North East and North Cumbria Formulary


	North East and North Cumbria ICS Formulary

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Formulary Chapter 5: Infections - Full Chapter

Chapter Links...

COVID-19 Therapeutic Alert

Interim Clinical Commissioning Policy: Antivirals or neutralising monoclonal antibodies in the treatment of COVID-19 in hospitalised patients (Version 5 - effective from 10th February 2022)

NICE NG15: Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use

NICE NG63: Antimicrobial stewardship: changing risk-related behaviours in the general population

North of Tyne, Gateshead and North Cumbria - Antibiotic and Diagnostic quick reference tools

Primary Care Antimicrobial Guidelines

TEWV: Antibiotic Prescribing Procedure

UK Interim Clinical Commissioning Police - Therapies for patients with symptomatic hospital-onset COVID-19

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05.02

Antifungal drugs

05.02

Treatment of fungal infections

05.02

Drugs used in fungal infections

05.02.01

Triazole antifungals

Fluconazole Oral Preparations

Formulary

Capsules: 50mg, 150mg, 200mg
Oral solution: 50mg/5ml, 200mg/5ml

Itraconazole Oral Preparations

Formulary

100mg capsules
50mg in 5ml oral solution

Fluconazole Infusion

Formulary

IV infusion: 50mg/25ml, 200mg/100ml

Isavuconazole (Cresemba^®)

Formulary

Approved for use in line with licensed indications and specifically in solid organ transplant and bone marrow transplant recipients.

Itraconazole Infusion

Formulary

250mg in 25ml injection for IV infusion

Posaconazole (Noxafil^®)

Formulary

Approved for the prevention of invasive fungal infection in immunocompromised patients in whom there is a specific risk of aspergillus infection or where fluconazole and itraconazole are not tolerated or are unlikely to be sufficiently effective (largely for secondary prevention).
Approved for patients with invasive fungal infections that are not responding to other treatments or where they are not tolerated (largely in place of liposomal amphotericin/ voriconazole).

Voriconazole

Formulary

MHRA Safety Alert (May 2014): Voriconazole: reminder of liver toxicity, phototoxicity and squamous cell carcinoma

05.02.02

Imidazole antifungals

05.02.03

Polyene antifungals

Nystatin

Formulary

100,000 units/ml suspension .
100,000 unit pessaries unlicensed
- Second line treatment for vaginal non albicans infection, for patients who have not responded to standard treatments such as azoles. Prescribing is restricted to the GUM clinics.

Amphotericin

Formulary

50mg injection (Fungizone®)
50mg liposomal injection (Ambisome®)

MHRA Drug Safety Update (July 2018): Parenteral amphotericin B: reminder of risk of potentially fatal adverse reaction if formulations confused

MHRA Drug Safety Update (July 2020): Liposomal and lipid- complex formulations: name change to reduce medication errors

05.02.04

Echinocandin antifungals

Anidulafungin

Formulary

Caspofungin

Formulary

Micafungin

Formulary

05.02.05

Other antifungals

Terbinafine

Formulary

Griseofulvin

Formulary

For very limited use where terbinafine is contraindicated.

Flucytosine

Formulary

500mg tabletsunlicensed.
2.5g in 250ml IV infusion.

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Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	NHS England
	Homecare
	CCG

Traffic Light Status Information

Status	Description
	Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.
	Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.
	Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.
	Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.
	NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.
	UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.
	NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.