Antimicrobial formulary This list outlines ‘approved’ uses for antimicrobials within the Trust. Where agents are shaded in red a restricted form will be required in order to obtain supply from Pharmacy or the emergency drug cupboard. Completion of a restricted form is the responsibility of the prescriber (however this may be delegated to another doctor looking after the patient). In an emergency and when a form is unavailable e.g. outof-hours nurses may complete a form in order to acquire 1-3 doses – this is to ensure that the patient does not miss out on important therapy but should not be the mainstay of practice. Agent Aciclovir IV/PO/Topical Albendazole PO Amantadine PO Amikacin IV/IM Amoxicillin IV/PO Contains penicillin Amphotericin Fungizone Ambisome® IV Artemether/Lumefantrine (Riamet ®) PO Artesunate IV Atovaquone PO Azithromycin PO Aztreonam IV Benzathine penicillin Contains penicillin Benzylpenicillin IV Contains penicillin Caspofungin IV Cefalexin PO Cefixime PO Cefotaxime IV Ceftazidime IV Ceftriaxone IV Cefuroxime IV Indications Herpes simplex 1 & 2 Herpes encephalitis (IV ONLY) Herpatic keratitis (eye ointment) Paediatrics in accordance with local guidelines Varicella zoster Microbiology approval only Microbiology approval only (N.B. Unrestricted for the treatment of parkinsons disease) Cystic fibrosis (IV) / Bronciectasis / TB Bacterial meningitis Community acquired pneumonia (in accordance with guideline) Post-splenectomy prophylaxis Paediatrics in accordance with local guidelines Sepsis unknown site (in-accordance with guideline) Sinusitis (acute) – if antibiotic indicated Surgical infections (in accordance with guideline) Urinary tract infection (in accordance with guideline) Microbiology approval only In accordance with haematology/oncology guidelines (N.B. Initial test dose must be prescribed) Approval by Microbiology or Tropical Medicine Specialist only (Malaria) Approval by Microbiology or Tropical Medicine Specialist only (Malaria) rd Microbiology approval only (Pneumocystis carinii pneumonia 3 line) Cystic fibrosis/bronchiectasis GUM (in accordance with treatment guidelines) Obstetric & gynaecology surgical prophylaxis guidelines Paediatrics in accordance with guidelines Cystic fibrosis / Bronciectasis Neutropenic sepsis (severe penicillin allergy d/w Microbiology) Early and latent syphilis (unlicensed) – GUM specialist Cerebral abscess Endocarditis Paediatrics in accordance with local guidelines Febrile neutropenia post 96hrs with CT suspicious of infection UTI in pregnancy nd Uncomplicated gonorrhoea (2 line) Paediatrics in accordance with local guidelines Spontaneous bacterial peritonitis (SBP) Cerebral abscess Cystic fibrosis / bronchiectasis Bacterial meningitis Epididymo-orchitis (if STI suspected cause) Gastroenteritis (invasive/toxic or immunocompromised) GUM and gynaecology (PID/salpingitis/gonnorhoea) Out-patient cellulitis pathway nd C-section infection (2 line) Open fractures of the lower limb nd Peritonsular abscess (2 line) Surgical prophylaxis (general, orthopaedics, obstetrics & gynaecology) Antimicrobial Formulary (Version5) th Approved by the Antimicrobial Stewardship Group: December 13 2011 Updated: 18.09.12 Review date: September 2015 Page 1 of 5 Chloramphenicol PO Chloramphenicol IV Chloramphenicol eye drops/ ointment Chloroquine Cidofovir IV Ciprofloxacin IV/PO IV only if patient unable to receive PO therapy Clarythromycin IV/PO Clindamycin IV/PO Clotrimazole cream 1% Co-amoxiclav IV Contains penicillin Co-amoxiclav PO Contains penicillin Colistin IV Colistin nebs Co-trimoxazole Dapsone PO Daptomycin IV Demeclocycline PO Diloxanide furoate PO Doxycycline PO Microbiology approval only Bacterial meningitis in severe penicillin allergy