| Formulary Chapter 5: Infections - Full Chapter
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| Chapter Links... |
 UKMI Q&A: Cross-sensitivity between penicillins and cephalosporins |
| UKMI Q&A: Penicillins and cephalosporins safety in breast feeding |
| Details... |
| 05.01 |
Antibacterial drugs |
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| 05.01 |
Table 1. Summary of antibacterial therapy |
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| 05.01 |
Table 2. Summary of antibacterial prophylaxis |
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| 05.01.01 |
Penicillins |
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| 05.01.01.01 |
Benzylpenicillin and phenoxymethylpenicillin |
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Benzylpenicillin Benzathine
|
Formulary
|
Secondary care use only. APCO July 2010.
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Benzylpenicillin Sodium
|
Formulary
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In line with SCAN guidelines.
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Phenoxymethylpenicillin
|
Formulary
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In line with SCAN guidelines.
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Procaine Benzylpenicillin
|
 Unlicensed
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Secondary care use only. APCO July 2010.
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| 05.01.01.02 |
Penicillinase-resistant penicillins |
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Flucloxacillin
|
Formulary
|
In line with SCAN guidelines.
|
 UKMI Q&A: Q&A Can a 2 gram dose of flucloxacillin be given as a slow intravenous injection?
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Temocillin (Negaban®)
|
Formulary
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Secondary care use only. APCO July 2010.
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| 05.01.01.03 |
Broad-spectrum penicillins |
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Amoxicillin
(Oral)
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Formulary
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In line with SCAN guidelines.
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Amoxicillin
(Injection)
|
Formulary
|
Secondary care use only. APCO July 2010.
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Co-Amoxiclav
(Oral)
|
Formulary
|
In line with SCAN guidelines.
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Co-Amoxiclav
(Injection)
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Formulary
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Secondary care use only. APCO July 2010.
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| 05.01.01.04 |
Antipseudomonal penicillins |
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Piperacillin and Tazobactam (Tazocin®)
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Formulary
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Secondary care use only. APCO July 2010.
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Ticarcillin with Clavulanic acid (Timentin®)
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Formulary
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Secondary care use only. APCO July 2010.
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| 05.01.01.05 |
Mecillinams |
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Pivmecillinam Hydrochloride (Selexid®)
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Second Choice
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If first line treatment for UTI unsuitable or GFR<45ml/min, in line with SCAN guidelines.
APCO September 2018.
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| 05.01.02 |
Cephalosporins, carbapenems and other beta-lactums |
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Ceftazidime and Avibactam (Zavicefta®)
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Formulary
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Specialist prescribing only. APCO July 2017.
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Ceftolozane & tazobactam (Zerbaxa®)
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Formulary
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Specialist prescribing only. APCO July 2017.
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NICE 2016: Evidence summary of new medicines: intra-abdominal
NICE 2016: Evidence summary of new medicines: UTI
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| 05.01.02 |
Cephalosporins |
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| 05.01.02.01 |
Cephalosporins |
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Cefalexin
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Formulary
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In line with SCAN guidelines.
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Cefixime (Suprax®)
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Formulary
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For continuation only when started in secondary care.
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Cefotaxime
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Formulary
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Secondary care use only. APCO July 2010.
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Ceftazidime
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Formulary
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Secondary care use only. APCO July 2010.
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Ceftriaxone
|
Formulary
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Secondary care use only. APCO July 2010.
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Cefuroxime
(Injection)
|
Formulary
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Secondary care use only. APCO July 2010.
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Cefazolin
|
Unlicensed
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Micro ID use only for Staph infections.
APCO September 2018.
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Cefoxitin
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Unlicensed
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For the treatment of non-tuberculous mycobacteria (NTM) in adult patients with cystic fibrosis. APCO July 2010.
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| 05.01.02.02 |
Carbapenems |
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Ertapenem (Invanz®)
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Formulary
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Secondary care use only. APCO July 2010.
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Imipenem with Cilastatin (Primaxin®)
|
Formulary
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Secondary care use only. APCO July 2010.
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Meropenem (Meronem®)
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Formulary
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Secondary care use only. APCO July 2010.
