout the day.
• Take antibiotics exactly as prescribed, never save them for future use, never share them with others.
• If you don’t start to feel better within a few days of starting antibiotics, contact your pharmacist or GP for advice.

Antibiotic How to take Common Side Effects Cautions/Major Interactions* Pregnancy and Breastfeeding
Amoxicillin • Take with or without • Nausea/vomiting • Amoxicillin is predicted to Pregnancy:
food. • Diarrhoea increase the risk of toxicity when Not known to be harmful
• Alcohol in moderation is • Skin rashes/allergy given with methotrexate. Breastfeeding:
unlikely to cause • May affect INR in patients on Trace amount in milk but
problems. warfarin. appropriate to use

Clarithromycin • Take with or without • Nausea/vomiting • Caution in patients with a Pregnancy: Manufacturer advises
food. • Stomach cramps predisposition to QT avoid, particularly in the first
• Alcohol in moderation is • Diarrhoea prolongation/arrythmias. trimester, unless potential benefit
unlikely to cause • Loss of appetite • Interacts with QT prolonging outweighs risk.
problems. • Insomnia medication Breastfeeding:
• Commonly interacts • Withhold statins, can cause Manufacturer advises avoid
with medication myalgia/rhabdomyolysis. unless potential benefit
• May affect INR in patients on outweighs risk—present in milk.
warfarin.
*not exhaustive Version 3. Published September 2021. Review by September 2024.
 Antibiotic Counselling Sheet

Antibiotic How to take Common Side Effects Cautions/Major Interactions* Pregnancy and Breastfeeding
Co-amoxiclav • Take with food. • Diarrhoea • Amoxicillin component is Pregnancy:
• No specific warning • Oral/genital thrush predicted to increase the risk of Not known to be harmful
relating to alcohol while • Nausea/vomiting toxicity when given with Breastfeeding:
taking co-amoxiclav. • Skin rashes/allergy methotrexate. Trace amounts in milk but safe to
• May affect INR in patients on use
warfarin.
Doxycycline • Swallow whole with a full • Skin can be more • Should not be given to children Pregnancy:
glass of water. sensitive to strong <12 years. Do not use in pregnancy – risk of
• Take while in an upright sunlight or UV light – • Oral antacids decrease adverse effect on teeth and
position and well before protect skin and absorption of doxycycline; leave skeletal development.
bed to avoid oesophageal avoid exposure to 2-3h between administration. Breastfeeding:
irritation and ulceration. sunlight or sun lamps. • May affect INR in patients on Avoid as tetracyclines excreted in
• Take with food if you get • Headaches warfarin milk.
stomach irritation or feel • Nausea and vomiting • Increased risk of lithium toxicity
nauseous. • Diarrhoea – manufacturer advises avoid
• Do not drink alcohol • Oesophageal
while taking doxycycline. irritation and
ulceration
Flucloxacillin • Take on an empty • Nausea/vomiting • Use with caution in hepatic Pregnancy:
stomach 60 minutes • Diarrhoea impairment. Not known to be harmful
before food or at least 2 • May affect INR in patients on Breastfeeding:
hours after. warfarin Trace amounts in milk but
• Take with a full glass of • Increased risk of methotrexate appropriate to use
water (250ml). toxicity
• Alcohol in moderation is
unlikely to cause
problems.

*not exhaustive Version 3. Published September 2021. Review by September 2024.

 Antibiotic Counselling Sheet

Antibiotic How to take Common Side Effects Cautions/Major Interactions* Pregnancy and Breastfeeding
Metronidazole • Take with or after food • Nausea and vomiting • May affect INR in patients on Pregnancy:
with a full glass of water. • Diarrhoea warfarin. Use if benefit outweighs risk –
• Do not drink alcohol • Taste disturbances • avoid high doses
Increased risk of lithium toxicity –
while taking and for at manufacturer advises avoid Breastfeeding:
least 48 hours after Significant amount in milk,
finishing treatment. avoid high single doses. May
give milk a bitter taste.
Nitrofurantoin • Take with or after food • Nausea/vomiting • Avoid in renal impairment/CKD Pregnancy:
to avoid gastric upset. • Diarrhoea • In courses >6 months monitor for Avoid at term – may produce
• Alcohol in moderation is • Dark yellow/brown development of non- neonatal haemolysis.
unlikely to cause urine productive/progressive/persistent Breastfeeding:
problems. • Loss of appetite cough Avoid, small amounts in milk but
• Headaches • Contraindicated in infants less enough to produce haemolysis
than 3 months old in G6PD-deficient infants

Phenoxymethylpenicillin • Take one hour before or • Nausea/vomiting • Phenoxymethylpenicillin is Pregnancy:

(Pen V) at least 2 hours after • Diarrhoea predicted to increase the risk of Not known to be harmful
food. • Skin rash/allergy toxicity when given with Breastfeeding:
• Alcohol in moderation is methotrexate. Trace amounts in milk but
unlikely to cause • May affect INR in patients on appropriate to use
problems warfarin.
Trimethoprim • Take with or without • Mild rash/itching • Trimethoprim should be avoided Pregnancy:
food • Nausea/vomiting in patients who take Avoid especially in 1st trimester.
• Alcohol in moderation is • Diarrhoea methotrexate – contact Breastfeeding:
unlikely to cause • Headaches prescriber for an alternative. Not known to be harmful in
problems • May affect INR in patients on short term use
warfarin.
• Counsel patients re signs and
symptoms of blood disorders if
for long-term use

*not exhaustive Version 3. Published September 2021. Review by September 2024.