Community acquired pneumonia (in accordance with guideline) Hospital acquired pneumonia (in accordance with guideline) Corneal abrasion (ointment) Superficial bacterial eye infections/purulent conjunctivitis Approval by Microbiology or Tropical Medicine Specialist only (Malaria) CMV: Microbiology approval only Dermatology department (intralesional injections) nd Acute prostatitis (2 line, discuss with Microbiology) Cystic fibrosis Diabetic foot infection (in accordance with guidelines) Epididymo-orchitis (if enteric organisms likely cause) Meningitis prophylaxis (post exposure) PD peritonitis Surgical prophylaxis (PO for TRPB, TRUS and ERCP) Community acquired pneumonia (in accordance with guideline) nd Impetigo (2 line if widespread) Neutropenic sepsis (in accordance with guideline) Sore throat – if antibiotic is appropriate Cellulitis (if severe and or rapidly spreading) Diabetic foot (in accordance with guideline) Gas gangrene Necrotising fasciitis / PVL infection Orbital/pre-septal cellulitis (severe) Paediatrics in accordance with local guidelines nd Pneumocystis pneumonia (2 line) Post-natal metritis Septic abortion Surgical prophylaxis (general, orthopaedics, obstetrics & gynaecology) in accordance with guideline Fungal skin infections Vulvovaginal candadiasis (N.B. pessaries also available for this indication) Bites (animal and human) C-section infection Diabetic foot (in accordance with guideline) Open fractures of the lower limb Orbital/pre-septal cellulitis (moderate) Paediatrics in accordance with local guidelines Peritonsillar abscess Surgical prophylaxis (general, orthopaedics, obstetrics & gynaecology) Bites (animal and human) C-section infection Diabetic foot (in accordance with guideline) Orbital/pre-septal cellulitis (mild) Paediatrics in accordance with local guidelines Post-natal metritis (mild) Pyelonephritis CF / Bronchiectasis Pseudomonas lung infections in cystic fibrosis or chronic lung disease (Respiratory Consultant specialist initiation) Cystic fibrosis Diabetic foot (in accordance with guideline) Pneumocystis carinii pneumonia (treatment & prevention) discussed with a specialist or in accordance with haematology/oncology protocols Sepsis unknown site (in-accordance with guideline) – IV only Surgical infections (in accordance with guideline) – IV only Dermatology Microbiology approval only Hyponatremia Approval by Microbiology or Tropical Medicine Specialist only (Malaria) Bites (animal/human) if penicillin allergy Cellulitis (mild-moderate)/cannula infection if penicillin allergy Community acquired pneumonia (in accordance with guideline) Antimicrobial Formulary (Version5) th Approved by the Antimicrobial Stewardship Group: December 13 2011 Updated: 18.09.12 Review date: September 2015 Page 2 of 5 Ertapenem IV Erythromycin IV/PO Ethambutol Famciclovir PO Fidaxomicin Flucloxacillin IV/PO Contains penicillin Fluconazole IV/PO Flucytosine IV Foscarnet IV Fosfomycin IV Fosfomycin PO Fusidic acid Suspension PO Ganciclovir IV Griseofulvin Gentamicin IV/IM Imipenem with cilastin IV Isoniazid Itraconazole PO Liquid has superior bioavailability compared to capsules Ivermectin Ketoconazole Levamisole Levofloxacin Linezolid IV/PO Diabetic foot (in accordance with guideline) Epididymo-orchitis (if STI suspected cause) nd Genital Chlamydia (2 line for uncomplicated) GUM (in accordance with guidelines) Hospital acquired pneumonia Infective exacerbation of COPD PID/salpingitis Sepsis unknown site (in-accordance with guideline) Sinusitis (acute) – if antibiotic indicated & penicillin allergy Surgical infections (in accordance guideline) Microbiology approval only Moderate acne Obstetrics – ruptured membrane nd Paediatrics: Acute otitis media (2 line) Post-splenectomy prophylaxis