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Meropenem with Vaborbactam (Vaborem®)
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Formulary
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Specialist prescribing only.
APCO March 2020.
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| 05.01.02.03 |
Other beta-lactums antibiotics |
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Aztreonam (Azactam®)
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Formulary
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Secondary care use only. APCO July 2010.
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| 05.01.03 |
Tetracyclines |
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Demeclocycline Hydrochloride
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Formulary
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Suitable for prescribing in primary care following specialist recommendation for the treatment of chronic hyponatraemia associated with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). NB. Not routinely used as an antibiotic, please contact microbiology for advice.
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Doxycycline
|
Formulary
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In line with SCAN guidelines.
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Lymecycline (Tetralysal® 300)
|
Formulary
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For:
- Bullous pemphigoid and other immunobullous diseases eg mucous membrane pemhigoid, pemphigus (APCO July 2016).
- Use in line with SCAN guidelines.
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Minocycline
|
Formulary
|
Not recommended for acne, in line with NHS England Items which should not routinely be prescribed in primary care guidance.
APCO September 2019.
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NICE therapeutic topic: Minocycline
UKMI suggested drug monitoring schedule
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Oxytetracycline
|
Formulary
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In line with SCAN guidelines.
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Tetracycline
|
Formulary
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In line with SCAN guidelines.
|
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| 05.01.03 |
Tigecycline |
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Tigecycline (Tygacil®)
|
Formulary
|
Secondary care use only. APCO July 2010.
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| 05.01.04 |
Aminoglycosides |
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Amikacin
|
Formulary
|
Secondary care use only. APCO July 2010.
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Gentamicin
(Injection)
|
Formulary
|
Secondary care use only. APCO May 2012.
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Tobramycin
(Injection)
|
Formulary
|
Secondary care use only.
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Tobramycin
(Nebulised)
|
Formulary
|
For pseudomonas lung infection in cystic fibrosis as per NICE TA276. Nebulised tobramycin is considered an appropriate treatment that is, when colistimethate sodium is contraindicated, is not tolerated or has not produced an adequate clinical response. Funded by specialised commissioning. APCO May 2013.
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NICE TA276: Cystic fibrosis (pseudomonas lung infection) - colistimethate sodium and tobramycin
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Tobramycin inhaler (TOBI Podhaler®)
|
Formulary
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For pseudomonas lung infection in cystic fibrosis as per NICE TA276. Funded by specialised commissioning. APCO May 2013.
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NICE TA276: Cystic fibrosis (pseudomonas lung infection) - colistimethate sodium and tobramycin
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| 05.01.05 |
Macrolides |
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Clarithromycin
(Oral)
|
First Choice
|
In line with SCAN guidelines.
APCO March 2014.
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Azithromycin
|
Formulary
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In line with SCAN guidelines.
For continuation in patients with cystic fibrosis.
APCO March 2003.
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NICE Evidence Summary: long-term azithromycin for cystic fibrosis
NICE evidence summary: Long-term azithromycin for non-CF bronchiectasis
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Erythromycin
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Formulary
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In line with SCAN guidelines.
Prokinetic erythromycin should only be used in critically ill patients when other treatments have failed due to risk of resistance - UKMI Q&A dose advice.
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NICE Evidence summary: Erythromycin for gastroparesis in adults
UKMI Q&A: Erythromycin and Statins Interaction
UKMI Q&A: Optimal prokinetic dose of erythromycin in adults
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Clarithromycin
(Injection)
|
Formulary
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Secondary care use only. APCO July 2010.
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| 05.01.06 |
Clindamycin |
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Clindamycin 300mg/2mL Injection
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Formulary
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Secondary care use only. APCO July 2010.
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Clindamycin
(Oral)
|
 Restricted
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In line with SCAN guidelines.
APCO September 2018.
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| 05.01.07 |
Some other antibacterials |
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Pristinamycin 500mg Tablet
|
Unlicensed
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For staphylococcal infection or multi resistant organisms. APCO November 2006.
