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Nottinghamshire Area Prescribing Committee
Joint Formulary
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 Formulary Chapter 11: Eye - Full Chapter
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11.03.01  Expand sub section  Antibacterials
Chloramphenicol
(Ophthalmic)
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First Choice
Green

Eye drops 0.5%, Eye ointment 1%, Preservative free drops - Eykappo® 10ml bottle (~£12) or Minims (~£13 for 20) 

  • Most bacterial infections are self-limiting. Mild cases should not need
    treating. They are usually unilateral with yellow-white mucopurulent discharge.
  • See primary care antibiotic guidelines for more information
  • OTC Patients should be advised to purchase over the counter

  • May be prescribed if appropriate to in-patients; patients should be advised on discharge that further supply should be purchased
 
Fusidic Acid
(Ophthalmic)
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Second Choice
Green

Eye drops 1%

  • Alternative to chloramphenicol for empirical treatment in people who:
    - Are pregnant.
    - Have a personal or family history of blood dyscrasias, such as aplastic anaemia.
    - Are intolerant of chloramphenicol.
    - Need a twice-a-day treatment for infective conjunctivitis
    See CKS topic for more information.
  • Jan 2016: price increased from £2 a tube to £35 a tube!
 
Link  See unexpectedly expensive medicines list
   
Amikacin
(Ophthalmic)
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Restricted Drug Restricted
Red

- Eye drops 2.5% (preservative free)(Unlicensed special)
- Intravitreal injection 0.4mg in 0.1mL

  • NUH only: Intravitreal injection manufactured by Pharmacy Sterile Production Unit (Unlicensed Products).
  • For guidance on Intravitreal preparations at SFHT see link below
 
Link  SFH: Intravitreal antibiotic supply procedure
   
Azithromycin (Azyter®)
(ophthalmic)
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Restricted Drug Restricted
Red
Eye drops 1.5%
  • On recommendation from ophthalmology:
    - Ophthalmia neonatorum
    - Purulent bacterial conjunctivitis
    - Trachomatous conjunctivitis caused by Chlamydia trachomatis
     
  •    
    Benzylpenicillin
    (ophthalmic)
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    Restricted Drug Restricted
    Red

    0.3% (5,000 units/ml) PF eye drops (Unlicensed special)

     
       
    Ceftazidime
    (ophthalmic)
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    Restricted Drug Restricted
    Red
    Eye drops 5% (preservative free)-NUH only (specialist use)
  • For guidance on intravitreal anti-infections prepared at SFHT see link below
     
  • Link  SFH: Intravitreal antibiotic supply procedure
       
    Cefuroxime
    (ophthalmic)
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    Restricted Drug Restricted
    Red

    Unlicensed - Specialist use only.

    • Eye drops 5% (preservative free). Now £60 each.
    • Expiry is 14 days from defrosting when stored in a fridge unopened, or 7 days from opening when stored in the fridge (on the ward and at home).
    • Intracameral Injection 3mg in 0.3mL
     
    Link  Link to reviews
       
    Chlorhexidine
    (ophthalmic)
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    Restricted Drug Restricted
    Red

    0.02% eye drops

    • Specialist use only for Acanthamoeba keratitis.
    • Unlicensed preparation. (~£23 per 10ml bottle)
    • Usually kept as stock at NUH and SFH
     
    Link  MHRA alert: Anaphylaxis risk with chlorhexidine
       
    Ciprofloxacin
    (Ophthalmic)
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    Formulary
    Amber 2

    Eye drops 0.3% (Eye ointment 0.3% discontinued 2017)

    • SFH: Consultant request only - use ofloxacin instead if need a quinolone eyedrop.
     
       
    Erythromycin
    (ophthalmic)
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    Restricted Drug Restricted
    Red
    Eye ointment 0.5%
  • Imported (Unlicensed Product)
  • Specialist use only
  • For chlamydia, but see also azithromycin which is licensed and more easily available (or ofloxacin). 
  •    
    Gentamicin (ophthalmic)
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    Restricted Drug Restricted
    Red

    Available as:

    • Eye drops 0.3%
    • Eye drops 1.5% (forte)(preservative free - unlicensed). £10 each. Expiry once opened is 7 days when stored in the fridge (on the ward and at home).
    • At NUH amikacin 2.5% (preservative free - unlicensed) is used in place of gentamicin 1.5%.
     
