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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)

Chapter Links...
 Details...
05.01.02.02  Expand sub section  Carbapenems
Ertapenem (Invanz)
(Infusion)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital

  • Penicillin ( beta lactam) type antibiotic.

  • CUH info: Restricted use for OPAT for ESBL UTI and cellulitis to facilitate discharge. Only one dose should be given in hospital. AED can use one dose overnight for those patients deemed appropriate for OPAT whilst awaiting OPAT assessment the following day.

  • NWAFT info: Consultant Microbiologist approval required.

 
   
Meropenem
(Injection)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital

  • Penicillin ( beta- lactam) antibiotic.

  • NWAFT- no additional restriction

  • CUH additional info.


    • Microbiology approval required for the 1g TDS dosing regime. Microbiology approval not required for 500mg TDS dosing regime or 500mg QDS dosing regime.

    • The 1g TDS dose can be replaced with 500mg QDS unless used for the below indications:  • Patients with renal impairment • Neonatal and paediatric patients • Cystic fibrosis patients • Patients prescribed meropenem 2g IV TDS for bacterial meningitis or CNS infections • Pseudomonas infections • Acinetobacter infections (as the 500mg QDS dose has been shown to give a similar % time above the MIC to the 1g TDS dose for severe sepsis).  

    • Metronidazole and flucloxacillin are not normally needed with Meropenem. See abbreviated CUH  antibiotic guidelines on trust intranet for full guidance.


  • RPH: Not restricted for use by Thoracic Directorate


 

 
   
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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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