5.1. Antibacterial drugs
5.1.1. Penicillins
5.1.1.2. Penicillinase-resistant penicillins
Restrictions:
Restricted to specialist use only on the advice of a microbiologist or an infectious disease physician.
Prescribing Notes:
Please note: this is a PROTECTED ANTIBIOTIC (see policy here) and relevant paperwork should be completed.
5.1.1.4. Antipseudomonal penicillins
Restrictions:
Restricted to specialist initiation. Recommended for use on the advice of a microbiologist or an infectious disease physician as second line therapy in severely ill patients with multi-resistant organisms.
Prescribing Notes:
Please note: this is a PROTECTED ANTIBIOTIC (see policy here) and relevant paperwork should be completed.
5.1.2. Cephalosporins, carbapenems, and other beta-lactams
5.1.2.1. Cephalosporins
Restrictions:
Restricted to prescribing by specialists as per Sandyford treatment protocol.
Restrictions:
Included on the Formulary only for the treatment of complicated skin and soft tissue infections in adults. It is restricted to specialist use only on the advice of local microbiologists or specialists in infectious disease in accordance with the prescribing notes below.
Prescribing Notes:
It is Formulary for use in patients with known or suspected meticillin resistant Staphylococcus aureus (MRSA) infection in the following settings:
- For Gram-positive only infections where vancomycin iv is inappropriate/has not been tolerated or treatment modification is required; and daptomycin iv or linezolid iv is normally used.
- For polymicrobial Gram-positive and common Gram-negative pathogens, where vancomycin iv in combination with gentamicin iv is inappropriate/has not been tolerated or treatment modification is required; and daptomycin iv in combination with gentamicin iv, or linezolid iv in combination with gentamicin iv, or tigecycline iv is normally used.
Ceftaroline is also licensed for the treatment of community acquired pneumonia, but this indication has not been reviewed by SMC and is therefore non-Formulary
Restrictions:
Restricted to specialist initiation.
Prescribing Notes:
Please note: this is a PROTECTED ANTIBIOTIC (see policy here) and relevant paperwork should be completed.
Restrictions:
Restricted to use only on the advice of a Microbiologist or Infectious Disease specialist for use in the treatment of Hospital-acquired pneumonia (excluding ventilator-associated pneumonia) when activity is required against suspected methicillin-resistant Staphylococcus aureus (MRSA) and Gram-negative pathogens (including Pseudomona aeruginosa, Escherichia coli and Klebsiella pneumoniae) and when combination treatment that includes vancomycin or teicoplanin is inappropriate or has not been tolerated, or when treatment modification is required, i.e. as an alternative to linezolid-based regimen
Prescribing Notes:
Please note: this is a PROTECTED ANTIBIOTIC (see policy here) and relevant paperwork should be completed.
5.1.2.2. Carbapenems
Restrictions:
Restricted to specialist initiation. Restricted to second or third line treatment of community-acquired intra-abdominal infections resistant to current conventional treatments. Treatment of diabetic foot infections of the skin and soft tissue is restricted to use by specialists managing diabetic foot infection on the advice of a microbiologist. The indication of prophylaxis of surgical site infection following elective colorectal surgery in adults remains non-Formulary. The use for other infections should only be on the advice of a microbiologist or infectious disease physician.
Prescribing Notes:
Please note: this is a PROTECTED ANTIBIOTIC (see policy here) and relevant paperwork should be completed.
Restrictions:
Restricted to specialist initiation. Restricted to use on microbiological and infectious disease physician advice only.
Prescribing Notes:
Please note: this is a PROTECTED ANTIBIOTIC (see policy here) and relevant paperwork should be completed.
Restrictions:
Restricted to specialist initiation. Restricted to use on microbiological and infectious disease physician advice only.
Prescribing Notes:
Please note: this is a PROTECTED ANTIBIOTIC (see policy here) and relevant paperwork should be completed.
Restrictions:
Use in adult patients with confirmed carbapenem-resistant Enterobacteriaceae (CRE), which is involved in the production of Klebsiella pneumoniae carbapenemase (KPC) associated with
- complicated urinary tract infection (cUTI, including acute pyelonephritis [AP])
- complicated intra-abdominal infection (cIAI)
- hospital-acquired pneumonia (HAP), including ventilator associated pneumonia (VAP)
and bacteraemia that occurs in association with, or is suspected to be be associated with any of the infections previously mentioned, is restricted to use on the advice of a consultant microbiologist or infectious disease physician in adults with confirmed CRE.