 Antibiotic Counselling Sheet

Antibiotic How to take Common Side Effects Cautions/Major Interactions* Pregnancy and Breastfeeding
Quinolones • Take with or without • Nausea/vomiting • Avoid in patients with epilepsy Pregnancy:
(Ciprofloxacin and food but do not take • Diarrhoea • Avoid in patients with a history of Manufacturer advises to avoid.
Levofloxacin) with dairy products (e.g. • Tendon damage tendon damage Breastfeeding:
milk, yoghurt) or • Headaches • Caution in patients pre-disposed Manufacturer advises to avoid.
mineral-fortified fruit- • Dizziness to QT prolongation/arrythmias.
juice. • Avoid concomitant use of NSAIDs
• Avoid antacids 2 hours – risk of seizures increases.
before and 4 hours • Avoid exposure to excessive
after taking. sunlight during treatment and for
• May impair 48 hours after stopping treatment
performance of skilled • Increased risk of methotrexate
tasks (e.g. driving); toxicity
effects enhanced by • May affect INR in patients on
alcohol. warfarin
Co-trimoxazole • Take with or without • Diarrhoea • Avoid in patients who take Pregnancy:
(Trimethoprim and food • Nausea/vomiting methotrexate – contact Avoid especially in 1st trimester.
Sulfamethoxazole) • Taking with food can • Severe skin reaction prescriber for an alternative. Breastfeeding:
minimise the possibility • Headache • May affect INR in patients on Small risk of kernicterus in
of GI disturbance warfarin jaundiced infants and of
• Alcohol in moderation • Counsel patients re signs and haemolysis in G6PD-deficient
unlikely to cause symptoms of blood disorders if infants (due to
problems for long-term use sulfamethoxazole).
Erythromycin • Take with food to • Nausea/Vomiting • Caution in patients with a Pregnancy:
reduce nausea • Stomach cramps predisposition to QT Should only be used if benefit
• Alcohol in moderation • Diarrhoea prolongation/arrythmias. outweighs risk and no other
unlikely to cause • Loss of appetite • Interacts with QT prolonging alternative, small risk of
problems • Bloating and medication malformation and miscarriage.
indigestion • Withhold statins, can cause Breastfeeding:
myalgia/rhabdomyolysis. Small amounts in milk – not
• May affect INR in patients on known to be harmful.
warfarin.

*not exhaustive Version 3. Published September 2021. Review by September 2024.

 Antibiotic Counselling Sheet
More information available from:
BNF British National Formulary - NICE (https://bnf.nice.org.uk/)
Home - electronic medicines compendium (https://www.medicines.org.uk/emc/)
bumps - best use of medicine in pregnancy (medicinesinpregnancy.org)
Useful Patient Information Leaflets for children available at: www.medicinesforchildren.org.uk
Please seek further advice regarding pregnancy and breastfeeding from your local Medicines Information and Advice Service

References:

Joint Formulary Committee. British National Formulary (online). London: BMJ Group and Pharmaceutical Press. Available at: www.medicinescomplete.com. Publication last updated on 11-May-2021.
Joint Formulary Committee. British National Formulary for Children (online). London: BMJ Group and Pharmaceutical Press. Available at: www.medicinescomplete.com. Publication last updated on 11-May-2021.
Summary of Product Characteristics accessed via www.medicines.org.uk.
National Institute for Health and Care Excellence (NICE). Shared decision making NICE guideline [NG197]. 17 June 2021. Available at: https://www.nice.org.uk/guidance/ng197
Briggs GG, Freeman RK, Yaffe SJ, eds. Drugs in pregnancy and lactation. Philadelphia: Lippincott Williams & Wilkins. Available at: www.medicinescomplete.com. Publication last updated on 11-Apr-2021
NHS. Can I drink alcohol while taking antibiotics? Available at: https://www.nhs.uk/common-health-questions/medicines/can-i-drink-alcohol-while-taking-
antibiotics/#:~:text=Some%20antibiotics%20have%20a%20variety,and%20tinidazole%20can%20cause%20drowsiness. Page last reviewed: 11 May 2021
Medicines for Children Patient Information Leaflets. London: Royal College of Paediatrics and Child Health, Neonatal & Paediatric Pharmacists Group, WellChild. Available at: www.medicinesforchildren.org.uk

*not exhaustive Version 3. Published September 2021. Review by September 2024.