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 Formulary Chapter 5: Infections - Full Chapter
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 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...
05.03.03.02  Expand sub section  Chronic hepatitis C
Daclatasvir  (Daklinza®)
(Tablet)
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Restricted Drug Restricted
Red Hospital
High Cost Medicine
NHS England

 



  • Used in accordance with treatment options and run rates as established for the Eastern Liver Network ODN. All second and third line treatments must be discussed regionally for approval. Further information can be found at www.easternliver.net.



  • Commissioning policy NHS England B07/P/a and NICE TA 364: Commissioned for use in: • Genotype 3 with compensated cirrhosis in combination with sofosbuvir and ribavirin for 12 weeks where interferon is contraindicated (note regimen is unlicensed). • Genotype 3 with decompensated cirrhosis in combination with sofosbuvir and ribavirin for 12 weeks (note regimen is unlicensed).



  • Prior approval via Blueteq system required via Lloyds. 


 

 
Link  NHS England interim commissioning policy (NHS England B07/P/a)
Link  NICE TA 364: Daclatasvir for treating chronic hepatitis C
   
Dasabuvir (Exviera®)
(Tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital
High Cost Medicine
NHS England

  • Used in accordance with treatment options and run rates as established for the Eastern Liver Network ODN. All second and third line treatments must be discussed regionally for approval. Further information can be found at www.easternliver.net.



  • Commissioning policy NHS England B07/P/a and NICE TA365.



  • Prior approval via Blueteq system required : suppplied via Lloyds at CUH.



  • Commissioned for use in: • Genotype 1a and 1b with compensated cirrhosis in combination with ombitasvir/paritepravir/ritonavir and ribavirin for 12 weeks.




 
Link  NHS England interim commissioning policy (NHS England B07/P/a)
Link  NICE TA365: Ombitasvir–paritaprevir–ritonavir with or without dasabuvir for treating chronic hepatitis C
   
Elbasvir and Grazoprevir  (Zepatier®)
(Tablets)
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Restricted Drug Restricted
Red Hospital
High Cost Medicine
NHS England

 




    • As per NICE TA413 when funding confirmed by NHSE.



 




    • BlueTeq forms required.



 

 
Link  NICE TA413: Elbasvir-grazoprevir for treating chronic hepatitis C
   
Glecaprevir and Pibrentasvir (Maviret®)
(Tablets )
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Restricted Drug Restricted
Red Hospital
NHS England

  • Approved for use in line with NICE TA499 - Glecaprevir and Pibrentasvir for treating chronic hepatitis C. 

 
Link  NICE TA499: Glecaprevir–pibrentasvir for treating chronic hepatitis C
   
Ledipasvir and Sofosbuvir (Harvoni®)
(Tablet)
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Restricted Drug Restricted
Red Hospital
High Cost Medicine
NHS England

  • Used in accordance with treatment options and run rates as established for the Eastern Liver Network ODN. All second and third line treatments must be discussed regionally for approval. Further information can be found at www.easternliver.net.



  • Commissioning policy NHS England B07/P/a and NICE TA 363: Commissioned for use in: • Genotype 1a and 1b with compensated or decompensated cirrhosis in combination with ribavirin for 12 weeks (note regimen is unlicensed for some cohorts). • Genotype 3 with compensated or decompensated cirrhosis in combination with ribavirin for 12 weeks (note regimen is unlicensed). • Genotype 4 with compensated cirrhosis for 12 weeks (note regimen is unlicensed). • Genotype 4 with decompensated cirrhosis in combination with ribavirin for 12 weeks (note regimen is unlicensed).



  • Prior approval via Blueteq system required. Supplied via Lloyds at CUH.


 

 
Link  NHS England interim commissioning policy (NHS England b07/P/a)
Link  MHRA: Avoid use of amiodarone with sofosbuvir
Link  NICE TA 363: Ledipasvir and Sofosbuvir for treating chronic Hepatitis C
   
Ombitasvir, Paritaprevir and Ritonavir (Viekirax®)
(Tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital
High Cost Medicine
NHS England

 



  • Used in accordance with treatment options and run rates as established for the Eastern Liver Network ODN. All second and third line treatments must be discussed regionally for approval. Further information can be found at www.easternliver.net.



