Purpose & Scope

Provides empiric oral and topical antibiotic guidance for common, localized infections during prolonged remote-site care when timely physician evaluation is unavailable, as a bridge to definitive care. Operates under MN.01 Austere / Prolonged Field Care.

Antibiotic initiation requires an online medical-control order unless a standing exception is granted in writing by Medical Direction.

Before Giving Any Antibiotic

Confirm a clear indication; screen allergies (penicillin/cephalosporin cross-reactivity ~1–2% for anaphylactic-type), pregnancy (avoid doxycycline and fluoroquinolones), and interactions.
Document indication, agent, dose, duration, and ordering physician; obtain culture/photograph and mark margins when feasible; arrange follow-up.
Escalate / evacuate for systemic toxicity, sepsis, immunocompromise, rapidly spreading or facial/orbital infection, or signs of necrotizing infection — these need IV therapy and definitive care.
Do not treat in the field — escalate and arrange evacuation — for red-flag vitals or host factors: fever >101°F (38.3°C), chills/rigors, hypotension, or tachycardia >120 bpm; immunocompromise or complex comorbidity; or a patient unable to take oral medication or to follow up.

Empiric Regimens (adult)

Indication	First-line	If penicillin-allergic	Adult dose / duration
Nonpurulent cellulitis (strep/MSSA)	Cephalexin	Doxycycline or clindamycin	Cephalexin 500 mg PO q6h × 5–7 d; doxy 100 mg BID; clinda 300–450 mg q6–8h
Purulent SSTI / abscess (MRSA)	I&D + TMP-SMX or doxycycline	Clindamycin	TMP-SMX DS 1–2 tabs PO BID, or doxy 100 mg BID × 5–7 d
Dental abscess	Amoxicillin (+ source control)	Clindamycin	Amox 500 mg PO q8h × 5–7 d; clinda 300 mg q6–8h
Uncomplicated cystitis (female)	Nitrofurantoin	TMP-SMX or cephalexin	Nitrofurantoin 100 mg PO BID × 5 d; TMP-SMX DS BID × 3 d
Wound infection / mammal bite	Amoxicillin-clavulanate	Doxycycline + metronidazole	Amox-clav 875/125 mg PO BID × 5–7 d; verify tetanus, irrigate (MN.04)
Topical (impetigo / minor)	Mupirocin 2%	—	Apply TID × 5 d to localized lesions

Note: regimens are empiric starting points consistent with IDSA outpatient guidance and must be tailored to the patient and local resistance by Medical Direction. Adjust for renal/hepatic function and weight.

Field Workflow

Assess and confirm a clear indication (skin/soft-tissue, respiratory, urinary, or contaminated-wound prophylaxis); obtain history — allergies, medical history, recent antibiotic use, and pregnancy status — and record vitals.
Verify no contraindications (thresholds above) and confirm that delayed evacuation makes field treatment appropriate.
Select an agent from the empiric-regimen table; adjust for allergy, pregnancy, renal/hepatic function, and weight.
Administer and document: date/time, patient and unique ID, assessment and working diagnosis, agent/dose/route/duration, allergies, patient instructions, and medic signature; enter the agent in the Controlled Medication Supply Log.
Educate the patient: complete the full course, take with food and water, avoid alcohol and sun exposure with ciprofloxacin or TMP-SMX, and report rash, itching, shortness of breath, or swelling immediately.
Reassess within 24–48 h or at the next daily medical rounds; refer for physician evaluation or transport if there is no improvement by 48 h or any worsening (fever, spreading redness, increasing pain or swelling, or systemic signs). Dr. Fairbanks reviews all antibiotic cases.

Medical Direction Authorization

A signed standing order authorizing austere site antibiotic administration is in effect: Antibiotic Administration Protocol, David W. Fairbanks, M.D., FAAFP, Chief Medical Officer — effective 11/01/2025, review 11/01/2026. Only Front Line EMS medics credentialed by Dr. Fairbanks and trained in medication administration may administer antibiotics under this standing order.

Scope note: the executed standing order authorizes a narrower agent set — amoxicillin, azithromycin, ciprofloxacin, and TMP-SMX (Bactrim DS), plus benzonatate for symptomatic cough. The empiric formulary above reflects broader current outpatient guidance (cephalexin, doxycycline, clindamycin, nitrofurantoin, amoxicillin-clavulanate, mupirocin) and remains pending Medical Direction approval of these specific agents before field use.

Related protocols

Base: G.01 Foundations • M.18 Infectious Disease, M.10 Allergic Reaction (base).

Austere: MN.01 Austere / Prolonged Field Care • MN.04 Wound Care • MN.02 OTC Formulary.

Sources: IDSA Skin & Soft Tissue Infection guidelines (2014) and standard outpatient empiric regimens. Draft for Front Line EMS Medical Direction review — not field-active until approved.

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