Original Date of issue: 31/12/2005 Last Reviewed: 01/02/2013 Version: 3 Page 1 of 13
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1 File name: Infections BNF Section 5 Original Date of issue: 31/12/2005 Last eviewed: 01/02/2013 Version: 3 Page 1 of 13 Department: Pharmacy eview Date:01/02/2015 Authorised: Drug and 5: Infections 5.1 Antibacterial drugs Penicillins Benzylpenicillin and phenoxymethylpenicillin Benzylpenicillin Injection (600mg, 1.2g) Phenoxymethylpenicillin Solution (125mg/5ml, 250mg/5ml) Phenoxymethylpenicillin Tablets (250mg) Procaine penicillin G 3,000,000 units/vial Purchased on request of Consultant Microbiologist or GUM clinic only Penicillinase-resistant penicillins Flucloxacillin Capsules (250mg, 500mg) Flucloxacillin Syrup (125mg/5ml, 250mg/5ml) Flucloxacillin Injection (250mg, 500mg, 1g)
2 File name: Infections BNF Section 5 Original Date of issue: 31/12/2005 Last eviewed: 01/02/2013 Version: 3 Page 2 of 13 Department: Pharmacy eview Date:01/02/2015 Authorised: Drug and Broad-spectrum penicillins Amoxicillin Capsules (250mg, 500mg) Amoxicillin SF suspension (125mg/5ml, 250mg/5ml) Amoxicillin Injection (500mg) Co-Fluampicil Syrup (125/5ml) Co-Fluampicil Injection (250/250) Co-amoxiclav Tablets (375mg, 625mg) Co-amoxiclav SF Suspension (125/31, 260/62) Co-amoxiclav Injection (1.2g) Co-amoxiclav is for use in the following cases only a. Occasional paediatric patients b. Bite wounds in outpatients/a&e c. ENT out patients Amoxicillin SF Sachets (3g) NICE recommends against using for endocarditis prophylaxis (See Clinical Guideline 64). For use only where high doses of amoxicillin required (e.g. bronchiectasis) Antipseudomonal penicillins Piperacillin/Tazobactam (4.5g) (Tazocin ) 1) For use in the treatment of neutropenic sepsis 2) For the treatment of Healthcare acquired pneumonia Mecillinams Pivmecillinam Tablets (200mg) For use in elderly patients who fail to respond to trimethoprim or other antibiotics for urinary tract infections
3 File name: Infections BNF Section 5 Original Date of issue: 31/12/2005 Last eviewed: 01/02/2013 Version: 3 Page 3 of 13 Department: Pharmacy eview Date:01/02/2015 Authorised: Drug and Cephalosporins and other beta-lactams Cephalosporins are associated with an increased risk of Clostridium difficile infection compared with other antibiotics. They should be used only in line with the antibiotics policy. Cefaclor Capsules (250mg, 500mg) Cefaclor Suspension (125mg/5ml, 250mg/5ml) Cefalexin Capsules (250mg, 500mg) Cefalexin Syrup (250mg/5ml) Cefotaxime Injection (500mg, 1g, 2g) Cefuroxime Injection (750mg) Ceftazidime Injection (250mg, 1g, 2g, 2g monovial) eserved for treatment of pseudomonal infections Ceftriaxone Injection (250mg, eserved for paediatric use only 1g) S Cefuroxime Injection (250mg) eserved for Eye Theatre Cefixime Tablets 200mg eserved for GUM clinic only C Meropenem injection (500mg, 1g) Consultant Microbiologist recommendation or life threatening sepsis on intensive care only
4 File name: Infections BNF Section 5 Original Date of issue: 31/12/2005 Last eviewed: 01/02/2013 Version: 3 Page 4 of 13 Department: Pharmacy eview Date:01/02/2015 Authorised: Drug and Tetracyclines First line Second line Alternatives Oxytetracycline Tablets (250mg) Doxycycline Capsules (50mg, 100mg) Doxycycline Dispersible Tablets (100mg) Tetracycline Tablets (250mg) Comments Preferred agent in respiratory infections Doxycycline dispersible tablets are considerably more expensive than capsules Demeclocycline Capsules 150mg eserved for treatment of Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) Deteclo Genitourinary medicine only Doxycycline Injection (100mg in 5ml) Use supported for the treatment of malignant pleural effusions by espiratory Consultant. C Tigecycline Injection 50mg estricted to prescribing by Consultant Microbiologist only Aminoglycosides First line Gentamicin Injection (20mg/2ml, 80mg/2ml) Comments Tobramycin injection (20mg, 80mg) eserved for paediatric patients requiring an aminoglycoside who have come to us from Leeds Teaching Hospitals NHS Trust