  • Commissioning policy NHS England B07/P/a and NICE TA 365 Commissioned for use in: Genotype 1a with compensated cirrhosis in combination with dasabuvir and ribavirin for 12 weeks (note 12 week regimen unlicensed). • Genotype 1b with compensated cirrhosis in combination with dasabuvir and ribavirin for 12 weeks. 



  • Prior approval via Blueteq system required. Supplied via Lloyds at CUH.


 


 

 
Link  NHS England interim commissioning policy (NHS England B07/P/a)
Link  NICE TA 365: Ombitasvir/ paritaprevir/ ritonavir with or without dasabuvir for treating chronic hepatitis C
   
Simeprevir (Olysio®)
(Capsule)
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Restricted Drug Restricted
Red Hospital
High Cost Medicine

  • Used in accordance with treatment options and run rates as established for the Eastern Liver Network ODN. All second and third line treatments must be discussed regionally for approval. Further information can be found at www.easternliver.net.



  • Commissioning policy NHS England B07/P/a and NICE TA 331 : Commissioned for use in: • Genotypes 1a and 1b and 4 with compensated cirrhosis in combination with peg-interferon and ribavirin for 12 weeks (followed by peg-interferon and ribavirin alone for a further 12 weeks). • Simeprevir is not recommended for people with genotype 1a and the Q80k polymorphism. • Simeprevir should be stopped at week 4 of treatment if HCV RNA is 25IU/ml or more and stopped at week 12 or 24 if HCV RNA is undetectable. • Peg-interferon and ribavirin treatment should continue for 36 weeks if patient is a null responder to previous treatment or has HIV co-infection. 



  • Prior approval via Blueteq system required.


 

 
Link  MHRA: Avoid use of amiodarone with simeprevir
Link  NHS England interim commissioning policy (NHS England B07/P/a)
Link  NICE TA331: Simeprevir with peginterferon alfa & ribavirin for hepatitis C
   
Sofosbuvir (Sovaldi®)
(Tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital
High Cost Medicine

  • Used in accordance with treatment options and run rates as established for the Eastern Liver Network ODN. All second and third line treatments must be discussed regionally for approval. Further information can be found at www.easternliver.net.



  • Commissioning policy NHS England B07/P/a and NICE TA 330 : Commissioned for use in: Genotype 3 with compensated cirrhosis in combination with • Genotype 3 with compensated cirrhosis in combination with peg-interferon and ribavirin for 12 weeks for patients likely to be interferon tolerant. • Genotype 3 with compensated cirrhosis in combination with daclatasvir and ribavirin for 12 weeks where interferon is contraindicated (note regimen is unlicensed).



  • Prior approval via Blueteq system required. 


 

 
Link  NHS England interim commissioning policy (NHS England B07/P/a)
Link  MHRA: Avoid use of amiodarone with sofosbuvir
Link  NICE TA330: Sofosbuvir for treating chronic hepatitis C
   
Sofosbuvir and Velpatasvir (Epclusa®)
(Tablets)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital

  • Approved in accordance with NICE TA430.



  • BlueTeq required.

 
Link  NICE TA430 Sofosbuvir–velpatasvir for treating chronic hepatitis C
   
Sofosbuvir, Velpatasvir and Voxilaprevir (Vosevi® )
(Tablets)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Hospital

  • Approved for use in accordance with NICE TA507 - Sofosbuvir, Velpatasvir and Voxilaprevir for treating chronic hepatitis C. 

 
   
 ....
 Non Formulary Items
Boceprevir  (Victrelis®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Black
High Cost Medicine

  • January 2015: WITHDRAWN AND DISCONTINUED. 

Link  Link to reviews
Link  MHRA Drug Safety Update December 2014: Boceprevir (Victrelis) and telaprevir (Incivo) - Predictive factors for sepsis, worsening liver function, and mortality
Link  NICE TA253 WITHDRAWN: Boceprevir for the treatment of genotype 1 chronic hepatitis C
 
  
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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