| Formulary Chapter 5: Infections - Full Chapter
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| 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  , 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 - February 2020 |
| CUHFT Antimicrobial Prescribing App |
| CUHFT: Emergency Medicine Sepsis Guideline |
| NWAFT - Antimicrobial Guidelines |
| Treat your infection: Patient information Leaflet |
| Details... |
| 05.03.01 |
HIV infection |
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Nucleoside reverse transcriptase inhibitors |
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Abacavir (Ziagen®)
(Tablet, Oral Solution)
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Restricted
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CUH additional advice:
- For Clinic 1A: HIV patients in whom all other HIV treatment has failed or had unacceptable side effects.
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Abacavir and Lamivudine
(Tablet)
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Restricted
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CUH additional advice:
- Restricted to ID / GU Medicine advice only clinic 1A. Generic prescribing.
- Abacavir sulphate 600mg and lamivudine 300mg Previously Kivexa® - Now prescribe as generic.
- Abacavir hydrochloride 600mg and lamivudine 300mg Previously Lupin – Now prescribe as generic.
- Abacavir hydrochloride 600mg and lamivudine 300mg Previously Mylan – Now prescribe as generic.
- Abacavir 600mg and lamivudine 300mg Previously Teva – Now prescribe as generic.
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Abacavir and Lamivudine and Zidovudine (Trizivir®)
(Tablet)
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Restricted
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CUH additional advice:
- Restricted to ID / GU Medicine advice only
- Clinic 1A - AIDS/HIV patients - combination to lighten pill-burden & increase compliance.
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Didanosine (Videx®)
(Tablet,Capsule EC, Powder for suspension)
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Restricted
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CUH additional advice:
- Powder for suspension is named patient.
- Restricted to ID / GU Medicine advice only.
- If needed tablets can be crushed and dispersed in water.
- HIV patients usually in combination with Zidovudine.
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Emtricitabine (Emtriva®)
(Capsule, Oral Solution)
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Restricted
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CUH additional advice:
- Restricted to ID / GU Medicine advice only.
- Clinic 1A only for AIDS/HIV patients.
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Emtricitabine 200mg, Rilpivirine 25mg and Tenofovir 245mg (Eviplera®)
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Restricted
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CUH additional advice:
- Restricted to ID / GU Medicine advice only.
- Clinic 1A - AIDS/HIV patients.
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Lamivudine (Epivir®)
(Tablet)
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Restricted
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CUH additional advice:
- For HIV infection in combination with other antiretroviral drugs.
- Restricted to ID / GU Medicine advice only.
- Tablets only. Treatment of patients with HIV/AIDS. Must be used as combination therapy in line with an agreed protocol.
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Lamivudine (Zeffix®)
(Tablet, Oral Solution)
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Restricted
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CUH additional advice:
- For chronic hepatitis B infection.
- Restricted to ID / GU Medicine advice only.
- Tablets only. For Dr. G. Alexander's Hepatitis B patients. Funding allowed for 10 patients annually.
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CG165: Chronic Hepatitis B
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Rilpivirine hydrochloride (Edurant®)
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Restricted
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CUH additional advice:
- For HIV infection in combination with other antiretroviral drugs
- Restricted to ID / GU Medicine advice only
- Efavirenz intolerant patients only.
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Stavudine (Zerit®)
(Capsule, Oral Solution)
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Restricted
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CUH additional advice:
- Restricted to ID / GU Medicine advice only.
- Clinic 1A - Management of AIDS/HIV patients.
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Tenofovir 245mg, Efavirenz 600mg and Emtricitabine 200mg (Atripla®)
(Tablet)
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Restricted
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CUH additional advice:
- Restricted to ID / GU Medicine advice only.
- Clinic 1a - restricted to patients stabilised on the separate components.
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Tenofovir and Emtricitabine (Truvada®)
(Tablet)
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Restricted
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CUH additional advice:
- Restricted to ID / GU Medicine advice only
- If needed tablets can be dispersed in 100ml of water, grape or orange juice for patients with swallowing difficulties.
- Restricted to patients stabilised on the two component drugs.
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Tenofovir Disproxil (Viread®)
(Tablet)
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Restricted
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CUH additional advice:
- Restricted to ID / GU Medicine advice only
- If needed tablets can be dispersed in half a glass of water or orange juice.
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NICE TA173: Hepatitis B (chronic) - tenofovir disoproxil
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Tenofovir, cobicistat, elvitegravir & emtricitabine (Stribild®)
(Film-coated tablet)
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Restricted
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CUH additional advice:
- Restricted to use in accordance with the NHS England commissioning statement.
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 Clinical commissioning policy statement: Stribild for the treatment of HIV-1 infection in adults
MHRA Drug Safety Update April 2019: Elvitegravir boosted with cobicistat - avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1
MHRA Letters sent to healthcare professionals in March 2019: Stribild® (elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil) - Increased risk of treatment failure and increased risk of mother-to-child transmission of HIV infection
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Zidovudine (Retrovir®)
(Capsule, Oral solution, Injection)
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Restricted
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CUH additional advice:
- Restricted to ID / GU Medicine and Microbiology advice only.
- Clinic 1A (for AIDS/HIV pts) & Needle stick injuries.
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Zidovudine and lamivudine
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Restricted
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CUH additional advice:
- The generic combination product of zidovudine 300mg/lamivudine 150mg is now cheaper than the separate ingredients so should be used in preference. This replaces branded Combivir® which formerly was not funded by NHSE on cost grounds.
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Protease inhibitors |
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| 05.03.01 |
Non-nucleoside reverse transcriptase inhibitors |
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Other antiretrovirals |
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| 05.03.01 |
Pharmacokinetic enhancers of antiretrovirals |
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Combination Products |
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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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