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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
05.03.01  Expand sub section  Non-nucleoside reverse transcriptase inhibitors
05.03.01  Expand sub section  Other antiretrovirals to top
Dolutegravir
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
Homecare

Tablet

  • NUH and SFH for use in line with NHS England Commissioning statement
  • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
 
Link  MHRA: Avoid dolutegravir in women attempting to conceive
   
Dolutegravir and lamivudine (Dovato®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
Homecare

Tablet

  • Available at NUH Only: Restricted to ID / GU Medicine advice only, for treating HIV-1 infected adults in accordance with the NHS England Clinical Commissioning Policy statement.
  • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
 
Link  Clinical Commissioning Policy Statement: Dolutegravir/lamivudine for the treatment of Human Immunodeficiency Virus (HIV-1) infected adults and adolescents over 12 years of age
   
Dolutegravir and rilpivirine (Juluca®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
Homecare

Tablet

  • Available at NUH Only: Restricted to ID / GU Medicine advice only, for treating HIV-1 in adults in accordance with the NHS England Clinical Commissioning Policy.
  • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
 
Link  Clinical Commissioning Policy: Dolutegravir-rilpivirine for treating HIV-1 in adults
   
Dolutegravir, abacavir & lamivudine (Triumeq®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
Homecare

Tablet

  • NUH and SFH for use in line with NHS England Commissioning statement
  • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
 
Link  MHRA: Avoid dolutegravir in women attempting to conceive
   
Enfuvirtide (Fuzeon®)
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Formulary
Red
High Cost Medicine

Injection

  • Restricted to ID / GU Medicine advice only
 
Link  Link to reviews
   
Maraviroc (Celsentri®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
Homecare

Tablet

  • Restricted to GU med only
  • NUH approved for adults
  • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
 
Link  Link to reviews
   
Raltegravir (Isentress ®)
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Formulary
Red
High Cost Medicine
Homecare

Film Coated Tablet, Chewable tablet (NUH only),Sachets for oral suspension (NUH only)

  • Restricted to ID / GU Medicine advice only
  • Available through homecare for NUH patients. Please contact pharmacy medicines homecare team for further information
    Note: Doses differ according to formulation used and thus tablets and chewable tablets are not equivalent. When prescribing, the formulation must be specified.
 
Link  Link to reviews
Link  NUH Poster: Caution raltegravir doses differ according to formulation
Link  UKMI Q&A: Which medicines require extra care when switching between liquid and tablet/capsule formulations?
   
 ....
 Non Formulary Items
Dolutegravir, lamivudine & tenofovir  (Acriptega®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Grey
High Cost Medicine
Homecare

No formal assessment

 
  
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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