Prokinetic TB Microbiology approval only Microbiology approval only Cannula infection Cellulitis / erysipelas Diabetic foot (in accordance with guideline) Impetigo (if widespread) Osteomyelitis (acute) Otitis externa (severe cases) Paediatrics in accordance with local guidelines Septic arthritis (native joint) Tunnelled CVC insertion prophylaxis in renal Oesophageal candidiasis Vulvovaginal candidiasis (simple or recurrent) Microbiology approval only Microbiology approval only Cystic fibrosis Microbiology approval only (resistant UTIs) - unlicensed Staphylococci infections in accordance with sensitivities (must always be prescribed with a second anti-staphylococcal antibiotic to prevent resistance) Acute herpetic keratitis (eye drops) CMV infections in transplant patients Microbiology approval only Community acquired pneumonia (in accordance with guideline) Endocarditis Line-infection Osteomyelitis (acute) Paediatrics in accordance with local guidelines Pyelonephritis/complicated UTI Sepsis unknown site (in-accordance with guideline) Septic arthritis (native joint) Surgical infections (in accordance with guideline) Surgical prophylaxis (general, orthopaedics, obstetrics & gynaecology) Tunnelled CVC insertion prophylaxis in renal Microbiology approval only TB nd Dermatophyte infection (2 line) Non-dermatophyte fungal infections nd Pityrasis versicolor (2 line) Microbiology approval only – unlicensed special order for crusted scabies Microbiology approval only Microbiology approvel only - unlicenesed special order for ascaricides Haematology/oncology (in accordance with protocols) Legionnaires disease Pelvic inflammatory disease Cystic fibrosis Antimicrobial Formulary (Version5) th Approved by the Antimicrobial Stewardship Group: December 13 2011 Updated: 18.09.12 Review date: September 2015 Page 3 of 5 Excellent oral bioavailability Lymecycline Malarone PO (Proguanil with atovaquone) Malathion 0.5% liquid Mebendazole PO Mepacrine PO Meropenem IV Discuss with Microbiology Metronidazole IV/PO/PR Excellent oral bioavailability Metronidazole Topical Miconazole Topical Minocycline Moxifloxacin Nitrofurantoin PO Norfloxacin PO Nystatin oral suspension Ofloxacin PO Oseltamivir PO Oxytetracycline PO Palivizumab IM Pentamidine Nebs Penicillin V PO Contains penicillin Permethrin 5% Piperacillin and tazobactam (Tazocin®) IV Contains penicillin Necrotising faciitis - discuss with Microbiology Toxic shock/PVL - discuss with Microbiology nd Moderate acne (2 line) Approval by Microbiology or Tropical Medicine Specialist only (Malaria) Crab lice Head lice Scabies Threadworms in adult/child over 6 months (other worms – consult Microbiology) Dermatology – specialist use Cystic fibrosis / Bronchiectasis Orbital/pre-septal cellulitis (severe) Post-natal metritis Severe orbital cellulitis Septic abortion Severe sepsis/septic shock if history of ESBLs Anaerobic vaginosis Bites (cat or animal/human if penicillin allergic) Cerebral abscess Clostridium difficile infection nd C-section infection (2 line) GUM (in accordance with guidelines) Open fractures of the lower limb nd Peritonsillar abscess (2 line) PID/salpingitis Sepsis unknown site (in-accordance with guideline) Surgical infections (in accordance with guideline) Surgical prophylaxis (general, orthopaedics, obstetrics & gynaecology) Anaerobic vaginosis Dermatology (rosacea) Fungating tumours nd Oropharangeal candidiasis (2 line) Cystic fibrosis MDRTB nd UTI (2 line or according to sensitivities) Prophylaxis against spontaneous bacterial peritonitis (initiated by specialist) Oropharangeal candadiasis GUM (in accordance with guidelines) including PID/salphingitis In accordance with Flu guidelines nd Moderate acne or rosacea (2 line) Prophylaxis