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 Formulary Chapter 5: Infections - Full Chapter
Notes:

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)

Chapter Links...
 Details...
05.01.01.03  Expand sub section  Broad-spectrum penicillins
Amoxicillin
(Capsule, Oral suspension. )
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Formulary
Green

  • Prophylaxis against endocarditis in dental procedures is generally not required.

  • CUHFT info: Sachets  restricted to Chest physicians only.

  • Amoxil 500mg and 250mg Capsules discontinued 31/12/2018 please prescribe generically.

 
Link  NICE CG64 Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures
   
Co-Amoxiclav
(Tablet, Oral suspension)
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Formulary
Green

  • NOTE: contains penicillin

  • CSM has advised that cholestatic jaundice may occur either during or just after treatment with co-amoxiclav. It is more common in patients above the age of 65 years and in males. The duration of treatment should be appropriate to the indication and should not usually exceed 14 days.

  • Prescribe generically in Primary Care


  • Co-amoxiclav provides anaerobic cover. Addition of metronidazole not normally required


     




 

 
   
Amoxicillin IV
(injection)
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Formulary
Red Hospital
 
   
Co-Amoxiclav IV
(Injection)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red Hospital

  • NOTE: contains penicillin

  • CSM has advised that cholestatic jaundice may occur either during or just after treatment with co-amoxiclav. It is more common in patients above the age of 65 years and in males. The duration of treatment should be appropriate to the indication and should not usually exceed 14 days.

  • Co-amoxiclav provides anaerobic cover. Addition of metronidazole not normally required

  • RPH info: Restricted to Consultant and Microbiologist advice only

  • CUHFT info: not to be used for discharge via OPAT. Ceftriaxone once daily is normally a suitable alternative


 

 
   
 ....
 Non Formulary Items
Ampicillin
(Injection)

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Non Formulary
Grey
  • IV ampicillin to be substituted with IV amoxicillin (dose equivalent).
 
Co-Fluampicil

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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 - Hospital only, 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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