5 File name: Infections BNF Section 5 Original Date of issue: 31/12/2005 Last eviewed: 01/02/2013 Version: 3 Page 5 of 13 Department: Pharmacy eview Date:01/02/2015 Authorised: Drug and Macrolides First line Second line Erythromycin Tablets (250mg) Erythromycin Ethyl Succinate SF suspension (125mg/5ml, 250mg/5ml, 500mg/5ml) Erythromycin infusion 1g in 500ml sodium chloride 0.9% Clarithromycin Tablets (250mg) Clarithromycin Suspension (125mg/5ml, 250mg/5ml) Clarithromycin Sachets (250mg) Comments Predominantly for chest infections and as part of H. pylori eradication therapy Erythromycin Lactobionate Injection (1g) vial Azithromycin Suspension (300mg in 7.5ml) Azithromycin capsules 250mg eserved for aseptic unit and theatre eserved for genitourinary medicine and the treatment of pneumonia in paediatric patients with penicillin allergy or suspected/confirmed Mycoplasma/Chlamydia Clindamycin Clindamycin Capsules (150mg) Clindamycin Injection (600mg/4ml) Some other antibacterials Chloramphenicol Capsules (250mg) Chloramphenicol Injection (1g) Sodium Fusidate Infusion (500mg) Sodium Fusidate Tablets (250mg) Vancomycin Injection (500mg, 1g) C Daptomycin injection 350mg estricted for prescribing by
6 File name: Infections BNF Section 5 Original Date of issue: 31/12/2005 Last eviewed: 01/02/2013 Version: 3 Page 6 of 13 Department: Pharmacy eview Date:01/02/2015 Authorised: Drug and Vancomycin Oral Solution (250mg in 5ml) Consultant Microbiologist prepared to order by pharmacy. eserved for 2 nd line treatment of Clostridium Difficile Vancomycin Capsules 125mg eserved for 2 nd line treatment of Clostridium Difficile Fosfomycin Sachets 3g NB: Unlicensed product in the UK eserved for the treatment of urinary tract infections associated with Extended-Spectrum Beta-Lactamase producing organisms (ESBLs) following advice from Microbiology C Colistimethate sodium Injection (500,000units, 1million units) Use under Consultant Microbiologist s recommendations C Linezolid Tablets (600mg) Linezolid is a third line antibiotic, to be used only with the agreement of Consultant Microbiologist s and a senior pharmacist. Potential for the development of resistance, side effects, interactions and it s high cost mean this antibiotic should be reserved for infections resistant to or non-responsive to vancomycin. Patients should be is monitored for blood dyscrasias (weekly FBC) and interactions (Linezolid shares MAOI interactions). Other serious side effects can occur with medium to long-term use(>14 days). C Teicoplanin Injection (200mg, 400mg) 1) As single dose for surgical prophylaxis in patients with anaphylaxis to penicillins or beta-lactam antibiotics 2) The treatment of other infections following recommendation by Consultant Microbiologist
7 File name: Infections BNF Section 5 Original Date of issue: 31/12/2005 Last eviewed: 01/02/2013 Version: 3 Page 7 of 13 Department: Pharmacy eview Date:01/02/2015 Authorised: Drug and Sulphonamides and trimethoprim First line Trimethoprim Tablets (100mg) Trimethoprim SF Suspension (50mg/5ml) Comments Co-trimoxazole Tablets (480mg) Co-trimoxazole Syrup (480mg/5ml, 240mg/5ml) eserved for prophylaxis and treatment of Pneumocystis carnii Pneumonia (PCP) and prophylaxis of spontaneous bacterial peritonitis Co-trimoxazole Injection (480mg/5ml) To be prepared by the aseptic unit eserved for prophylaxis and treatment of Pneumocystis carnii Pneumonia (PCP) S Trimethoprim Tablets 200mg 200mg For use in TTO packs for A&E only Antituberculous drugs Ethambutol Tablets (100mg, 400mg) Isoniazid Elixir (50mg/5ml) Isoniazid Injection (50mg/2ml) Isoniazid Tablets (100mg) ifampicin Capsules (150mg, 300mg) ifampicin Syrup (100mg/5ml) ifampicin Infusion (600mg) C Pyrazinamide Tablets (500mg) Available from IDIS on a Named Patient Basis only. The appropriate forms will need to be filled in by a consultant.
