| Formulary Chapter 5: Infections - Full Chapter
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| 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... |
| 05.01.07 |
Some other antibacterials |
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Dalbavancin (Xydalba ®)
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Formulary
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- 500mg injection
- approved for the treatment of significant deep soft tissue infections such as joint, discitis and spinal infection, on the advice of infectious disease physicians or microbiology.
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Tedizolid (Sivextro®)
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Formulary
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- 200mg tablet and 200mg powder for concentrate for solution for infusion
- Approved for thre treatment of bacterial skin and skin structure infections only on the advice of microbiologists/ID physicians
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Pristinamycin
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 Unlicensed
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- Approved for
- Pregnant women infected with Mycoplasma Genitalium (MG) infection that is resistant to macrolides
- Mycoplasma Genitalium (MG) infection that is resistant to macrolides, quinolones and tetracyclines in both men and women
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Chloramphenicol |
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Chloramphenicol
(Systemic)
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Formulary
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- Restricted for use on microbiology/infectious diseases advice, or as agreed in Trust Guidelines.
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| 05.01.07 |
Fosfomycin |
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Fosfomycin
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Formulary
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- 500mg capsules unlicensed
- 4g injections
- 3g sachets: sachets can be initiated in primary care for the treatment of UTIs caused by multi-resistant organisms. Most cost effective option to be used
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| 05.01.07 |
Fusidic acid |
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Sodium fusidate
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Formulary
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- 250mg film coated tablets
- 250mg in 5ml suspension
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| 05.01.07 |
Vancomycin and teicoplanin |
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Teicoplanin
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Formulary
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- Restricted for use on microbiology/infectious diseases advice, or as agreed in Trust Guidelines.
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Vancomycin Injection
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Formulary
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Restricted for use on microbiology/infectious diseases advice, or as agreed in Trust Guidelines.
- 20mg in 4ml intrathecal injection unlicensed
- 500mg and 1g injections
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Vancomycin Oral Preparations
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Formulary
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- Restricted for use on microbiology/infectious diseases advice, or as agreed in Trust Guidelines.
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| 05.01.07 |
Daptomycin |
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Daptomycin
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Formulary
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| 05.01.07 |
Linezolid |
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Linezolid Infusion
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Formulary
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- Restricted for use on microbiology/infectious diseases advice, or as agreed in Trust Guidelines.
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MHRA Drug Safety Update (Dec 2014): Linezolid: restricted indication
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Linezolid Oral Preparations
(For courses greater than 14 days)
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Formulary
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- 600mg tablets
- 100mg in 5ml suspension
To be used only on the advice of a Consultant Microbiologist for resistant Gram-positive infections.
Patients must have weekly bloods taken to monitor for haematological side effects if receiving treatment for more than 10 to 14 days. In those receiving treatment for more than 4 weeks a pre-treatment eye assessment is recommended followed by monthly assessments. Patients should be warned to report any visual symptoms promptly (see BNF for CSM warning).
Linezolid is a MAO inhibitor and so potentially life threatening interactions can occur. Check before prescribing.
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MHRA Drug Safety Update (Dec 2014): Linezolid: restricted indication
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Linezolid Oral Preparations
(For courses up to 14 days)
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Formulary
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- 600mg tablets
- 100mg in 5ml suspension
To be used only on the advice of a Consultant Microbiologist for resistant Gram-positive infections.
RED drug for courses greater than 14 days 
Patients must have weekly bloods taken to monitor for haematological side effects if receiving treatment for more than 10 to 14 days. In those receiving treatment for more than 4 weeks a pre-treatment eye assessment is recommended followed by monthly assessments. Patients should be warned to report any visual symptoms promptly (see BNF for CSM warning).
Linezolid is a MAO inhibitor and so potentially life threatening interactions can occur. Check before prescribing.