Prescribing Notes:
Please note: this is a PROTECTED ANTIBIOTIC (see policy here) and relevant paperwork should be completed.
5.1.2.3. Other beta-lactam antibiotics
Restrictions:
Restricted to specialist initiation. Restricted to use on microbiological and infectious disease physician advice only.
Restrictions:
Restricted to specialist initiation for use as suppressive therapy of chronic pulmonary infections due to Pseudomonas aeriginosa in patients with cystic fibrosis (age 6 and above) when inhaled colistimethate sodium and inhaled tobramycin are not tolerated or not providing satisfactory therapeutic benefit (measured as a 2% decline in forced expiratory volume in 1 second (FEV1)
Prescribing Notes:
Aztreonam nebules for the suppressive therapy of Pseudomonas aeruginosa infections in adults with cystic fibrosis is not recommended for use by the SMC and is non-Formulary.
5.1.3. Tetracyclines
Restrictions:
Restricted to specialist initiation. Restricted to second or third line use under the advice of local microbiologists or specialists in infectious diseases.
Prescribing Notes:
Please note: this is a PROTECTED ANTIBIOTIC (see policy here) and relevant paperwork should be completed.
5.1.4. Aminoglycosides
Prescribing Notes:
Restricted to specialist initiation. Gentamicin should be prescribed in line with local guidelines and is subject to dose adjustment in line with therapeutic drug monitoring.
Restrictions:
Restricted to specialist initiation. Restricted to use on microbiological and infectious disease physician advice only.
Restrictions:
Treatment of non-tuberculous mycobacterial (NTM) lung infections caused by Mycobacterium avium Complex (MAC) in adults with limited treatment options who do not have cystic fibrosis is restricted to specialist use only in line with national guidance.
Prescribing Notes:
All requests for liposomal amikacin nebuliser solution must be approved by an antimicrobial pharmacist.
Restrictions:
Restricted to specialist initiation.
Prescribing Notes:
No licensed product available. Unlicensed product used for pre-op surgical prophylaxis for colonic surgery.
Restrictions:
Restricted to specialist initiation as second-line use after colistimethate (colistin).
Restrictions:
Restricted to specialist initiation as second-line use after colistimethate (colistin).
Prescribing Notes:
All available brand of nebulised tobramycin are included in the Formulary. Prescribers are asked to use the preparation with the lowest acquisition cost taking into account of patient tolerability.
5.1.5. Macrolides
Restrictions:
Azithromycin IV infusion is restricted to use for the treatment of community acquired pneumonia (CAP) and pelvic inflammatory disease (PID) only on the advice of a microbiologist or infectious disease physician when the oral route of administration is compromised.
Please note: the intravenous formulation is a PROTECTED ANTIBIOTIC (see policy here) and relevant paper work should be completed.
5.1.7. Some other antibacterials
Restrictions:
Restricted to specialist initiation where nebulised colistimethate is not tolerated and tobramycin is being considered.
Restrictions:
For restrictions please see prescribing notes below
Prescribing Notes:
- Restricted to specialist initiation. Restricted to use on microbiological and infectious disease physician advice only.
Restrictions:
Restricted to use on the advice of local microbiologists and infectious disease specialists only in the following situations:
- in accordance with OPAT service clinical management pathway for second-line use or when meticillin-resistant Staphylococcus aureus (MRSA) infection is suspected AND when the patient is initially hospitalised due to ABSSSI, requires intravenous antibiotics, but is eligible for early discharge as soon as their medical condition does not require further inpatient treatment.
Prescribing Notes:
Please note: this is a PROTECTED ANTIBIOTIC (see policy here) and relevant paper work should be completed.
Restrictions:
Restricted to specialist initiation by a microbiologist or specialist in infectious diseases. Restricted to use in patients not responding to or intolerant of a glycopeptide, or those with microbiological cultures which indicate glycopeptide resistance.
Prescribing Notes:
Please note, this is a PROTECTED ANTIBIOTIC (see policy here) and relevant paper work should be completed.
For daptomycin dosing in adults click here
Restrictions:
Restricted to use only on the advice of a microbiologist or infectious disease physician for multi-resistant organisms.
