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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...
05.03.02  Expand sub section  Herpesvirus infections
05.03.02.01  Expand sub section  Herpes simplex and varicella-zoster infection
 note  In immunocompromised patient for treatment or prophylaxis – please refer to specialist protocol or seek expert advice. In pregnancy please seek specialist advice.
Aciclovir
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tablet, Suspension, Injection

 
   
Famciclovir
View adult BNF View SPC online View childrens BNF
Formulary
Amber 2
Tablets
  • On GUM advice as a 2nd line agent to aciclovir in aciclovir resistant cases of genital herpes. 
  • Link  BASHH Guideline on Genital Herpes
    Link  Famciclovir is relatively expensive- see price graph
       
    Valaciclovir
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber 2
    Tablet
  • Restricted for use where compliance with aciclovir is a problem as more expensive than aciclovir.
  • 250mg tablets are significantly more expensive than 500mg.
     
  •    
    05.03.02.02  Expand sub section  Cytomegalovirus infection
    Cidofovir infusion
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Infusion- NUH only
     
       
    Foscarnet Sodium (Foscavir®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Infusion- NUH only
  • Restricted use- see local guidelines
     
  •    
    Ganciclovir
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine

    Infusion

    • Restricted use- see local guidelines
     
    Link  SFH: Ganciclovir information
       
    Letermovir (Prevymis®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    High Cost Medicine

    Film-Coated Tablets

    Available at NUH only:

    • Approved in accordance with NICE TA591 for preventing cytomegalovirus disease after a stem cell transplant
     
       
    Valganciclovir
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Tablet, Liquid
  • Restricted use-see local guidelines 
  • Link  Link to reviews
       
     ....
     Non Formulary Items
    Aciclovir lauriad  (Sitavig)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    Mucoadhesive buccal tablet
  • No formal submission - treatment of recurrent labial herpes in immunocompetent pts presenting with more than four episodes a year
  •  
    Inosine Pranobex  (Imunovir®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
      
    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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