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| 05.01.07 |
Chloramphenicol |
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Chloramphenicol
(Injection)
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Formulary
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Secondary care use only. APCO July 2010.
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| 05.01.07 |
Fosfomycin |
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Fosfomycin 3g sachets
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Third Choice
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Oral fosfomycin is the third or forth line option for patients with an acute, uncomplicated urinary tract infection, In line with SCAN guidelines.
APCO July 2018.
|
NICE Evidence summary: Fosfomycin for resistant urinary tract infections
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| 05.01.07 |
Fusidic acid |
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Sodium Fusidate (Fucidin®)
|
Formulary
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Secondary care use only. APCO July 2010.
|
MHRA Safety Update: Systemic fusidic acid and interaction with statins
|
| 05.01.07 |
Vancomycin and teicoplanin |
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Teicoplanin (Targocid®)
|
Formulary
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Secondary care use only. APCO January 2005.
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Vancomycin
(Oral)
|
Restricted
|
Restricted for Clostridium difficile infection (CDI) or following Microbiology advice, in line with SCAN guidelines.
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Vancomycin
(Infusion)
|
Formulary
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Secondary care use only. APCO July 2010.
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| 05.01.07 |
Daptomycin |
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Daptomycin (Cubicin®)
|
Formulary
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For use at the NOC only on advice of ID or Microbiology Consultants in specific situations. APCO January 2011.
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| 05.01.07 |
Linezolid |
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Linezolid
|
Formulary
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Secondary care use only. APCO July 2010.
|
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| 05.01.07 |
Quinupristin and dalfopristin |
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Quinupristin and dalfopristin (Synercid®)
|
Formulary
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Secondary care use only. APCO July 2010.
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| 05.01.07 |
Polymyxins |
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Colistimethate Sodium
|
Formulary
|
For the treatment of Pseudomonas aeruginosa (PsA) colonised non-cystic fibrosis bronchiectasis. Colomycin is the product of choice. See OUH patient leaflet here.
For pseudomonas lung infection in cystic fibrosis as per NICE TA276. Funded by specialised commissioning (APCO May 2013).
|
NICE TA276: Cystic fibrosis (pseudomonas lung infection) - colistimethate sodium and tobramycin
NICE Evidence Summary: Non-cystic fibrosis bronchiectasis - colistimethate sodium
MHRA: Colobreathe: risk of capsule breakage—new instructions for use
UKMI: Safety Assessment for Different Formulations
|
| 05.01.07 |
Rifaximin |
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Rifaximin (Targaxan®)
(Encephalopathy)
|
Formulary
|
For preventing episodes of overt hepatic encephalopathy as per NICE TA337. APCO May 2015.
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NICE TA337: Rifaximin for preventing episodes of overt hepatic encephalopathy
|
| 05.01.07 |
Fidaxomicin |
|
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Fidaxomicin (Dificlir®)
|
Formulary
|
Secondary care use only for recurrent clostridium difficile infection.
See SCAN guidelines.
APCO March 2014.
|
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| 05.01.08 |
Sulphonamides and trimethoprim |
|
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Trimethoprim
|
Formulary
|
In line with SCAN guidelines.
NB. Trimethoprim should only be used in low resistance risk patients or where cultures show sensitivity
|
 OCCG Trimethoprim Patient Group Direction (PGD)
|
Co-trimoxazole
(Injection)
|
Formulary
|
Secondary care use only. APCO July 2010.
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Co-trimoxazole
(Oral)
|
Formulary
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For continuation following recommendation from specialist. APCO July 2010.
|
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Sulfadiazine
|
Formulary
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Secondary care use only. APCO July 2010.
|
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| 05.01.09 |
Antituberculosis drugs |
|
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Bedaquiline (Sirturo®)
|
Formulary
|
Secondary care use only.
|
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Capreomycin (Capastat®)
|
Formulary
|
For tuberculosis resistant to first-line drugs, in combination with other drugs. APCO July 2012.
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Cycloserine
|
Formulary
|
Secondary care use only. APCO July 2010.
|
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Delamanid (Deltyba®)
|
Formulary
|
Secondary care use only.
|
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Ethambutol
|
Formulary
|
Secondary care use only. APCO July 2010.
