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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)

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 Details...
05.03.01  Expand sub section  HIV infection
05.03.01  Expand sub section  Nucleoside reverse transcriptase inhibitors
Abacavir (Ziagen®)
(Tablet, Oral Solution)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital
High Cost Medicine

CUH additional advice:



  • For Clinic 1A: HIV patients in whom all other HIV treatment has failed or had unacceptable side effects.


 

 
   
Abacavir and Lamivudine
(Tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital
High Cost Medicine

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.


 

 
   
Abacavir and Lamivudine and Zidovudine (Trizivir®)
(Tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital
High Cost Medicine

CUH additional advice:



  • Restricted to ID / GU Medicine advice only



  • Clinic 1A - AIDS/HIV patients - combination to lighten pill-burden & increase compliance.


 

 
   
Didanosine (Videx®)
(Tablet,Capsule EC, Powder for suspension)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital
High Cost Medicine

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.


 

 
   
Emtricitabine (Emtriva®)
(Capsule, Oral Solution)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital
High Cost Medicine

CUH additional advice:



  • Restricted to ID / GU Medicine advice only.



  • Clinic 1A only for AIDS/HIV patients.


 

 
   
Emtricitabine 200mg, Rilpivirine 25mg and Tenofovir 245mg (Eviplera®)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital
High Cost Medicine

CUH additional advice:



  • Restricted to ID / GU Medicine advice only.



  • Clinic 1A - AIDS/HIV patients.


 

 
   
Lamivudine (Epivir®)
(Tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital
High Cost Medicine

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.


 

 
   
Lamivudine (Zeffix®)
(Tablet, Oral Solution)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital
High Cost Medicine

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.


 

 
Link  CG165: Chronic Hepatitis B
   
Rilpivirine hydrochloride (Edurant®)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital
High Cost Medicine

CUH additional advice:



  • For HIV infection in combination with other antiretroviral drugs



  • Restricted to ID / GU Medicine advice only



  • Efavirenz intolerant patients only.

 
   
Stavudine (Zerit®)
(Capsule, Oral Solution)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital
High Cost Medicine

CUH additional advice:



  • Restricted to ID / GU Medicine advice only.



  • Clinic 1A - Management of AIDS/HIV patients.


 

 
   
Tenofovir 245mg, Efavirenz 600mg and Emtricitabine 200mg (Atripla®)
(Tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital
High Cost Medicine

CUH additional advice:



  • Restricted to ID / GU Medicine advice only.



  • Clinic 1a - restricted to patients stabilised on the separate components.


 

 
   
Tenofovir and Emtricitabine (Truvada®)
(Tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital
High Cost Medicine

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.


 

 
   
Tenofovir Disproxil (Viread®)
(Tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital
High Cost Medicine

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.


 

 
Link  NICE TA173: Hepatitis B (chronic) - tenofovir disoproxil
   
Tenofovir, cobicistat, elvitegravir & emtricitabine (Stribild®)
(Film-coated tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital
High Cost Medicine

CUH additional advice:



  • Restricted to use in accordance with the NHS England commissioning statement.

 
Link  Clinical commissioning policy statement: Stribild for the treatment of HIV-1 infection in adults
Link  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
Link  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
   
Zidovudine (Retrovir®)
(Capsule, Oral solution, Injection)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital
High Cost Medicine

CUH additional advice:



  • Restricted to ID / GU Medicine and Microbiology advice only.



  • Clinic 1A (for AIDS/HIV pts) & Needle stick injuries.


 

 
   
Zidovudine and lamivudine
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital
High Cost Medicine

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.


 

 
   
05.03.01  Expand sub section  Protease inhibitors
05.03.01  Expand sub section  Non-nucleoside reverse transcriptase inhibitors
05.03.01  Expand sub section  Other antiretrovirals to top
05.03.01  Expand sub section  Pharmacokinetic enhancers of antiretrovirals
05.03.01  Expand sub section  Combination Products
 ....
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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