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 Formulary Chapter 5: Infections - Full Chapter
Notes:

Intravenous antibiotics are more expensive than oral equivalents, some are very expensive. They put patients at risk of IV cannula infections. Oral antibiotics are usually fairly cheap. IM injections are rarely if ever indicated.

Course lengths:
Prescriptions for oral antibiotics for in-patients should be reviewed at or before five days. Prescriptions for intravenous antibiotics should be reviewed at or before 48 hours after which the patient should be considered for an oral antibiotic if there is an equivalent available (see IV to oral switch policy). For uncomplicated urinary tract infections three days treatment is usually sufficient in adult women. Complicated infections require longer treatment.

When initiating therapy with agents marked with Restricted, you must seek Microbiology/Infectious Diseases advice.

The restricted antimicrobials may be prescribed without discussion with microbiology if they are being used for an approved indication as specified. Use outside these indications (and any use for some antimicrobials) requires DOCUMENTED approval from one of the medical microbiologists or Infectious Diseases Physician prior to prescribing.

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05.01.09  Expand sub section  Antituberculosis drugs
Aminosalicylic acid (Granupas®)
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Formulary
Red
Granules, e/c
NUH:
  • Restricted to respiratory/ID consultant recommendation only, post MDT decision
  • Restricted for use in adult patients with multi-drug-resistant tuberculosis 
  •    
    Bedaquiline (Sirturo® )
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Tablet

    NUH: Approved in accordance with NHS England commissioning policy for multi drug resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB).

     
    Link  Link to reviews
       
    Capreomycin (Capastat®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Injection
    Restricted for use in resistant tuberculosis
     
       
    Cycloserine
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    Restricted Drug Restricted
    Red

    Capsule
    Restricted for use in resistant tuberculosis
    May 2020 - long term supply problems. Unlicensed imports may be required.

     

     
       
    Ethambutol
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

    Tablet

    • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
    • If liquid is needed for paediatric use, local recommended strength is 400mg/5mL as per RCPCH guidance.
    • See local guidelines. [SFH guideline][NUH guideline]
     
       
    Isoniazid
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    Formulary
    Red
    Tablet
    Elixir 50mg/5ml (unlicensed)
    Injection
  • See local guidelines. [SFH guideline][NUH guideline
  •    
    Prothionamide
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    Restricted Drug Restricted
    Red
    Capsule (Unlicensed- Named patient use)
    Restricted for use in resistant tuberculosis 
       
    Pyrazinamide
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

    Tablet, liquid (unlicenced - recommended strength is 500mg/5mL as per RCPCH guidance)

    • Tablets disperse in water (within 1-5 minutes) if needed. See here for general advice on dispersing tablets.
    • Unlicenced liquid for paediatric patients only where tablets are unsuitable.
    • See local guidelines. [SFH guideline][NUH guideline]
     
       
    Rifabutin (Mycobutin®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Capsule
    Restricted for use in mycobacterial disease 
       
    Rifampicin and Isoniazid (Rifinah® 300)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Tablet 
       
    Rifampicin and Isoniazid (Rifinah® 150)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Tablet 
       
    Rifampicin and Isoniazid (Rimactazid® 300)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Tablet 
       
    Rifampicin and Isoniazid and Pyrazinamide (Rifater®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Tablet
  • Tablets disperse in water if needed but use seperate components where possible. See here for general advice on dispersing tablets. 
  •    
    Rifampicin, isoniazid, pyrazinamide and ethambutol (Voractiv®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Tablet
    NUH only:
  • Selective patients to aid compliance  
  • Link  Link to reviews
       
    Streptomycin Sulphate
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Injection (unlicensed)
    Restricted for use in resistant tuberculosis
    Recipharm preparation is out of stock from Nov 12 until mid 2013. Unlicensed product is available from importers if required. 
       
    Terizidone
    Restricted Drug Restricted
    Red

    Capsule. Unlicensed medicine - named patient use only

    • Restricted for use in resistant tuberculosis in adults when cycloserine is not available. (May 2020 - long term supply problems with cycloserine .)
     
       
    Rifampicin
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber 2

    Capsule, Syrup, Infusion

    • on secondary care advice or
    • GP initiation in line with primary care antimicrobial guidelines
    • when used for TB.
    • Should not be used as a single agent (except in meningitis post-exposure prophylaxis)
    • See local guidelines. [SFH guideline][NUH guideline]
    • Use of rifampicin and clarithromycin for hirdradenitis suppurativa should only be initiated on recommendation of a dermatology specialist
     
       
     ....
     Non Formulary Items
    Delamanid  (Deltyba®)

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    Non Formulary
    Grey
    High Cost Medicine
    Tablets
  • Grey (No formal assessment)
  • Link  Link to reviews
     
      
    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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