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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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05.03.01  Expand sub section  HIV infection
 note 

At SFH: PEP packs are available from GU Medicine, A&E (KMH) and Newark emergency cupboard. These packs should be used at all times of the day (not just out of hours) and a request for a replacement pack sent to pharmacy. The current regime is one Truvada  tablet (245mg tenofovir + 200mg emtricitabine) o.d. plus raltegravir 400mg b.d.

05.03.01  Expand sub section  Nucleoside reverse transcriptase inhibitors
05.03.01  Expand sub section  Protease inhibitors
Amprenavir (Agenerase®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red
Capsule, Oral Solution
  • Restricted to ID / GU Medicine advice only
     
  •    
    Atazanavir
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Capsule

    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
       
    Darunavir
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablets, Oral suspension

    • Restricted to ID / GU Medicine advice only
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  Link to reviews
       
    Darunavir and Cobicistat (Rezolsta®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablet

    • NUH Only Restricted to ID / GU Medicine advice only, in accordance with commissioning approval.
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  MHRA: Avoid darunavir with cobicistat in pregnancy
       
    Fosamprenavir (Telzir®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Tablet, Oral Suspension
  • Restricted to ID / GU Medicine advice only
     
  • Link  Link to reviews
       
    Lopinavir and Ritonavir (Kaletra®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablet, Liquid 

    • Available through homecare. Please contact pharmacy medicines homecare team for further information.
     
       
    Ritonavir
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Homecare

    Tablets, Powder for oral suspension sachets

    • 100mg Capsules - supply problem until end 2021. Strictly limited to 2 months supply at once.
    • Restricted to ID / GU Medicine advice only
    • Oral solution (90ml bottles) discontinued Sept 2016
    • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
     
    Link  MHRA Drug Safety Update
       
    Saquinavir (Invirase®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Capsule, Tablet
  • Restricted to ID / GU Medicine advice only
     
  • Link  MHRA safety advice: update on risk of arrhythmias - reduced dose for initial treatment
       
    Tipranavir (Aptivus®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Capsule
  • Restricted to ID / GU Medicine advice only
     
  • Link  Link to reviews
    Link  UKMI Q&A: Which medicines require extra care when switching between liquid and tablet/capsule formulations?
       
    05.03.01  Expand sub section  Non-nucleoside reverse transcriptase inhibitors
    05.03.01  Expand sub section  Other antiretrovirals to top
     ....
     Non Formulary Items
    Indinavir  (Crixivan®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    High Cost Medicine
    Capsule
  • Restricted to ID / GU Medicine advice only
  • Feb 2017 - Discontinued
  •  
    Nelfinavir  (Viracept®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    High Cost Medicine
    Due to be discontinued on 23rd Jan 2013
     
      
    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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