against RSV (Initiated by Paediatric Consultant in accordance with guidelines) Prevention of Pneumocystis carinii pneumonia in selected immunocompromised patients – HIV/haematology/oncology Paediatrics in accordance with local guidelines Pharyngitis – if antibiotic is appropriate Post-splenectomy prophylaxis Crab lice Scabies Cystic fibrosis Diabetic foot (in accordance with guideline) Hospital acquired pneumonia (severe)/ aspiration pneumonia Neutropenic sepsis Paediatrics in accordance with local guidelines Sepsis unknown site (in-accordance with guideline) Surgical infections (in accordance with guideline) Threadworms in children aged 3-6 months Piperazine with senna Praziquantel Microbiology approval only nd Pneumocystis pneumonia (2 line) Primaquine GUM Procaine benzylpenicillin Contains penicillin TB Pyrazinamide Antimicrobial Formulary (Version5) th Approved by the Antimicrobial Stewardship Group: December 13 2011 Updated: 18.09.12 Review date: September 2015 Page 4 of 5 Pyrimethamine Quinine dihydrochloride / Quinine sulphate Posaconazole PO Ribavirin Rifampicin PO/IV Rifaximin Sodium fusidate PO IV = Microbiology ONLY Sulfadiazine Sulfadoxine with pyrimethamine Sulphamethoxypyridazine Streptomycin IV/IM Teicoplanin IV Temocillin sodium Terbinafine PO/Topical Tetracycline Ticarcillin with clavulanic acid (Timentin®) Contains penicillin Tigecycline IV Tobramycin IV/Nebs Trimethoprim PO Valaciclovir Valganciclovir PO Vancomycin IV N.B. follow Trust vancomycin dosing/monitoring guidelines Vancomycin PO Oral not well absorbed Voriconazole IV/PO Zanamivir Microbiology approval only (Malaria & Toxoplasmosis) Approval by Microbiology or Tropical Medicine Specialist only (Malaria) N.B. non-infectious indications unrestricted In accordance with haematology/oncology protocols Treatment of hepatitis C (in accordance with NICE) Oral = TB, Post-exposure meningitis prophylaxis IV should only be used where oral therapy is not possible / appropriate Hepatic encephalopathy for patients awaiting transplant – Gastroenterology Consultant & Directorate Managers approval required inadvance of treatment initiation Infections caused by staphylococci in accordance with Microbiology sensitivities N.B. Must always be prescribed with a second antistaphylococcal antibiotic to prevent resistance On Microbiology approval only (Toxoplasmmosis) Approval by Microbiology or Tropical Medicine Specialist only (Malaria) Dermatology TB (IM) nd Cellulitis (2 line) as OPAT Surgical prophylaxis (general, orthopaedics, obstetrics & gynaecology) Tunnelled CVC insertion prophylaxis in renal (penicillin allergy/MRSA positive) Microbiology approval only Dermatophyte infections of nails (PO) Fungal skin infection (cream) Ringworm (PO/cream according to severity/site) Cancer services (as per protocols) Cystic fibrosis Cystic fibrosis Cystic fibrosis/bronchiectasis Paediatrics in accordance with local guidelines UTI in accordance with guidelines Microbiology approval only Treatment / prophylaxis of cytomegalovirus infection Diabetic foot (in accordance with guideline) Endocarditis Hospital acquired pneumonia (severe & if high risk MRSA) Line infection (if TPN patient refer to NST) Post-op neurosurgical cases pending MRSA results Sepsis unknown site (in-accordance with guideline) Skin & soft tissue infection (in accordance with guideline) Surgical infections (in accordance with guideline) Clostridium difficile infection – IV can be given orally or capsules available Haematology in accordance with IDSA guidelines discuss with Mcrobiology In accordance with Flu guidelines Antimicrobial Formulary (Version5) th Approved by the Antimicrobial Stewardship Group: December 13 2011 Updated: 18.09.12 Review date: September 2015 Page 5 of 5