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Isoniazid
|
Formulary
|
Secondary care use only. APCO July 2010.
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Prothionamide
|
Formulary
|
NB. No longer available on UK market. APCO July 2010.
|
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Pyrazinamide
|
Formulary
|
Secondary care use only. APCO July 2010.
|
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Rifabutin (Mycobutin®)
|
Formulary
|
Secondary care use only. APCO July 2010.
|
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Rifampicin
(Oral)
|
Formulary
|
Secondary care use only for Tuberculosis (APCO July 2010).
For meningococcal meningitis prophylaxis in line with SCAN guidelines.
APCO July 2010.
 For the management of Bone and Joint Infections in adults.
Bone infections clinic to provide first four weeks of treatment course. Course to be continued by GP for up to 6 months (individual treatment plans will be provided for each patient), in line with Shared Care Protocol.
APCO September 2018.
For all other indications.
APCO May 2012.
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Rifampicin (Rifadin® )
(Solution for infusion)
|
Formulary
|
Secondary care use only. APCO July 2010.
|
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Rifampicin and Isoniazid (Rifinah® 150mg/100mg)
|
Formulary
|
Secondary care use only. APCO July 2010.
|
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Rifampicin and Isoniazid (Rifinah® 300mg/150mg)
|
Formulary
|
Secondary care use only. APCO July 2010.
|
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Rifampicin and Isoniazid and Pyrazinamide (Rifater®)
|
Formulary
|
Secondary care use only. APCO July 2010.
|
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Streptomycin Sulphate
|
Formulary
|
Secondary care use only. APCO July 2010.
|
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|
Aminosalicylic acid (Granupas®)
|
Unlicensed
|
Secondary care use only. APCO July 2010.
|
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|
| 05.01.10 |
Antileprotic drugs |
|
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Clofazimine
|
Formulary
|
Secondary care use only. APCO July 2010.
|
|
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Dapsone
|
Formulary
|
Use in line with shared care protocol.
APCO November 2020.
|
|
|
| 05.01.11 |
Metronidazole and tinidazole |
|
|
Metronidazole
(Oral)
|
Formulary
|
In line with SCAN guidelines.
|
UKMI Q&A: safety of metronidazole in breastfeeding
|
Metronidazole
(Injection)
|
Formulary
|
Secondary care use only. APCO July 2010.
|
|
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Tinidazole (Fasigyn®)
|
Formulary
|
Secondary care use only. APCO July 2010.
|
|
|
| 05.01.12 |
Quinolones |
|
|
Ciprofloxacin
(Oral)
|
Formulary
|
In line with SCAN guidelines.
|
|
|
Levofloxacin
|
Formulary
|
For eradication of Helicobacter pylori in line with SCAN guidelines.
|
|
|
Moxifloxacin
|
Formulary
|
For treatment of diabetic foot ulcer in line with SCAN guidelines.
|
|
|
Ofloxacin
|
Formulary
|
In line with SCAN guidelines.
|
|
|
Ciprofloxacin
(Injection)
|
Formulary
|
Secondary care use only. APCO July 2010.
|
|
|
Levofloxacin (Quinsair®)
(Nebulised solution)
|
Formulary
|
Secondary care prescribing only for adult cystic fibrosis patients. Funded by specialised commissioning.
APCO January 2019.
|
|
|
| 05.01.13 |
Urinary-tract infections |
|
|
Nitrofurantoin
|
First Choice
|
First line treatment for lower UTI, in line with SCAN guidelines.
|
MHRA: Nitrofurantoin contraindicated in most patients with an eGFR < 45 ml/min
|
Trimethoprim
|
Formulary
|
In line with SCAN guidelines.
NB. Trimethoprim should only be used in low resistance risk patients or where cultures show sensitivity
|
OCCG Trimethoprim Patient Group Direction (PGD)
|
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| .... |
| Non Formulary Items |
Ampicillin
|
Non Formulary
|
Please use amoxicillin. APCO July 2010. |
|
|
Aztreonam nebuliser solution (Cayston®)
|
Non Formulary
|
|
|
|
Bezlotoxumab (Zinplava®)
|
Non Formulary
|
Not recommended for preventing recurrent Clostridium difficile infection (NICE TA601 - terminated appraisal).