8 File name: Infections BNF Section 5 Original Date of issue: 31/12/2005 Last eviewed: 01/02/2013 Version: 3 Page 8 of 13 Department: Pharmacy eview Date:01/02/2015 Authorised: Drug and Antileprotic drugs Please seek expert advice from the Consultant Microbiologist for treatment of all tropical diseases. Dapsone 100mg tablets For second-line prophylaxis of Pneumocystis pneumonia (PCP), in patients who are unable to take cotrimoxazole Metronidazole Metronidazole Suspension (200mg/5ml) Metronidazole Infusion (500mg/100ml) Metronidazole Suppositories (1g, 500mg) Metronidazole Tablets (200mg, 400mg) Quinolones Ciprofloxacin tablets (250mg) Ciprofloxacin Suspension (250mg/5ml) Ciprofloxacin infusion (400mg/200ml, 200mg/100ml) Levofloxacin Tablets 500mg, infusion 500mg Only for use in patients that cannot take oral ciprofloxacin. There is absolutely no benefit over oral formulations otherwise. Prescribed by the espiratory Consultants only after failure to respond to or intolerance to a penicillin or macrolide S Ofloxacin tablets 200mg Prescribed by the urology team for the treatment of epididymorchitis (Usual dose: 200mg PO BD for 14 days.) Nitrofurantoin
9 File name: Infections BNF Section 5 Original Date of issue: 31/12/2005 Last eviewed: 01/02/2013 Version: 3 Page 9 of 13 Department: Pharmacy eview Date:01/02/2015 Authorised: Drug and Nitrofurantoin 50mg TABLETS Nitrofurantoin 25mg/5mL SUSPENSION
10 File name: Infections BNF Section 5 Original Date of issue: 31/12/2005 Last eviewed: 01/02/2013 Version: 3 Page 10 of 13 Department: Pharmacy eview Date:01/02/2015 Authorised: Drug and 5.2 Antifungal drugs Amphotericin SF Suspension (500mg/5ml) Amphotericin Complex Injection (50mg) Amphotericin Liposomal Injection (50mg) Fluconazole Capsules (50mg, 150mg, 200mg) Fluconazole Suspension (50mg/5ml) Fluconazole Injection (50mg/25ml) Fluconazole Infusion (200mg/100ml) Griseofulvin Suspension (125mg/5ml) Griseofulvin Tablets (125mg, 500mg0 Terbinafine Tablets (250mg) Voriconazole Tablets (50mg, 200mg) Oral use supported for the treatment of systemic fungal infections. 2 nd line after amphotericin B Caspofungin Infusion (50mg) Use supported for systemic fungal infections. Third line after amphotericin B and oral voriconazole 5.3 Antiviral drugs HIV infection S Nevirapine Tablets (200mg) Efavirenz Capsules (200mg) Didanosine E/C Capsules (400mg, 200mg) Didanosine Tablets (100mg) Zidovudine Capsules (100mg, 250mg) Zidovudine SF Solution (50mg/5ml) eserved for patients as part of a HIV treatment plan under a HIV specialist consultant
