Bottom Line: The Antibiotic guidelines have had their biggest revision in years. Review your default empirical choices against the updated eTG — most notably, nitrofurantoin is now favoured over trimethoprim for uncomplicated cystitis on resistance grounds. Do not rely on memory of the old guidelines.
Background
The Therapeutic Guidelines Antibiotic title is the reference most Australian GPs reach for when choosing empirical therapy. Because antimicrobial resistance patterns and the evidence base shift over time, periodic revision is essential — but the scale of the current update is unusual.
Described in RACGP coverage as an “unprecedented” revision, it is the first comprehensive update to the antibiotic guidelines in approximately six years. More than 100 multidisciplinary clinicians contributed. The work is so substantial that it is being published in three stages: the first release in March 2025, with two further stages across late 2025 and into 2026.
The first release alone covered more than 200 existing and new clinical topics and over 1,400 drug recommendations. For prescribers, the key implication is simple but important: prescribing habits formed under the previous edition may no longer match current guidance.
The Change in Detail
Scope of the update
The revision touches a broad range of infections relevant to primary care. Areas highlighted in the staged release include:
- Community-acquired pneumonia
- Infectious diarrhoea
- Otitis media
- Urinary tract infections, including cystitis
- Skin and soft tissue infections
- Perinatal infections
- Surgical prophylaxis
- Traumatic wounds
Because the update is staged, not every topic changes at once. GPs should treat the eTG as the live source of truth and check the specific topic at the point of prescribing rather than assuming a regimen is unchanged.
The headline GP-facing change: cystitis
The change most likely to affect day-to-day GP prescribing is in uncomplicated cystitis. The updated guidance recommends nitrofurantoin as a first choice, in preference to trimethoprim, reflecting local resistance patterns. Trimethoprim resistance in community urinary isolates has risen to a level that undermines its reliability as an empirical first-line agent for many patients.
This is a meaningful shift because trimethoprim has been a long-standing reflexive choice for uncomplicated UTI. GPs who default to trimethoprim should revisit that habit and confirm the current first-line recommendation, dose and duration in the eTG, taking into account individual factors such as renal function and pregnancy status where nitrofurantoin may not be suitable.
Why resistance is driving the changes
A recurring theme across the update is alignment of empirical recommendations with contemporary Australian resistance data and antimicrobial stewardship principles. Where an older first-line agent has lost reliability due to rising resistance, the guidelines have shifted toward agents with better current activity, while continuing to emphasise narrow-spectrum choices, appropriate durations, and avoiding unnecessary antibiotics altogether.
Clinical and Practical Implications
For general practice, the practical message is less about memorising a list of new regimens and more about changing a habit: stop prescribing from memory of the previous guidelines. With more than 1,400 recommendations revised, the probability that a familiar default has changed is high enough that checking the current eTG topic should become routine.
The cystitis change is the clearest example of why this matters. Empirical UTI treatment is one of the highest-volume prescribing decisions in general practice, and a shift in the first-line agent has an immediate, large-scale effect on appropriateness and on resistance outcomes at a population level.
Beyond any single regimen, the update is a useful prompt for practice-level antimicrobial stewardship. It is an opportunity to review practice prescribing templates, favourites lists in clinical software, and patient information sheets, all of which can quietly entrench outdated choices long after the guidelines have moved on.
GPs should also note the staged nature of the release. Because topics are being updated across 2025 and 2026, the safest approach is to check each relevant topic at the time of prescribing rather than assuming the version in memory, or even in a saved template, is current.
What You Need to Do
- Make checking the current eTG routine for empirical antibiotic decisions, given the scale of the revision.
- Revisit your cystitis default. Confirm the current first-line recommendation (nitrofurantoin is now favoured over trimethoprim), with appropriate attention to renal function, pregnancy and individual suitability.
- Audit your software favourites and prescribing templates for outdated default antibiotics, particularly for high-volume conditions like UTI, skin infections and respiratory infections.
- Update patient information and practice protocols that reference specific antibiotic regimens.
- Watch for the remaining staged releases across 2026 and re-check topics you prescribe for frequently as they are updated.
- Reinforce stewardship principles — narrow spectrum where appropriate, correct duration, and avoiding antibiotics where they are not indicated.
Summary
- What: First comprehensive update to Therapeutic Guidelines Antibiotic in around six years; more than 200 topics and 1,400+ drug recommendations revised
- Rollout: Staged across three releases (first March 2025, with further stages in late 2025 and 2026)
- Headline GP change: Nitrofurantoin favoured over trimethoprim as first choice for uncomplicated cystitis, on resistance grounds
- Other updated areas: Community-acquired pneumonia, infectious diarrhoea, otitis media, skin and soft tissue infections, perinatal infections, surgical prophylaxis, traumatic wounds
- Driver: Alignment with current Australian resistance data and antimicrobial stewardship
- GP action: Check the current eTG at the point of prescribing, revisit cystitis defaults, and audit software favourites and templates
- Source: Therapeutic Guidelines (Antibiotic updates); RACGP newsGP coverage of the antibiotic guidelines update
This article is intended as educational information for Australian general practitioners and is not a substitute for the current Therapeutic Guidelines. Always confirm the specific agent, dose and duration in the live eTG for the individual clinical situation, including patient factors such as renal function, pregnancy and allergies.