APCO November 2019. |
|
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Cefaclor
|
Non Formulary
|
APCO July 2010. |
|
|
Cefadroxil
|
Non Formulary
|
APCO July 2010. |
|
|
Cefpodoxime (Orelox®)
|
Non Formulary
|
APCO July 2010. |
|
|
Cefradine (Velosef®)
|
Non Formulary
|
APCO July 2010. |
|
|
Ceftaroline Fosamil (Zinforo®)
|
Non Formulary
|
|
|
|
Ceftobiprole (Zevtera®)
|
Non Formulary
|
|
|
|
Cefuroxime
(Oral)
|
Non Formulary
|
APCO July 2010. |
|
|
Co-Fluampicil
|
Non Formulary
|
Use equivalent doses of flucloxacillin and amoxicillin. APCO July 2010. |
|
|
Collatamp EG Sponge
|
Non Formulary
|
|
|
|
Dalbavancin
|
Non Formulary
|
|
|
|
Doxycycline MR (Efracea® MR)
|
Non Formulary
|
|
|
|
Flucloxacillin (Floxapen®)
|
Non Formulary
|
|
|
|
Hyaluronic acid (Cystistat®)
|
Non Formulary
|
Not recommended for treatment of the symptoms of painful bladder syndrome or interstitial cystitis due to limited clinical benefit. APCO January 2011. |
|
|
Methenamine Hippurate (Hiprex®)
|
Non Formulary
|
Methanamine is not included in our local guidance or NICE guidance for recurrent UTI.
|
|
|
Nalidixic Acid (Uriben®)
|
Non Formulary
|
|
|
|
Neomycin Sulphate
(Tablets)
|
Non Formulary
|
APCO July 2010. |
|
|
Netilmicin (Netillin®)
|
Non Formulary
|
|
|
|
Norfloxacin
|
Non Formulary
|
APCO July 2010. |
|
|
Oritavancin (Orbactiv®)
|
Non Formulary
|
|
|
|
Rifampicin, isoniazid, pyrazinamide and ethambutol (Voractiv®)
|
Non Formulary
|
|
|
|
Rifaximin (Xifaxanta®)
(C.Diff and SIBO)
|
Non Formulary
|
|
NICE evidence summary: Rifaximin for pouchitis
|
SPL7013 (VivaGel®)
|
Non Formulary
|
|
|
|
Sulfamethoxypyridazine
|
Non Formulary
|
For the treatment of pemphigoid. Hospital-only. APCO May 2014. |
|
|
Tedizolid (Sivextro®)
|
Non Formulary
|
|
|
|
Telavancin
|
Non Formulary
|
|
|
|
Telithromycin (Ketek®)
|
Non Formulary
|
Not recommended for use, please refer to SCAN guidelines.
APCO July 2010. |
|
|
| |
Key |
|
|
|
|
Cytotoxic Drug
|
|
|
Controlled Drug
|
|
High Cost Medicine
|
|
Cancer Drugs Fund
|
|
NHS England |
|
Homecare |
|
CCG |
|
Traffic Light Status Information
| Status |
Description |
|
Red: Medicines which should only be prescribed in secondary care by a specialist. |
|
Amber Continuation: Medicines which should be initiated or recommended by a specialist for continuation in primary care. The specialist must notify the GP that the prescribing responsibility has been transferred. |
|
Amber Shared Care Protocol: Medicines which are appropriate to be initiated and stabilised by a specialist, once stabilised the medicine may be appropriate for responsibility to be transferred from secondary to primary care with the agreement of a GP and a formal ‘shared care’ agreement. The shared care protocol must be approved by the Area Prescribing Committee Oxfordshire (APCO). |
|
Green: Medicines which are suitable for initiation and ongoing prescribing within primary care. |
|
Brown: Medicines which should only be prescribed in restricted circumstances. |
|
Black: Medicines which are not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety. |
|
not used |
|
|
|