11 File name: Infections BNF Section 5 Original Date of issue: 31/12/2005 Last eviewed: 01/02/2013 Version: 3 Page 11 of 13 Department: Pharmacy eview Date:01/02/2015 Authorised: Drug and S C Nelfinavir Tablets (250mg) Combivir Tablets Tenofovir disoproxil Tablets 245mg eserved for patients as part of a HIV treatment plan under a HIV specialist consultant or Used for the purposes of HIV Post- Exposure Prophylaxis (PEP), in accordance with the local protocol Use supported for the treatment of patients with chronic hepatitis B in adults with compensated liver disease in-line with NICE TA173 Consultant Gastroenterologist use only Herpesvirus infections Herpes simplex and varicella-zoster infection Aciclovir SF Suspension (200mg/5ml) Aciclovir Injection (250mg, 500mg) Aciclovir Dispersible Tablets (200mg, 400mg, 800mg) Cytomegalovirus infection S Ganciclovir Capsules (500mg) Ganciclovir Injection (500mg) Under Consultant Microbiologist recommendation only Viral hepatitis C Boceprevir Capsules 200mg Use supported for the treatment of hepatitis C (genotype 1) in combination with peginterferon and ribavirin in-line with NICE TA 253 (April 2012). Use restricted to the Consultant Gastroenterologists.
12 File name: Infections BNF Section 5 Original Date of issue: 31/12/2005 Last eviewed: 01/02/2013 Version: 3 Page 12 of 13 Department: Pharmacy eview Date:01/02/2015 Authorised: Drug and C ibavirin capsules 200mg eserved for the treatment of hepatitis C in combination with Peginterferon under the recommendation of Consultant Gastroenterologists C Telaprevir Tablets 375mg Use supported for the treatment of hepatitis C (genotype 1) in combination with peginterferon and ribavirin in-line with NICE TA252 (April 2012). Use restricted to the Consultant Gastroenterologists Influenza Oseltamivir Capsules (30mg, 45mg and75mg) Oseltamivir Suspension (60mg /5ml) eserved for prophylaxis and treatment of seasonal influenza when NICE guidance is active (See technology appraisals TA158 and TA168) espiratory syncytial virus C Palivizumab Injection (100mg) Consultant Paediatrician use only after agreement with Director of Pharmacy C ibavirin inhalation 6g Consultant Paediatrician use only
13 File name: Infections BNF Section 5 Original Date of issue: 31/12/2005 Last eviewed: 01/02/2013 Version: 3 Page 13 of 13 Department: Pharmacy eview Date:01/02/2015 Authorised: Drug and 5.4 Antiprotozoal drugs Antimalarials Chloroquine Sulphate Syrup (68mg/5ml) Chloroquine Phosphate Tablets (250mg) Chloroquine Sulphate Tablets (200mg) Fansidar Tablets Primaquine Tablets (7.5mg) Proguanil Tablets (100mg) Quinine Sulphate Tablets (200mg, 300mg) Ameobicides Trichomonacides Antigiardial drugs Leishmaniacides Trypanocides Drugs for toxoplasmosis Drugs for pneumocystis pneumonia 5.5 Anthelmintics The Airedale NHS Trust formulary does not cover medicines in these BNF categories. Please seek expert advice from the consultant microbiologist for treatment of these infections Drugs for threadworms Mebendazole Suspension (100mg/5ml) Mebendazole Tablets (100mg) Pripsen Sachets Ascaricides Drugs for tapeworm infections Drugs for hookworms Schistosomicides Filaricides Drugs for Cutaneous larva migrans Drugs for strongyloidiasis The Airedale NHS Trust formulary does not cover medicines in these BNF categories. Please seek expert advice from the Consultant Microbiologist for treatment of these infections.
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