Formulary Chapter 5: Infections - Full Chapter
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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... |
05.03.01 |
HIV infection |
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05.03.01 |
Nucleoside reverse transcriptase inhibitors |
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Protease inhibitors |
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Atazanavir (Reyataz®) (Capsule)
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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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Darunavir (Prezista®) (Tablets, Oral suspension)
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Restricted
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CUH additional advice:
- Restricted to ID / GU Medicine advice only.
- Clinic 1A.
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Darunavir & cobicistat (Rezolsta®) (Tablet)
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Formulary
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CUH additional advice: JDTC October 2016:
- Clinical and funding approval granted.
- Issues around service capacity to switch eligible patients onto more cost effective brands.
- For now, patients can continue treatment if admitted on this but no patient's to be switched until HIV Pharmacist in post.
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CCP: Tenofovir Alafenamide for treatment of HIV 1 in adults and adolescents
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Fosamprenavir (Telzir®) (Tablet, Oral Suspension)
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Restricted
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CUH additional advice:
- Restricted to ID / GU Medicine advice only.
- Restricted to Clinic 1A consultants only - funding not agreed.
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Indinavir (Crixivan®) (Capsule)
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Restricted
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CUH additional advice:
- Restricted to ID / GU Medicine advice only.
- Clinic 1A - Treatment of HIV patients in combinaton with nucleoside analogues.
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Lopinavir and Ritonavir (Kaletra®) (Tablet, Liquid)
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Restricted
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CUH additional advice:
- Clinic 1A - for AIDS/HIV patients only (the combination helps with compliance).
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Ritonavir (Norvir®) (Tablets, Oral Solution)
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Restricted
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CUH additional advice:
- Restricted to ID / GU Medicine advice only.
- Clinic 1a - AIDS/HIV patients in combination with nucleoside analogues.
- Powder sachets (3 year expiry).
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Saquinavir (Invirase®) (Capsule, Tablet)
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Restricted
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CUH additional advice:
- Restricted to ID / GU Medicine advice only.
- Treatment of HIV patients in combination with nucleoside analogues.
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MHRA safety advice (Dec 2010) : update on risk of arrhythmias - reduced dose for initial treatment
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Tipranavir (Aptivus®) (Capsule)
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Restricted
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CUH additional advice:
- Restricted to ID / GU Medicine advice only.
- Restricted to Clinic 1A Consultant prescribing only.
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Non-nucleoside reverse transcriptase inhibitors |
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05.03.01 |
Other antiretrovirals |
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Pharmacokinetic enhancers of antiretrovirals |
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Combination Products |
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Non Formulary Items |
Amprenavir (Agenerase®)

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Non Formulary
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Capsule, Oral Solution |
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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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