| Formulary Chapter 5: Infections - Full Chapter
|
| Chapter Links... |
 COVID-19 Therapeutic Alert |
| Interim Clinical Commissioning Policy: Antivirals or neutralising monoclonal antibodies in the treatment of COVID-19 in hospitalised patients (Version 5 - effective from 10th February 2022) |
 NENC ICB - Cellulitis Diagnosis and Management in Ambulatory Adults in primary care; Supporting Information |
| NICE NG15: Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use |
| NICE NG63: Antimicrobial stewardship: changing risk-related behaviours in the general population |
| North of Tyne, Gateshead and North Cumbria - Antibiotic and Diagnostic quick reference tools |
| Primary Care Antimicrobial Guidelines |
| TEWV: Antibiotic Prescribing Procedure |
| UK Interim Clinical Commissioning Police - Therapies for patients with symptomatic hospital-onset COVID-19 |
| Details... |
| 05.04 |
Antiprotozoal drugs |
|
|
Paromomycin
|
 Unlicensed
|
- 250mg tablets and Injection
- For Leishmaniasis
- Infectious diseases of microbiology advice only
|
|
|
| 05.04.01 |
Antimalarials |
|
|
| 05.04.01 |
Treatment of malaria |
|
|
Dihydroartemisinin / piperaquine phosphate (Eurartesim®)
|
Formulary
|
- 160mg/20mg & 320mg/40mg tablets
- Approved for the treatment for plasmodium falciparum malaria in line with current UK and WHO guidelines.
- Only available from Newcastle Hospitals (RVI)
|
|
|
Artesunate
(injection)
|
Unlicensed
|
- Approved for severe malaria in in line WHO guidance.
|
|
|
| 05.04.01 |
Falciparum malaria (treatment) |
|
|
| 05.04.01 |
Benign malarias (treatment) |
|
|
| 05.04.01 |
Prophylaxis against malaria |
|
|
| 05.04.01 |
Specific recommendations |
|
|
| 05.04.01 |
Artemether with lumefabtrine |
|
|
| 05.04.01 |
Chloroquine |
|
|
Chloroquine
|
Formulary
|
- 200mg tablets (=150mg chloroquine base)
 Not NHS.
- 68mg in 5ml syrup (=50mg in 5ml chloroquine) Not NHS
272.5mg in 5ml injection (=200mg in 5ml chloroquine) unlicensed .
|
MHRA Drug Safety Update (Feb 2022): Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions
|
| 05.04.01 |
Mefloquine |
|
|
Mefloquine
|
Formulary
|
Note: not approved on the NHS for prophylaxis.
|
|
|
| 05.04.01 |
Primaquine |
|
|
Primaquine
|
Unlicensed
|
|
|
|
| 05.04.01 |
Proguanil |
|
|
| 05.04.01 |
Pyrimethamine |
|
|
Pyrimethamine (Darprim®)
|
Formulary
|
|
|
|
| 05.04.01 |
Quinine |
|
|
Quinine sulphate
|
Formulary
|
|
MHRA Drug Safety Alert (Nov 2017): Quinine: reminder of dose-dependent QT-prolonging effects; updated medicine interactions
|
Quinine Dyhydrochloride
|
Unlicensed
|
|
MHRA Drug Safety Alert (Nov 2017): Quinine: reminder of dose-dependent QT-prolonging effects; updated medicine interactions
|
| 05.04.01 |
Tetracyclines |
|
|
| 05.04.02 |
Amoebicides |
|
|
Metronidazole
|
Formulary
|
|
|
|
Diloxanide
|
Formulary
|
|
|
|
Tinidazole
|
Alternatives
|
- 500mg tablets
- Last line option for resistant Trichomonas vaginalis
- unlicensed
|
|
|
| 05.04.03 |
Trichomonacides |
|
|
| 05.04.04 |
Antigiardial drugs |
|
|
Metronidazole
(giardia)
|
Formulary
|
|
|
|
Mepacrine Hydrochloride
|
Unlicensed
|
|
|
|
| 05.04.05 |
Leishmaniacides |
|
|
Sodium Stibogluconate
|
Formulary
|
|
|
|
| 05.04.06 |
Trypanocides |
|
|
| 05.04.07 |
Drugs for toxoplasmosis |
|
|
Sulfadiazine
|
Formulary
|
- Infectious diseases or microbiology advice only
|
|
|
| 05.04.08 |
Drugs for pneumocystis pneumonia |
|
|
Co-trimoxazole
|
Formulary
|
|
|
|
Atovaquone
|
Formulary
|
- Approved for use in patients intolerant of co-trimoxazole
|
|
|
Co-trimoxazole Infusion
|
Formulary
|
|
|
|
Pentamidine Isetionate
|
Formulary
|
|
|
|
| 05.04.08 |
Treatment |
|
|
| 05.04.08 |
Prophylaxis |
|
|
| .... |
Key |
|
|
|
|
Cytotoxic Drug
|
|
|
Controlled Drug
|
|
High Cost Medicine
|
|
NHS England |
|
Homecare |
|
CCG |
|
Traffic Light Status Information
| Status |
Description |
|
Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment.
In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances.
For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing. |
|
Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement.
The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber.
If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care. |
|
Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs. |
|
Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care. |
|
NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria. |
|
UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review. |
|
NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status. |
|
|
|
