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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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 Details...
05.02.04  Expand sub section  Echinocandin antifungals
Caspofungin
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red
High Cost Medicine

Infusion

  • At NUH: First line echinocandin. Approved for use in paediatric patients and adult haematology See Haematology guidelines or Microbiology guidelines
  • At SFH: Approved to be used for neutropenic patients with approval of consultant haematologist and microbiologist. Contact High Cost Drugs Team ext 4567 for more information. See local guideline below.
  • See local guidelines. [SFH guideline][NUH guideline]
 
Anidulafungin (Ecalta)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red
High Cost Medicine

Infusion

  • Approved for use in adults. Not licensed in under 18s.
  • Second line  echinodandin where caspofungin is deemed inappropriate e.g moderate to severe liver impairment (Child Pugh score >7) . First line use in haematology remains caspofungin [NUH guideline] [SFH guideline]
 
Link  Link to reviews
   
Micafungin (Mycamine)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red
High Cost Medicine

Infusion

  • At NUH: removed from formulary as of 6th June 2016.
  • At SFH: not routinely stocked. Available on Microbiologist request only.
  • See local guidelines. [SFH guideline][NUH guideline]
  • Prescriber checklist available via the SPC - see risk materials link at the top of the SPC.
 
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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