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 Formulary Chapter 5: Infections - Full Chapter
Notes:

FOR THE LATEST INFORMATION REGARDING COVID_19 PLEASE SEE:

COVID-19: guidance for health professionals 

https://www.gov.uk/government/collections/wuhan-novel-coronavirus 

https://www.england.nhs.uk/coronavirus/primary-care/ 

 

Intravenous antibiotics are more expensive than oral equivalents and some are very expensive they also 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. 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.

For further information on prescribing antimicrobials at Royal Papworth Hospital please refer to the Microguide

Prescribing in Primary Care and CPFT should follow the Primary Care Prescribing Guidelines and initiate only those treatments recommended as Green (unless on the advice of a microbiologist).

Use in pregnancy

  • It is important to ensure adequate treatment of maternal infection in pregnancy as failure to treat may lead to adverse maternal and fetal outcome as a consequence of uncontrolled infection or fever.
  • When considering treatment with antibacterial agents during pregnancy, the following factors should be taken into account: the severity of the maternal infection, the presence of fever, the maternal and fetal risks associated with failing to treat the mother adequately, the pharmacokinetic and pharmacodynamic effects (where known) of pregnancy on drug absorption, distribution, metabolism and excretion, and the potential fetotoxicity of the treatments being considered.
  • Where possible, antibiotic choice should be informed by culture and sensitivity tests, however if treatment is required urgently or before test results become available, then penicillins or cephalosporins should be considered where clinically appropriate.
  • See UKTIS Antibiotic use in Pregnancy for further information. 
  • Prescribing in Primary Care and CPFT should follow the Primary Care Prescribing Guidelines which includes specific guidance for pregnancy and initiate only those treatments recommended as Green (unless on the advice of a microbiologist).
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 Details...
05.01.02.01  Expand sub section  Cephalosporins
 note 

CUHFT: See Trust antibiotic guidelines for approved indications. For all other indications microbiology approval is required.

Avoid using parenteral cephalosporins for empirical treatment unless specifically indicated in Trust antibiotic guidelines or microbiology approval has been obtained.

Cefalexin
(Capsules, liquid)
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Formulary
Green

 

  • Primary Care: Recommended as a treatment option for the management of lower UTI in pregnancy. See Primary care Antibiotic Guideline for further information.
  • NWAFT: First line in treatment of UTI in pregnancy.
  • CUHFT: Empiric first line for pregnant UTI treatment.
  • RPH: Non-formulary.

     

 

 
Link  MHRA Drug Safety Update: Nitrofurantoin and eGFR less than 45mls/min (Sep 2014)
Link  NICE CKS: lower UTI in women (July 2015)
   
Cefixime (Suprax®)
(Tablet, Oral Suspension)
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Restricted Drug Restricted
Green

  • Primary Care: Suspected Epididymo-orchitis- high risk of STI, 2nd line 400mg single dose as an alternative to ceftriaxone if not available.

    Ideally, refer for same-day or next-day assessment by a sexual health specialist (if mumps orchitis is not diagnosed).


    Only treat if urgent referral to a sexual health service is not possible:


    Obtain a MSU for dipstick, microscopy and culture. Test for STI. Treat without waiting for test results for all suspected organisms.


    In sexually active adolescents and men younger than 35 years of age, the causative organism is likely to be Chlamydia trachomatis or Neisseria gonorrhoeae


     

  • CUH info : For Clinic 1A/ID only for treatment of gonorrhoea (400mg stat).

  • NWAFT info: Non formulary

 
   
Cefepime (Renapime®)
(Powder for solution for injection)
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Restricted Drug Restricted
Red Hospital
  • NWAFT only via OPAT: Restricted to use on the recommendation of Microbiology only as a second line treatment option when first line anti-pseudomonal therapies are unsuitable due to resistance/allergies. 
 
