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 Formulary Chapter 5: Infections - Full Chapter
Notes:

See
NHS
MicroGuide Icon on Trust desktops EKHUFT Antimicrobial Guidelines are in Microguide on Trust desktop PCs and as App www

Please refer to the EKHUFT antimicrobial guidelines via the link above for detailed information.

Updates of this chapter are ongoing. Please contact the antimicrobial team with any queries.
See Key messages for hospital prescribers from European Antibiotic Awareness and be aware Dutch hospital antimicrobial use is about one third less than UK

All antimicrobials should be prescribed according to the trust antimicrobial policy or on the advice of a microbiologist. Restricted antimicrobials should be prescribed for the use or department specified unless authorised by a microbiologist.

Please Note some non formulary items may be prescribed in exceptional circumstances under the Microbiology Team direction

 

 Details...
05.02  Expand sub section  Antifungal drugs
Griseofulvin
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
  • Dermatology
    MicroGuide Icon on Trust desktops link to microguide
     
  •    
    Amphotericin (AmBisome)
    (amphotericin encapsulated in liposomes)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Injection only
  • Test dose is required
  • Microbiology advice

    Star High cost drug reimbursed separately from NHS England tariff (PBR excluded)

    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.
    MicroGuide Icon on Trust desktops link to microguide 
  • Link  NPSA alert on injectable amphotericin
       
    Flucytosine (Ancotil)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted Injection, Tablets(Unlicensed)
  • Microbiology / renal

    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.
    MicroGuide Icon on Trust desktops link to microguide  
  •    
    Itraconazole (Sporanox)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted

    Capsules, Liquid :-Not approved for use as specific COVID-19 treatment - see FAQs on Prescribing.
    Haematology/Oncology Prophylaxis only

     
       
    Posaconazole (Noxafil)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted Suspension
  • Haematology
  • Use as per guidelines

    Star High cost drug reimbursed separately from NHS England tariff (PBR excluded)

    Note: posaconazole tablets and suspension are not interchangeable. Substitution of the tablets for the oral suspension, or vice versa, can result in inadvertent overdosing or underdosing, and the risk of serious adverse drug reactions or lack of efficacy. Prescribers should specify the dosage form for posaconazole on each prescription and pharmacists should ensure the correct oral form is dispensed to patients.
    MicroGuide Icon on Trust desktops link to microguide 
  •    
    Terbinafine
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted Tablets
  • Dermatology
    MicroGuide Icon on Trust desktops link to microguide 
  •    
    Voriconazole (Vfend)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted Injection, Oral suspension, Tablets
  • Haematology
  • Therapeutic Drug Monitoring (TDM)
  • Microbiology advice

    Star High cost drug reimbursed separately from NHS England tariff (PBR excluded)

    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.
    MicroGuide Icon on Trust desktops link to microguide 
  •    
    05.02  Expand sub section  Treatment of fungal infections
    05.02  Expand sub section  Drugs used in fungal infections
    Fluconazole
    View adult BNF View SPC online View childrens BNF
    Formulary Capsules, Injection, Oral suspension

    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.
    MicroGuide Icon on Trust desktops link to microguide 
    Link  UKMI QA: Can oral fluconazole be used during prenancy?
    Link  UKMI QA: Can oral fluconazole be used with breastfeeding?
       
    Miconazole (Daktarin)
    View adult BNF View SPC online View childrens BNF
    Formulary Cream
    MicroGuide Icon on Trust desktops link to microguide 
       
    Nystatin (Nystan)
    View adult BNF View SPC online View childrens BNF
    Formulary Cream, Oral suspension
    MicroGuide Icon on Trust desktops link to microguide 
       
    05.02.01  Expand sub section  Triazole antifungals
    05.02.02  Expand sub section  Imidazole antifungals to top
    05.02.03  Expand sub section  Polyene antifungals
    05.02.04  Expand sub section  Echinocandin antifungals
    Anidulafungin
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted Available as injection only
  • Microbiology advice only

    Star High cost drug reimbursed separately from NHS England tariff (PBR excluded)
    MicroGuide Icon on Trust desktops link to microguide 
  •    
    Caspofungin (Cancidas)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted Available as injection only
  • Microbiology advice
  • Haematology exempt from restriction

    Star High cost drug reimbursed separately from NHS England tariff (PBR excluded)
    MicroGuide Icon on Trust desktops link to microguide 
  •    
    Micafungin (Mycamine)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted Injection only
  • Microbiology advice only

    Star High cost drug reimbursed separately from NHS England tariff (PBR excluded)
    MicroGuide Icon on Trust desktops link to microguide 
  •    
    05.02.05  Expand sub section  Other antifungals
     ....
     Non Formulary Items
    Amphotericin  (Abelcet)
    (Amphotericin B Lipid Complex)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Red

    Star High cost drug reimbursed separately from NHS England tariff (PBR excluded)
     
    Amphotericin  (Amphocil®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Amphotericin  (Fungilin)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Amphotericin  (Fungizone)

    View adult BNF View SPC online View childrens BNF
    Non Formulary NOT ROUTINELY STOCKED IN EKHUFT
    Link  NPSA alert on injectable amphotericin
     
    Griseofulvin  (Fulsovin®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Isavuconazole
    (BAL-4185, BAL-8557, Isavuconazonium)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black

    Black triangle drug

    NHS status Not routinely commissioned by NHS England

     
    Ketoconazole  (Nizoral)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
  • Oral Ketoconazole preparations will be withdrawn in 2013 by regulatory action
  •  
    Terbinafine  (Lamisil®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
      
    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
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Amber

    Requires to be initiated by specialist for repeat GP Prescribing (Purple as per Eclipse East Kent Primary Care Formulary, may be top sliced) If a downloadable EKPG Prescribing Information Sheet exists in the formulary entry for the drug, it, or an URL (shortcut to webpage/document) should be sent to the GP. See also "Hints in how to incorporate documents for medicines information into clinical communications to GPs".  

    Amber 1

    Shared Care (Orange as per Eclipse East Kent Primary Care Formulary). See the Principles of Shared Care Agreements and Shared Care Agreements: Assessment against agreed Principles of Shared Care documents. If a downloadable template document exists in the formulary entry for this drug, it should be sent to the GP (and patient) once patient specific details are incorporated. See "Hints in how to incorporate shared care documents for medicines into clinical communications to GPs".  

    Amber 2

    Shared Care and topsliced (Orange as per Eclipse East Kent Primary Care Formulary) See the Principles of Shared Care Agreements and Shared Care Agreements: Assessment against agreed Principles of Shared Care documents. If a downloadable template document exists in the formulary entry for this drug, it should be sent to the GP (and patient) once patient specific details are incorporated. See "Hints in how to incorporate shared care documents for medicines into clinical communications to GPs".  

    Black

    A decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications  

    Blue

    No comment on drug in East Kent Primary Care Formulary (Blue as per Eclipse East Kent Primary Care Formulary)  

    Brown

    Exceptional Use Only (Brown as per Eclipse East Kent Primary Care Formulary)   

    Green

    On East Kent Primary Care Formulary (Pink or Green as per Eclipse East Kent Primary Care Formulary)  

    Grey

    Not assessed/Not recommended (As per Eclipse East Kent Primary Care Formulary)  

    Red

    Hospital Only (As per Eclipse East Kent Primary Care Formulary)  

    RedRed

    Known to be commissioned for local NHS patients but only available to them from another provider than EKHUFT  

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