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Area Prescribing Committee
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 Formulary Chapter 5: Infections - Full Chapter
Notes:

Primary Care
Please refer to the Antimicrobial Guide (web-based).
PDF documents are available from the APC website.

Secondary Care
Please refer to any individual Hospital Trust guidelines for guidance on antibiotic treatment in hospitals.

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 Details...
05.01  Antibacterial drugs
05.01.02.03  Other beta-lactums antibiotics
Aztreonam nebuliser solution
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Red
NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

For Cystic Fibrosis 
   
05.01.04  Aminoglycosides
Gentamicin (for nebulisation)
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Red

Cystic fibrosis
NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

Bronchiectasis (non-cystic fibrosis)
Amber Patient Retained Pan Mersey APC (2019). BRONCHIECTASIS (non-cystic fibrosis), nebulised antibiotics

 
   
Tobramycin nebuliser solution
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Red

Cystic fibrosis
NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

Bronchiectasis (non-cystic fibrosis)
Amber Patient Retained Pan Mersey APC (2019). BRONCHIECTASIS (non-cystic fibrosis), nebulised antibiotics

 
Link  NICE TA276: Colistimethate sodium and tobramycin dry powders for inhalation for treating pseudomonas lung infection in cystic fibrosis
   
05.01.05  Macrolides
05.01.07  Fosfomycin to top
05.01.07  Linezolid
Linezolid
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Amber Recommended
Tablets 600mg
Suspension 100mg/5ml

Short-term use (14 days or less) in patients not admitted to hospital.

Red for long-term use (>14days) and where patient has been admitted to hospital.

Microbiologist recommendation only.


 
   
05.01.07  Polymyxins
Colistimethate for nebulisation
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Red

Powder for reconstitution, colistimethate sodium, 1 million-unit vial and 2 million-unit vial

Cystic fibrosis
NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

Bronchiectasis (non-cystic fibrosis)
Amber Patient Retained Pan Mersey APC (2019). BRONCHIECTASIS (non-cystic fibrosis), nebulised antibiotics

 
Link  NICE TA276: Colistimethate sodium and tobramycin dry powders for inhalation for treating pseudomonas lung infection in cystic fibrosis
   
05.01.07  Rifaximin
Rifaximin (Targaxan®)
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Amber Retained
Tablets 550mg

For treatment of hepatic encephalopathy only. Other strengths & indications are non-formulary. 
Link  RIFAXIMIN for Hepatic Encephalopathy, Pan Mersey Area Prescribing Committee Policy Statement
Link  NICE TA337: Rifaximin for preventing episodes of overt hepatic encephalopathy
   
05.01.07  Fidaxomicin
Fidaxomicin (Dificlir®)
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Amber Recommended
Tablets 200mg

For the treatment of Clostridium difficile Infections in adults following recommendation by a consultant microbiologist or consultant in infectious diseases 
Link  Public Health England: Updated guidance on the management and treatment of Clostridium difficile infection, May 2013
   
05.01.08  Sulphonamides and trimethoprim to top
Co-trimoxazole
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Red

Tablets 480mg
Oral suspension 240mg/5ml and 480mg/5ml

Designated red for long-term use, and for short-term use where the hospital clinician has requested sensitivities on a sample.

Amber Recommended Designated amber recommended for short-term use where the GP has initially requested sensitivities on a sample, and they would then receive or request advice from a specialist with the recommendation for prescribing co-trimoxazole. 

 

 
   
05.01.09  Antituberculosis drugs
 note 

Red Antibacterial drugs when used for tuberculosis

NHSE NHSE commissioned drug - see Specialised Commissioning: Key documents

05.02.01  Triazole antifungals
Itraconazole
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Green

capsules 100mg

Red  for Chronic Pulmonary Aspergillosis NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

 

Amber Patient Retained for Allergic Pulmonary Aspergillosis

 
Link  Pan Mersey Area Prescribing Committee (2019): ITRACONAZOLE for allergic bronchopulmonary aspergillosis
   
Posaconazole
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Red

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents
for Fungal infection or Chronic Pulmonary Aspergillosis

