What’s New: Antibiotic April 2026

The April 2026 release is the fourth and final in this staggered review of the Antibiotic guidelines. For information on the 2025 updates, see the March, September and December What’s new pages.

For an overview of the guideline review process, including previous releases and topic groupings; see What’s new: Antibiotic.

A selection of important changes in the topics completely revised or newly developed for the April 2026 release are listed below; see:

• Cytomegalovirus (CMV)
• Dengue
• Febrile neutropenia
• Fever in the returned traveller
• Melioidosis
• Mycobacterium avium complex (MAC) infection
• Mycobacterium leprae infection
• Mycobacterium ulcerans infection (Buruli ulcer)
• Oesophageal infections
• Opportunistic and co-infections in adults with HIV
• Pharyngeal diphtheria
• Prevention of infection in patients with immune compromise
• Tuberculosis

Cytomegalovirus (CMV)

• New advice on managing prenatal,neonatal and postnatal CMV infection has been added.
• Prophylaxis and pre-emptive treatment recommendations are now included for children with immune compromise.
• Maribavir is included as an option for pre-emptive treatment, or treatment of CMV in adults who have received a solid organ or haematopoietic stem cell transplant, and who have either pre-existing kidney impairment or Grade 3 neutropenia (neutrophil count less than 1 × 109/L).
• Letermovir is included as an option for primary CMV prophylaxis for both adults and children . Letermovir does not cause bone marrow suppression, so may be preferred for people who have recently received a haematopoietic stem cell transplant and are still in the pre-engraftment.

Dengue

• A new topic on Dengue provides guidance on the clincial presentation, diagnosis, management and prevention of dengue.

Febrile neutropenia

• A tiered approach to the timing of antimicrobial administration has been introduced for febrile neutropenia. Timing now depends on confirmation of neutropenia and whether the patient has sepsis, septic shock or requires intensive care support.
• Empirical regimens are now differentiated by the presence of sepsis, septic shock or intensive care support requirements, and by whether patients are colonised with or have risk factors directs users to the correct empirical regimen. A new table directs users to the correct empirical regimen.
• Combination therapy with an aminoglycoside and an antipseudomonal beta lactam is now recommended only for patients with septic shock or intensive care support requirements, and for patients with sepsis who are colonised with or have risk factors for infection with a multidrug-resistant gram-negative bacterium.
• Vancomycin is not routinely recommended for patients with febrile neutropenia, but can be considered in patients at increased risk of infection with resistant gram-positive bacteria.

Fever in the returned traveller

• New guidance on Fever in the returned traveller , includes:
  • the assessment of a febrile returned traveller
  • the typical incubation periods and key clinical findings of infections that cause fever
  • when to refer a patient to the emergency department or an infectious diseases physician.

Malaria

• Updated advice on the diagnosis of malaria includes the importance of thick and thin blood films, the potential use of rapid antigen tests, and the interpretation of results.
• Quinine is no longer recommended as a third-line option for uncomplicated malaria . The standard treatment of uncomplicated malaria is artemether+lumefantrine or atovaquone+proguanil.
• The primaquine lower age limit is lowered from age 6 months to 1 month.
• Clarification is provided that tafenoquine has no role as radical cure (prevention of relapse) of Plasmodiun vivax malaria in Australia.
• Tafenoquine is now included as a first-line recommendation for malaria prophylaxis for adults travelling to areas endemic Plasmodium vivax malaria with or without Plasmodium falciparum malaria.

Melioidosis

• Updated recommendations to treat patients with non-neurological melioidosis are included:
• ceftazidime is recommended to treat patients with non-neurological melioidosis who are not critically ill.
• meropenem is recommended to treat patients with non-neurological melioidosis who are critically ill.
• Guidance is included about starting trimethoprim+sulfamethoxazole gradually for the treatment of non-neurological melioidosis , with the aim of reducing adverse effects.
• A new photo is included of a typical melioidosis skin lesion.

Mycobacterium avium complex (MAC) infection

• Clofazimine is included as an alternative to the rifamycins as part of the 3-drug regimen for the daily treatment of pulmonary Mycobacterium avium complex disease.
• New guidance on inhaled amikacin for pulmonary Mycobacterium avium complex disease is included.

Mycobacterium leprae infection

• A new photo is included of a typical Mycobacterium leprae skin lesion.