| Formulary Chapter 5: Infections - Full Chapter
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| Notes: |
This chapter of the formulary is under development, please use local/national antimicrobial guidelines to support prescribing choices.
Prescribers must follow the relevant local and national guidance when treating an infection. Some anti-infectives require approval from the local Trust microbiology team for use, consult local guidance for further information.
Not all anti-infectives listed in this chapter will be available in all localities; availability will be guided by local need and resistance patterns.
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| Chapter Links... |
 Blackpool Teaching Hospitals: Antimicrobial Formulary |
| Central Lancashire/LSCFT/Morecambe Bay Primary Care: NICE Summary of antimicrobial prescribing guidance - managing common infections |
| East Lancashire Primary Care: Antimicrobial guide primary care |
| East Lancashire Secondary Care: Antimicrobial guide secondary care |
| Lancashire Teaching Hospitals Secondary Care: Tap on the bugs app (App store) |
| Lancashire Teaching Hospitals Secondary Care: Tap on the bugs app (Google) |
| University Hospitals of Morecambe Bay: Antimicrobial guide secondary care |
| West Lancashire Primary Care: Pan Mersey antimicrobial guide |
| British Association for Sexual Health and HIV |
| NICE CG165: Hepatitis B (chronic): diagnosis and management |
| NICE NG120: Cough (acute): antimicrobial prescribing |
| NICE NG125: Surgical site infections: prevention and treatment |
| NICE NG19: Diabetic foot problems: prevention and management |
| NICE NG191: COVID-19 rapid guideline: managing COVID-19 |
| NICE NG240: Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management |
| WHO: AWaRe classification of antibiotics for evaluation and monitoring of use, 2023 |
| NICE NG51: Sepsis: recognition, diagnosis and early management |
| NICE NG78: Cystic fibrosis: diagnosis and management |
| Details... |
| 05.02 |
Antifungal drugs |
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Amphotericin B (liposomal) (AmBisome Liposomal®)
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Formulary
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Intravenous infusion 50mg
On advice of Microbiology only.
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 MHRA: Liposomal and lipid-complex formulations: name change to reduce medication errors
MHRA: Parenteral amphotericin B: reminder of risk of potentially fatal adverse reaction if formulations confused
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Fluconazole
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Formulary
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Intravenous infusion 50mg/25mL, 200mg/100mL
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Fluconazole
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Formulary
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Capsules 50mg, 200mg, 150mg single-dose pack
Liquid 50mg/5mL, 200mg/5mL
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Flucytosine (Ancotil®)
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Formulary
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Intravenous infusion 2.5g/250mL
On advice of Microbiology only.
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MHRA: Flucytosine (Ancotil): new contraindication in patients with DPD deficiency
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Itraconazole
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Formulary
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Capsules 100mg
Liquid 10mg/mL
On advice of Microbiology only.
There have been reports of heart failure associated with itraconazole.
**RAG under consultation and awaiting update - Please use local/national antimicrobial guidelines to support prescribing choices. **
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Miconazole (Daktarin®)
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Formulary
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Oral gel 20mg/g
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MHRA: Miconazole (Daktarin): over-the-counter oral gel contraindicated in patients taking warfarin
MHRA: Topical miconazole, including oral gel: reminder of potential for serious interactions with warfarin
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Nystatin
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Formulary
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Liquid 100,000units/mL 30mL
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Posaconazole
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Formulary
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Tablets 100mg
Oral suspension 40mg/mL
On advice of Microbiology only.
Posaconazole tablets and oral suspension are not bioequivalent and should not be used interchangeably, due to differences in dosing frequency, administration with regards to food, and the plasma-drug concentration achieved.
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MHRA: Posaconazole (Noxafil): tablets and oral suspension are not directly interchangeable
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Rezafungin (Rezzayo®)
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Formulary
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Powder for concentrate for solution for infusion 200mg
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Terbinafine
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Formulary
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Tablets 250mg
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Voriconazole
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Formulary
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Tablets 50mg, 200mg
Liquid 200mg/5mL
Intravenous infusion 200mg
On advice of Microbiology only.
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MHRA: Voriconazole: reminder of risk of liver toxicity, phototoxicity, and squamous cell carcinoma
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| 05.02 |
Treatment of fungal infections |
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| 05.02.01 |
Triazole antifungals |
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| 05.02.02 |
Imidazole antifungals |
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| 05.02.03 |
Polyene antifungals |
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| 05.02.04 |
Echinocandin antifungals |
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Anidulafungin
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Formulary
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Powder for concentrate for solution for infusion 100mg
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Caspofungin
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Formulary
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Infusion 50mg, 70mg
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| 05.02.05 |
Other antifungals |
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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Traffic Light Status Information
| Status |
Description |
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Green:
Appropriate for initiation and ongoing prescribing in both primary and secondary care.
Generally, little or no routine drug monitoring is required. |
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Green (Restricted):
Appropriate for initiation and ongoing prescribing in both primary and secondary care provided:
Additional criteria specific to the medicine or device are met, or
The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway.
Generally, little or no routine drug monitoring is required.
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Red medicines:
Medicine is supplied by the hospital for the duration of the treatment course.
Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP.
Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this.
Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care. |
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Amber level 0:
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Little or no specific monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Brief prescribing document or information sheet may be required.
Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information.
When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe. |
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Amber level 1 (with shared care):
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Minimal monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care. |
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Amber level 2 (with shared care and enhanced service):
Initiated by specialist and transferred to primary care following a successful initiation period.
Significant monitoring required on an on-going basis.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Suitable for enhanced service.
These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements). |
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Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria.
Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need. |
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Grey medicines:
Medicines which have not yet been reviewed or are under the review process.
GPs and specialists are recommended not to prescribe these drugs.
This category includes drugs where funding has not yet been agreed.
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Refer to local guidance. |
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