BLACK for Allergic Pulmonary Aspergillosis

 
Link  Pan Mersey Area Prescribing Committee (2019): VORICONAZOLE (VFEND®) or POSACONAZOLE (Noxafil®) for allergic bronchopulmonary aspergillosis
   
Voriconazole
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Red

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents
for Fungal infection or Chronic Pulmonary Aspergillosis

BLACK for Allergic Pulmonary Aspergillosis

 
Link  Pan Mersey Area Prescribing Committee (2019): VORICONAZOLE (VFEND®) or POSACONAZOLE (Noxafil®) for allergic bronchopulmonary aspergillosis
   
05.03.01  HIV infection
 note  NHS NHSE commissioned service- see Specialised Commissioning: Key documents  for further information.
Red Antivirals in HIV
05.03.02.02  Cytomegalovirus infection
 note  NHS NHSE commissioned service- see Specialised Commissioning: Key documents  for further information.

Red Drugs for Cytomegalovirus infection
05.03.03  Viral hepatitis (B&C) to top
 note  NHS NHSE commissioned service- see Specialised Commissioning: Key documents and relevant NICE TAs for further information. 


Red Antivirals in viral hepatitis
05.03.04  Influenza
05.06  Eye, Ear, Nose and Throat
 ....
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
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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

Green

Medicines considered suitable for non-specialist prescribing in primary or secondary care.  

Amber Recommended

Requires specialist assessment to enable patient selection.  Amber Recommended medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Following specialist assessment, the medicine is suitable for prescribing in Primary Care.  

Amber Initiated

Amber Initiated. Requires specialist initiation of prescribing. Prescribing to be continued by the specialist until stabilisation of the dose is achieved and the patient has been reviewed. Amber Initiated medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable   

Amber Retained

Amber Patient Retained. Requires specialist initiation of prescribing. Prescribing to be continued by specialist until stabilisation of the dose is achieved and the patient had been reviewed. Patient remains under the care of specialist (ie not discharged) as occasional specialist input may be required. Amber Patient Retained medicines must meet criteria: (1)Requires specialist assessment to enable patient selection (2)Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable (4) May require occasional specialist input indefinitely and therefore the patient should not be discharged from specialist care   

Amber

Medicines recommended or initiated by specialists in primary or secondary care. Non-specialist prescribing in primary care may follow according the RAG criteria. In process of being superceded by Amber Recommended, Amber Initiated and Amber Patient Retained.  

Purple

Shared Care. Medicines are considered suitable for Primary Care prescribing and/or management, following specialist initiation of therapy, with on-going communication between the Primary Care prescriber and specialist, within the framework of a Shared Care Agreement. Medicines designated as requiring Shared Care require on-going input from both Specialist and Primary Care clinicians and patients should not be discharged from Specialist care. Where prescribing and monitoring are required under shared care, it is implicit that the responsibility for both of these tasks rests with the prescriber. A Shared Care Agreement will always be available for Shared Care medicines and this document will include a Shared Care Agreement pro-forma which will be completed by all involved clinicians. This pro-forma will record agreement to take on defined aspects of care e.g. monitoring and/or on-going prescribing for the individual patients. A policy detailing clinician responsibilities in Shared Care Agreements must be referred to in all cases of Shared Care. All drugs to be included in this category must meet Shared Care criteria 1 to 3: SC1 Requires specialist assessment to enable patient selection and also initiation, stabilisation and review of treatment and the patient`s condition. SC2 Prescribing and/or management of the drug in Primary Care with specialist support and input, within the framework of the Shared Care Agreement is safe and convenient and that there is an appropriate mechanism for individual patient access in Primary Care. SC3 Requires specific long-term monitoring (blood test or other measurement) for adverse effects and / or efficacy of the drug to be completed in Primary Care, and requires on-going specialist support for the dose changes or management of adverse effects. Monitoring is required on a regular basis (typically four times a year). Implicit in any shared care agreement is the understanding that participation is at the discretion of the Primary Care prescriber subject to their clinical confidence.   

Red

Primary care prescribing of these medicines is NOT recommended. These treatments should be initiated by specialists only; ongoing prescribing is retained within secondary care.   

Black

Not recommended for use. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist.   

Grey

Not recommended for use at this time. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist. Further guidance will be issued when more information or evidence is made available.  

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