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MHRA Drug Safety Update (Dec 2014): Linezolid: restricted indication
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| 05.01.07 |
Quinupristin and dalfopristin |
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| 05.01.07 |
Polymyxins |
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Colistimethate
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Formulary
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- 1 million-unit & 2 million-unit vial for nebulisation/intravenous injection
- Nebulised therapy for bronchiectasis
- Nebulised therapy for patients on assisted ventilation, patients with tracheostomies and those with persistant bacterial bronchitis
- To be used for treatment of Cystic Fibrosis in accordance with NHS England Commissioning Policy/NICE Guidance.
- Nebulised therapy for CF .
- Intravenous therapy .
- Dry powder for inhalation (Colobreath®) .
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Clinical Commissioning Policy: Inhaled Therapy for Adults and Children with Cystic Fibrosis
TA276:Colistimethate sodium and tobramycin dry powders for inhalation for treating pseudomonas lung infection in cystic fibrosis
MHRA Drug Safety Update (Nov 2014): Colobreathe (colistimethate sodium dry powder for inhalation): risk of capsule breakage from inhaler device
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| 05.01.07 |
Rifaximin |
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Rifaximin
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Formulary
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- 550mg Tablets: Only approved for use in accordance with NICE guidance.
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TA337: Rifaximin for preventing episodes of overt hepatic encephalopathy
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| 05.01.07 |
Fidaxomicin |
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Fidaxomicin (Dificlir®)
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Formulary
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- 200mg tablets
- Fidaxomicin 40mg/ml granules for oral suspension
- Approved for use in the treatment of C. difficile. To be initiated on the recommendation of a consultant microbiologist.
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Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine |
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NHS England |
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Homecare |
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ICB |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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| Status |
Description |
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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. |
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Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. These medicines are considered suitable for primary care prescribing following specialist initiation of therapy and stabilisation, with ongoing communication between the primary care prescriber and specialist as set out in the associated shared care guideline (SCG). Shared care should be initiated by the specialist, which includes consultant, suitably trained specialist non-medical prescriber or GPwER within a secondary, tertiary, or primary care clinic.
The specialist should send the primary care prescriber a copy of the NENC Clinical Effectiveness and Governance (CEG) Subcommittee approved SCG to sign. The primary care prescriber should sign the SCG or indicate reasons why they are unable to accept the agreement and return a copy back to the specialist, as soon as possible.
SCGs are available or are being developed for most of the drugs listed as AMBER. |
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Drugs normally recommended or initiated by a hospital specialist who is a prescriber, a GP with an extended role [GPwER], or a specialist within primary care which can be safely maintained in primary care and monitored in primary care. In some cases, a further restriction for use may be defined. The primary care prescriber must be familiar with the drug to take on prescribing responsibility or must obtain the required information from the specialist. Therefore, provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by primary care prescriber or provide information re stopping criteria.
These are considered suitable for primary care prescribing following specialist assessment and recommendation of therapy, with ongoing communication between the primary care prescriber and specialist, if necessary.
In some case these drugs require specialist initiation and short to medium term monitoring of efficacy or toxicity until the patient’s dose is stable. Following specialist review the patient may be transferred to primary care for ongoing prescribing. Ongoing prescribing by primary care can include, if required, additional dose titrations and assessment of efficacy, with ongoing communication between the primary care prescriber and specialist, if necessary.
If the drug requires urgent initiation, it is expected that the specialist undertakes the initial prescribing responsibility for an appropriate period of time, usually a minimum of 28 days. A GREEN+ drug can only be recommended to primary care for initiation if does not need to be initiated within 28 days. |
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Medicines suitable for initiation, ongoing prescribing and discontinuation in all care settings, subject to appropriate communication between those responsible. |
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UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review. |
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Drugs that have been considered by the NENC Clinical Effectiveness and Governance (CEG) Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria ICS. These may also include all medicines with a “not NHS” or “DLCV” classification in the BNF, those agents as included within the NICE “Do not do” list, and those agents included with the NHS England: Items which should not routinely be prescribed in primary care. |
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