Prescribing Notes:
Please note: the IV FORM of fosfomycin is a PROTECTED ANTIBIOTIC (see policy here) and relevant paperwork should be completed.
Restrictions:
Restricted to specialist use only. Restricted to hospital-based use on the advice of a microbiologist or infectious disease physician. Prolonged use (>2 weeks) must be avoided.
Prescribing Notes:
Access Linezolid treatment protocol and discharge & outpatient checklist by clicking the hyperlinks.
Please note: this is a PROTECTED ANTIBIOTIC (see policy here) and relevant paperwork should be completed.
Restrictions:
Restricted to use on the advice of local microbiologists and infectious disease specialists only in the following situation:
- in accordance with OPAT service clinical management pathway for second-line use or when meticillin-resistant Staphylococcus aureus (MRSA) infection is suspected AND when the patient is initially hospitalised due to ABSSSI, requires intravenous antibiotics, but is eligible for early discharge as soon as their medical condition does not require further inpatient treatment.
Prescribing Notes:
Please note: this is a PROTECTED ANTIBIOTIC (see policy here) and relevant paper work should be completed.
Restrictions:
Restricted to use only on the advice of microbiologists and specialists in infectious diseases for use in patients with ABSSSI caused by Gram-positive Staphylococcus aureus (specifically methicillin-resistant Staphylococcus aureus [MRSA] isolates) as an alternative oxazolidinone antibacterial.
Please note: this is a PROTECTED ANTIBIOTIC (see policy here) and relevant paper work should be completed.
Restrictions:
Restricted to specialist initiation. Restricted to use on microbiological and infectious disease physician advice only. Vancomycin is the first line glycopeptide.
Restrictions:
Restricted to specialist initiation. Restricted to use on microbiological and infectious disease physician advice only. Vancomycin is the first line glycopeptide.
5.1.9. Antituberculosis drugs
Restrictions:
Restricted to specialist initiation. Restricted to patients with mycobacterial infections resistant to conventional anti-tuberculosis drugs.
Prescribing Notes:
Recommended for the prevention of secondary cases of meningococcal meningitis and Haemophilus influenza type B infection.
5.1.10. Antileprotic drugs
Restrictions:
Restricted to specialist initiation.
Prescribing Notes:
For indications in dermatology please refer to section 13.10.1.2
5.1.12. Quinolones
Prescribing Notes:
- Due to the risk of severe, disabling and potentially permanent adverse events, new restrictions apply to the prescribing of fluoroquinolones. Please see new MHRA advice (January 2024) and NHSGGC statement (April 2024) for more details.
- Ciprofloxacin should be prescribed by mouth in preference to IV where possible, as oral dosing gives similar concentrations to IV administration. The exception is when the oral route is compromised (e.g. nil by mouth, reduced absorption, unconsciousness, vomiting or mechanical swallowing disorder).
- The NHSGGC Infection Management guidelines can provide advice on when use is appropriate.
- Please note: the IV FORM of ciprofloxacin is a PROTECTED ANTIBIOTIC (see policy here) and relevant paperwork should be completed.
Restrictions:
Restricted to use on the advice of a consultant microbiologist or consultant infectious disease physician for patients with acute bacterial skin and skin structure infections (ABSSSI) who have suspected or confirmed polymicrobial infection following treatment failure or when standard antibacterial therapies are not suitable.
Please note: this is a PROTECTED ANTIBIOTIC (see policy here) and relevant paper work should be completed.
Prescribing Notes:
Due to the risk of severe, disabling and potentially permanent adverse events, new restrictions apply to the prescribing of fluoroquinolones.
Please see new MHRA advice (January 2024) and NHSGGC statement (March 2024) for more details.
Restrictions:
Restricted to specialist initiation. Treatment of community acquired pneumonia (CAP) is restricted to use on the advice of microbiologists or specialists in infectious diseases. Restricted to second line use by hospital specialists for cystic fibrosis patients intolerant of ciprofloxacin where a quinolone is required.
Prescribing Notes:
Due to the risk of severe, disabling and potentially permanent adverse events, new restrictions apply to the prescribing of fluoroquinolones.
Please see new MHRA advice (January 2024) and NHSGGC statement (March 2024) for more details.
Please note: Oral and IV forms are a PROTECTED ANTIBIOTIC (see policy here) and relevant paperwork should be completed.