Formulary Chapter 5: Infections - Full Chapter
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Notes: |
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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 , 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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Chapter Links... |
C & P Primary Care Antimicrobial Guidelines - November 2020 |
CUHFT Antimicrobial Prescribing App |
CUHFT: Emergency Medicine Sepsis Guideline |
NWAFT - Antimicrobial Guidelines |
Treat your infection: Patient information Leaflet |
Details... |
05.01.01.03 |
Broad-spectrum penicillins |
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Amoxicillin (Capsule, Oral suspension. )
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Formulary
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- 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.
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NICE CG64 Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures
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Co-Amoxiclav (Tablet, Oral suspension)
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Formulary
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Amoxicillin IV (injection)
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Formulary
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Co-Amoxiclav IV (Injection)
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Formulary
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- 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
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Non Formulary Items |
Ampicillin (Injection, capsules, suspension)

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Non Formulary
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- Ampicillin (any formulation) to be substituted with amoxicillin (dose equivalent).
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Co-Fluampicil

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Non Formulary
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October 2020 - discontinuation of Co-fluampicil 250mg/250mg capsules (Crescent)
- Crescent, sole supplier are discontinuing co-fluampicil 250mg/250mg capsules from the UK market in December 2020 due to a manufacturing issue.
- The separate components – amoxicillin and flucloxacillin – remain available from several manufacturers.
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
Status |
Description |

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Available Over the Counter. Consider Self Care |

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

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

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Formulary - Specialist initiation without shared care guidance. |

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Formulary - Specialist initiation with shared care guidance. |

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

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

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Not recommended for prescribing in primary or secondary care. |

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Not recommended as no formal application made for addition to the formulary. Contact relevant pharmacy team for further information.
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Non-Formulary (category under review). |
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