       
    Levofloxacin
    (ophthalmic)
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    Restricted Drug Restricted
    Red
    Eye drops (0.5%) preservative free single use.
  • Restricted for use where preservative free 4-fluoroquinolone prep required. 
  • Link  Link to reviews
       
    Moxifloxacin eye drops (Moxivig®)
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    Restricted Drug Restricted
    Red

    Eye drops (0.5%) - self preserved 5mL bottle

    Available at NUH:

    • Restricted for use where 4-fluoroquinolone preparation without additional preservatives required.  Preferred alternative to levofloxacin PF eye drops.
    • 4 week expiry from opening
     
       
    Ofloxacin Eye drops (Exocin®)
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    Formulary
    Amber 2
    Eye drops 0.3%
  • At SFH preferred quinolone eye drop
  • At NUH restricted for Chlamydial infections if erythromycin ointment is unavailable 
  •    
    Polihexanide
    (eye drops)
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    Restricted Drug Restricted
    Red
    Eye drops 0.02% (Unlicensed Product)
  • Also known as polyhexamethylene biguanide (PHMB)
  • Expires 7 days once opened.
  • One routinely stocked at SFH.
  • Polihexanide eye drops is the usual choice for treatment of Acanthamoeba keratitis. Alternatives are propamidine (Brolene®) and chlorhexidine 0.02% eye preparations. 
  •    
    Povidone iodine 5%
    (ophthalmic)
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    Restricted Drug Restricted
    Red
    Available as 30ml bottle (NUH) or as Minims (NUH and SFH). 
       
    Propamidine Isetionate (Brolene® eye drops)
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    Formulary
    Red
    Eye drops 0.1%
    Eye ointment (dibrompropamidine isetionate 0.15%) 5g
  • Red - if used for Acanthamoeba keratitis (specialist only) 
  •    
    Vancomycin
    (ophthalmic)
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    Restricted Drug Restricted
    Red
    Specialist only
  • Eye drops 5% (preservative free) - Special order, takes a few days to arrive at SFH.
  • Intravitreal injection:
    - NUH: 3mg in 0.3ml and 2mg in 0.2mL
    manufactured by Pharmacy Sterile Production Unit (Unlicensed Products - extra volume counts for dead space in the needle).
    - SFH: For guidance on Intravitreal preparations at SFHT see link below. 
  • Link  SFH: Intravitreal antibiotic supply procedure
       
     ....
     Non Formulary Items
    Chlortetracycline
    (ophthalmic)

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    Non Formulary
    Red
    Eye ointment
  • SFH specialist only
  • Discontinued in the UK 2004, but may be available as an import.
  • Azithromycin now available for chlamydia
  •  
    Gentamicin single use  (Minims® Gentamicin Sulphate)

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    Non Formulary
    Grey
    • Discontinued
     
    Neomycin Eye drops

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    Non Formulary
    Grey
    Discontinued
     
    Polymyxin B Sulphate eye ointment  (Polyfax®)

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    Non Formulary
    Grey
    Discontinued March 2012
  • Alternative for Acanthamoeba keratitis is dibrompropamidine eye ointment (in conjunction with polihexanide 0.02% eye drops, propamidine isetionate 0.1%(Brolene) eye drops during the day and chlorhexidine 0.02% eye drops if not responding)
  •  
      
    Key
    note Notes
    Section Title Section Title (top level)
    Section Title Section Title (sub level)
    First Choice Item First Choice item
    Non Formulary Item Non Formulary section
    Restricted Drug
    Restricted Drug
    Unlicensed Drug
    Unlicensed
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to children's BNF
    click to search medicines.org.uk
    Link to SPCs
    SMC
    Scottish Medicines Consortium
    Cytotoxic Drug
    Cytotoxic Drug
    CD
    Controlled Drug
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Grey

    Grey / Non-Formulary: Medicines, which the Nottinghamshire APC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.
    Grey / Non-Formulary (undergoing assessment): Work is ongoing and will be reviewed at a future APC meeting.
    Grey / Non-Formulary (no formal assessment): APC has not formally reviewed this medicine or indication because it had never been requested for formulary inclusion. Often used for drugs new to market.
      

    Red

    Medicines which should normally be prescribed by specialists only. eg hospital only.
    For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.
      

    Amber 1

    Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised.
    Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the Nottinghamshire APC.
      

    Amber 2

    Medicines suitable to be prescribed in primary care / general practice after specialist* recommendation or initiation.
    A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust DTCs and approved by the Nottinghamshire APC.
    *Specialist is defined by the APC as a clinician who has undertaken an appropriate formal qualification or recognised training programme within the described area of practice
      

    Amber 3

    Primary care/ non specialist may initiate as per APC guideline.
    The supporting prescribing guideline must have been agreed by the relevant secondary care trust D&TC(s) and approved by the Nottinghamshire APC.
      

    Green

    Medicines suitable for routine use within primary care.
    Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.   

    OTC

      

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