As a part of the trust antibiotic stewardship programme to reduce C. difficile, MRSA and other multi-drug resistant infections some high-risk antimicrobial agents have been designated as “restricted drugs” and their use must be discussed with microbiologist.
Pharmacy will NOT supply antimicrobials on the restricted list unless there is documented evidence of Consultant Microbiologist / ID Physician approval in the medical notes and / or prescription chart.
Non-formulary antimicrobials
A Consultant may discuss with microbiologist and then obtain approval from the Chair of the Drugs and Therapeutics Committee on a named patient basis for any non-formulary antibiotics.
These antimicrobials may only be prescribed and supplied after approval from a named Consultant Microbiologist or Infectious Disease Physician. Pharmacists are required to confirm Microbiology approval before dispensing red restricted antimicrobials.
Red restricted antimicrobials are:
Amikacin
Amphotericin B (Fungizone®)
Aztreonam
Ceftazidime
Ceftaroline
Ceftazidime-avibactam
Ceftolozane-tazobactam
Cefiderocol
Colistin IV
Chloramphenicol IV/PO
Dalbavancin
Daptomycin
Ertapenem
Fidaxomicin
Flucyctosine
Fosfomycin PO/IV
Ivermectin (Unlicensed)
Levofloxacin
Linezolid
Pivmecillinam
Quinine IV
Ticarcillin- clavulanic acid (Timentin)
Tigecycline
Temocillin
These antimicrobials maybe prescribed without discussion with a Consultant Microbiologist/ ID Physician only if they are being used for an approved indication/ specialty as listed below. Consultant Microbiologist/ ID Physician can authorize off-guideline use of amber restricted antimicrobials for individual patients; this should be documented in the medical notes and/ or on the prescription chart. Pharmacists will discuss with Microbiologists all unautherised off-guideline use of amber restricted antimicrobials.
Amber restricted antimicrobials are:
| Amphotericin (AmBisome®) | Consultant Micobiologist/ Haematologist approval for Haematology/ Oncology treatment of invasive fungal infections |
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| Anti-tuberculosis drugs | Tuberculosis as advised by Consultant Respiratory Physician |
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| Azithromycin | GUM only and pertussis prophylaxis |
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| Caspofungin | Consultant Micobiologist/ Haematologist approval for Haematology/ Oncology |
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| Cefixime | Paediatrics / GUM / Oral cephalosporin step down if H.influenzae isolates and other agents cannot be used. |
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| Cefotaxime |
SCBU only |
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| Ceftazidime | Indications specified in the antimicrobial formulary |
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| Ceftriaxone | GUM or indications specified in the Antimicrobial Formulary |
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| Ciprofloxacin | SBP prophylaxis, Meningococcal prophylaxis, prophylaxis in patients at high risk of neutropenic sepsis, indications specified in the antimicrobial formulary |
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| Co-amoxiclav | Indications as specified in the Antimicrobial Formulary |
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| Colistin nebs | Respiratory only |
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| Co-trimoxazole | Prophylaxis and treatment of PCP / Prophylaxis for SBP where sensitivity has been confirmed / Listeria meningitis (3rd line serious penicillin allergy). Treatment of Stenotrophomonas |
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| Dapsone | Prophylaxis and treatment of PCP / toxoplasma |
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| Famciclovir | GUM only |
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| Itraconazole | Posaconazole is now used instead for the prophylaxis in haematology/oncology patients |
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| Meropenem | Indications specified in the antimicrobial formulary |
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| Micafungin | Consultant Micobiologist/ Haematologist approval for Haematology/ Oncology |
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| Minocycline | Dermatology only |
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| Ofloxacin |
GUM/Prostatitis and Epididymo-orchitis as per formulary |
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| Posaconazole | Consultant Micobiologist/ Haematologist approval for Haematology/ Oncology |
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| Rifaximin | Hepatic encephalopathy – recurrence as per gastroenterology |
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| Rifampicin | Tuberculosis as advised by consultant respiratory physician / combination therapy for deep seated MRSA infections as advised by microbiologist |
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| Sodium fusidate | Combination therapy for osteomyelitis on microbiologist advice onlyCombination therapy for MRSA |
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| Tazocin (piperacillin-tazobactam) | Specific indications as in formulary |
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| Teicoplanin | Specific indication listed in formulary |
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| Terbinafine | Dermatology only |
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| Tobramycin | Cystic fibrosis |
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| Valaciclovir | GUM only |
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| Vancomycin (oral) | First line in severe Clostridium difficile infection Second line in moderate Clostridium difficile infection |
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| Voriconazole | Consultant Micobiologist/ Haematologist approval for Haematology/ Oncology |