   
Cefotaxime
(Injection)
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Restricted Drug Restricted
Red Hospital

 




  • NWAFT info: restricted to use in neonates and children under 3 months

 

  • RPH: Non-formulary


GP surgeries - out of stock information December 2020 

Wockhardt UK Ltd are out of stock of cefotaxime injections and have no resupply date. Bowmed Ibisqus Ltd have 500mg ang 1g vials in stock but only supply to hospitals. However, they are aware that many manufacturers no longer make this, therefore they will supply to GP surgeries on a case-by-case basis, known as '‘H Marker Release’. This means the supply is authorized by Bowmed and supplied by AAH to the GP surgery – if this is the case surgery need to contact Bowmed directly on 0845 643 6703 or email info@bowmed.com.    

 
   
Ceftazidime
(Injection)
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Restricted Drug Restricted
Red Hospital

 




    • CUH additional info: Injection can be used to manufacture an intravitreal injection. See appropriate monograph on Trust Intranet.

    • NWAFT info: Restricted to Pseudomonas infection in respitatory patients.

    • RPH: Use is not restricted within the Thoracic Directorate



 

 
Link  CUH Intravitreal monographs
   
Ceftazidime and Avibactam (Zavicefta®)
(Injection)
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Restricted Drug Restricted
Red Hospital

  • CUHFT: (Micro Consultant Advice Only):

    • Clinically approved for the treatment of of carbapenemase-producing organisms (CPO) specifically Klebsiella pneumoniae Carbapenemase (KPC)-Producing where alternative treatments are not tolerated or where antibiotic resistance leaves no alternative efficacious regime in adults

    • 3rd or 4th line where standard antimicrobials had failed to treat the infection and probably in combination with either amikacin or colistemethate (to reduce resistance), where sensitivity tests had proven susceptibility and there was no other alternative or if a patient had experienced nephrotoxicity then it may be used as monotherapy.



  • NWAFT: Non-formulary

  • RPH: Restricted use

 
   
Ceftolozane and Tazobactam (Zerbaxa®)
(Injection)
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Restricted Drug Restricted
Red Hospital

  • CUHFT: (Micro Consultant Advice Only):

    • Clinically approved for the treatment of multi-drug resistant Pseudomonas aeruginosa infections in adults

    • 3rd or 4th line where standard antimicrobials had failed to treat the infection and probably in combination with either amikacin or colistemethate (to reduce resistance), where sensitivity tests had proven susceptibility and there was no other alternative or if a patient had experienced nephrotoxicity then it may be used as monotherapy. Double the standard, licensed dose may be used if appropriate.



  • NWAFT: Non-formulary

  • RPH: Restricted use

 
   
Ceftriaxone
(Injection)
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Restricted Drug Restricted
Red Hospital

  • CUH info: Ceftriaxone no longer feature as first line therapy in the ADULT antibiotic guidelines and requires Microbiology or Infectious Diseases approval : EXCEPTIONS include community acquired CNS infections such as meningitis or brain abscess. Ceftriaxone is not restricted in paediatric patients.

  • NWAFT info: Restricted to treatment of meningitis, typhoid fever and  for use in paediatrics.

 
   
 ....
 Non Formulary Items
Cefaclor

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Grey
 
Cefadroxil

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Grey
 
Cefradine

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Grey
 
Ceftaroline  (Zinforo®)

View adult BNF View SPC online View childrens BNF Track Changes
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

OTC

Available Over the Counter. Consider Self Care   

Green

Formulary - Can be prescribed in both secondary and primary care.   

Advice

Formulary - Specialist Advice, secondary care advice provided for primary care initiation.  

Amber No SCG

Formulary - Specialist initiation without shared care guidance.  

Amber SCG

Formulary - Specialist initiation with shared care guidance.  

Red Hospital

Restricted - Prescribing (and monitoring where applicable) to remain with the hospital or specialist service. Not to be prescribed in Primary Care  

Switch

Not recommended for prescribing. Switch to alternative cost-effective option.   

Black

Not recommended for prescribing in primary or secondary care.  

Grey

Not recommended as no formal application made for addition to the formulary. Contact relevant pharmacy team for further information.   

Non Formulary

Non-Formulary (category under review).  

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