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 Formulary Chapter 5: Infections - Full Chapter
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05.01.07  Expand sub section  Some other antibacterials
Dalbavancin (Xydalba ®)
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Formulary
Red
  • 500mg injection
    • approved for the treatment of significant deep soft tissue infections such as joint, discitis and spinal infection, on the advice of infectious disease physicians or microbiology.

 
 
Tedizolid (Sivextro®)
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Formulary
Red
  • 200mg tablet and 200mg powder for concentrate for solution for infusion
  • Approved for thre treatment of bacterial skin and skin structure infections only on the advice of microbiologists/ID physicians
 
 
Pristinamycin
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Unlicensed Drug Unlicensed
Red
  • Tablets: 500 mg

 

  • Approved for
    • Pregnant women infected with Mycoplasma Genitalium (MG) infection that is resistant to macrolides
    • Mycoplasma Genitalium (MG) infection that is resistant to macrolides, quinolones and tetracyclines in both men and women
 
 
05.01.07  Expand sub section  Chloramphenicol
Chloramphenicol
(Systemic)
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Formulary
Red
  • Restricted for use on microbiology/infectious diseases advice, or as agreed in Trust Guidelines.
 
 
05.01.07  Expand sub section  Fosfomycin
Fosfomycin
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Formulary
  • 500mg capsules unlicensedunlicensed Red Traffic Light
  • 4g injections Red Traffic Light
  • 3g sachets: sachets can be initiated in primary care for the treatment of UTIs caused by multi-resistant organisms following advice from microbiology only. Most cost effective option to be used Green
 
 
05.01.07  Expand sub section  Fusidic acid
Sodium fusidate
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Formulary
Green
  • 250mg film coated tablets
  • 250mg in 5ml suspension
 
 
05.01.07  Expand sub section  Vancomycin and teicoplanin to top
Teicoplanin
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Formulary
Red
  • Restricted for use on microbiology/infectious diseases advice, or as agreed in Trust Guidelines.
 
 
Vancomycin Injection
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Formulary
Red

Restricted for use on microbiology/infectious diseases advice, or as agreed in Trust Guidelines.

  • 20mg in 4ml intrathecal injection unlicensedunlicensed 
  • 500mg and 1g injections 
 
 
Vancomycin Oral Preparations
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Formulary
Green plus
  • Restricted for use on microbiology/infectious diseases advice, or as agreed in Trust Guidelines.
    • 125mg capsules 
 
 
05.01.07  Expand sub section  Daptomycin
Daptomycin
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Formulary
Red
 
 
05.01.07  Expand sub section  Linezolid
Linezolid Infusion
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Formulary
Red
  • IV infusion: 600mg/300ml

 

  • Restricted for use on microbiology/infectious diseases advice, or as agreed in Trust Guidelines.
 
Link   MHRA Drug Safety Update (Dec 2014): Linezolid: restricted indication
 
Linezolid Oral Preparations
(For courses greater than 14 days)
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Formulary
Red
  • 600mg tablets
  • 100mg in 5ml suspension

 

To be used only on the advice of a Consultant Microbiologist for resistant Gram-positive infections.

Patients must have weekly bloods taken to monitor for haematological side effects if receiving treatment for more than 10 to 14 days. In those receiving treatment for more than 4 weeks a pre-treatment eye assessment is recommended followed by monthly assessments. Patients should be warned to report any visual symptoms promptly (see BNF for CSM warning).

Linezolid is a MAO inhibitor and so potentially life threatening interactions can occur. Check before prescribing.

 
Link  MHRA Drug Safety Update (Dec 2014): Linezolid: restricted indication
 
Linezolid Oral Preparations
(For courses up to 14 days)
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Formulary
Green plus
  • 600mg tablets
  • 100mg in 5ml suspension

 

To be used only on the advice of a Consultant Microbiologist for resistant Gram-positive infections.

RED drug for courses greater than 14 days  Red Traffic Light

Patients must have weekly bloods taken to monitor for haematological side effects if receiving treatment for more than 10 to 14 days. In those receiving treatment for more than 4 weeks a pre-treatment eye assessment is recommended followed by monthly assessments. Patients should be warned to report any visual symptoms promptly (see BNF for CSM warning).

Linezolid is a MAO inhibitor and so potentially life threatening interactions can occur. Check before prescribing.

 
Link  MHRA Drug Safety Update (Dec 2014): Linezolid: restricted indication
 
05.01.07  Expand sub section  Quinupristin and dalfopristin
05.01.07  Expand sub section  Polymyxins
Colistimethate
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Formulary
Green plus
  • 1 million-unit & 2 million-unit vial for nebulisation/intravenous injection
    • Nebulised therapy for bronchiectasis Green Traffic Light
    • Nebulised therapy for patients on assisted ventilation, patients with tracheostomies and those with persistant bacterial bronchitis Green plus
    • To be used for treatment of Cystic Fibrosis in accordance with NHS England Commissioning Policy/NICE Guidance.
    • Nebulised therapy for CF Red Traffic Light.
    • Intravenous therapy Red Traffic Light.
    • Dry powder for inhalation (Colobreath®) Red Traffic Light.

 
Link  Clinical Commissioning Policy: Inhaled Therapy for Adults and Children with Cystic Fibrosis
Link  TA276:Colistimethate sodium and tobramycin dry powders for inhalation for treating pseudomonas lung infection in cystic fibrosis
Link  MHRA Drug Safety Update (Nov 2014): Colobreathe (colistimethate sodium dry powder for inhalation): risk of capsule breakage from inhaler device
 
05.01.07  Expand sub section  Rifaximin to top
Rifaximin
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Formulary
Green plus
  • 550mg Tablets: Only approved for use in accordance with NICE guidance. 

 

 
Link  TA337: Rifaximin for preventing episodes of overt hepatic encephalopathy
 
05.01.07  Expand sub section  Fidaxomicin
Fidaxomicin (Dificlir®)
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Formulary
Green plus
High Cost Medicine
  • 200mg tablets
  • Fidaxomicin 40mg/ml granules for oral suspension
    • Approved for use in the treatment of C. difficile. To be initiated on the recommendation of a consultant microbiologist.
 
 
 ....
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
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

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.  

Amber

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.  

Green plus

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.  

Green

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.  

Black

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.   

Brown

UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

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.  

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