An anti-infective formulary is a powerful tool that Trusts can employ to help ensure prudent antibiotic prescribing. This is not intended to undermine clinical freedom but is an attempt to achieve optimum therapeutic efficacy while managing costs and promotion of resistance.

trafficlight2.jpg

Protected antimicrobials requiring approval by a Microbiologist.

  • Some antimicrobials, for all or some indications, are classified as ‘protected’ and must be used ONLY on the advice of a microbiologist
  • Microbiologist approval must be documented in the patient’s health care record including the working diagnosis with the name and bleep number of the prescribing doctor
  • Use of restricted antimicrobials will be closely monitored by both pharmacy and microbiology

Specific-use antimicrobials protected for speciality use, specific indications or Microbiologist approval.

  • Antimicrobials in this group can only be prescribed by the designated specialties or for specific indications
  • Prescribing these antimicrobials outside these specialities or indications requires approval from a microbiologist
  • Microbiologist approval must be documented in the patient’s health care record including the working diagnosis with the name and bleep number of the prescribing doctor

Unrestricted use antimicrobials:

  • This covers the remaining antimicrobials kept on the hospital formulary
  • Antimicrobial prescribing must accord with the trusts antibiotic policy unless there are good documented reasons to do otherwise.

Anti-infective formulary

Agent

 

Specific Protection measure in place

Penicillins

Amoxicillin

 

 

Co-amoxiclav (amoxicillin + clavulanic acid)

 

 

Flucloxacillin

 

 

Penicillin V

 

 

Piperacillin-tazobactam

 

 

Pivmecillinam

 

 

Temocillin

 

Microbiology approval

Cephalosporins

Cefalexin

 

 

Cefuroxime

 

 

Ceftazidime

 

Microbiology approval (except in neonatology and cystic fibrosis)

Cefotaxime

 

Meningitis/intracranial infections/paediatric

Ceftolozane-tazobactam

 

Microbiology approval

Ceftriaxone

 

Microbiology approval (except paeds)

Cefixime

 

Microbiology approval

Monobactams

Aztreonam

 

Named patient due to ongoing supply issues

Carbapenems

Ertapenem

 

Microbiology approval

Meropenem

 

Microbiology approval (except guidelines for treating neutropenic sepsis)

Tetracyclines

Doxycycline

 

 

Lymecycline

 

 

Minocycline

 

 

Oxytetracycline

 

 

Tigecycline

 

Microbiology approval

Aminoglycosides

Gentamicin

 

Refer to gentamicin guideline

Amikacin

 

 

Tobramycin

 

Microbiology approval (except Paeds, Respiratory Medicine)

Macrolides, azalides and lincosamides

Erythromycin

 

 

Clarithromycin

 

 

Azithromycin

 

 

Clindamycin

 

Caution if high risk of CDI

Glycopeptides and lipopeptides

Vancomycin

 

Refer to vancomycin guideline

Teicoplanin

 

 

Daptomycin

 

Microbiology approval (except some cases of severe cellulitis)

Quinolones

Ciprofloxacin IV

 

Microbiology approval (except when in line with guideline use)

Ciprofloxacin PO

 

 

Ofloxacin

 

Use for PID only

Moxifloxacin

 

 

Levofloxacin

 

H. pylori eradication and some haematology protocols

Miscellaneous

Trimethoprim

 

 

Co-trimoxazole

 

 

Colistin IV

 

Systemic use on Microbiology approval

Chloramphenicol

 

Systemic use on Microbiology approval

Linezolid

 

 

Rifampicin

 

A second agent is usually required to prevent the emergence of resistance

Sodium fusidate / fusidic acid

 

A second agent is usually required to prevent the emergence of resistance

Nitrofurantoin

 

 

Metronidazole

 

 

Fosfomycin

 

 

Fidaxomicin

 

Microbiology approval for CDI

Antituberculous
Mycobacterial diseases such as TB should be managed by a clinician with expertise such as a respiratory physician

Rifampicin

 

 

Ethambutol

 

 

Isoniazid

 

 

Pyrazinamide

 

 

Rifater (rifampicin + isoniazid + pyrazinamide)

 

 

Rifinah (rifampicin + isoniazid)

 

 

Streptomycin

 

 

Antifungals

Nystatin

 

 

Terbinafine

 

 

Fluconazole

 

IV Microbiology approval (except Haematology, Neonatology)

Itraconazole

 

 

Voriconazole

 

Microbiology approval (except Haem)

Caspofungin

 

Microbiology approval (except Haem)

Ambisome (liposomal amphotericin B)

 

Microbiology approval (except Haematology, Neonatology)

Amphotericin B

 

No longer used systemically: remains on formulary for intra-ocular use

Posaconazole

 

Microbiology approval only (except Haem)

Antivirals  (other treatment options available for the treatment of HIV, contact pharmacy for information)

Aciclovir

 

 

Ganciclovir

 

Microbiology approval (except renal)

Valaciclovir

 

Microbiology approval

Valganciclovir

 

 

Oseltamivir

 

Influenza only: refer to influenza guideline

Zanamivir

 

Influenza only: refer to influenza guideline

Ribavirin

 

Hepatitis C: refer to NICE guidance

Tenofovir + emtricitabine(generic Truvda) and Raltegravir  

 

 HIV Post-Exposure Prophylaxis

Anthelminthics

Mebendazole

 

 

 

Return to General Information