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Guy's and St Thomas' NHS Foundation Trust
Kings College Hospital NHS Foundation Trust
Lewisham and Greenwich NHS Trust
 
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 Formulary Chapter 5: Infections - Full Chapter
Notes:

Where a formulary entry does not detail a medicine’s indications for use, the medicine can be assumed to be approved for all licensed indications.

Formulary approved "off-label" use is detailed separately.

This section advises on the choice of anti-infective agents available at each Trust.  Doctors should refer to local or departmental antibiotic  guidelines for advice regarding specific treatments within specialised  units (including prophylaxis for surgical, medical and dental  procedures). Different antibiotic policies can be found in different  hospitals due to local variations in resistance and antibiotic  susceptibility.

M: Use of this agent only to be initiated under the advice of a  microbiologist or virologist as appropriate.

S: Use of this agent only to be initiated under the advice of a relevant clinical specialist.

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 Details...
05.01  Antibacterial drugs
05.01.01  Penicillins
Benzathine penicillin injection
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Unlicensed Drug Unlicensed
Red

Treatment of syphilis in accordance with GUM guidelines.

IM injection only

 
   
05.01.01.01  Benzylpenicillin and phenoxymethylpenicillin
Benzylpenicillin injection (Penicillin G)
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Formulary
Red
 
   
Phenoxymethylpenicillin tabs, oral solution (Penicillin V)
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Formulary  
   
Procaine Penicillin G injection
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Unlicensed Drug Unlicensed
Red

Approved (as per BASHH guidance) for:

  • Early syphilis; dose = 600,000 units daily (i.m) for 10 days
  • Late latent, cardiovascualar and gummatous syphilis; dose = 600,000 units daily (i.m) for 14 days
  • Neurosyphilis, dose = 1.8 to 2.4 million units (i.m.) daily with probenecid 500mg qds for 14 days
 
   
05.01.01.02  Penicillinase-resistant penicillins
Flucloxacillin caps, syrup, injection
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Formulary

Refer to BNF for advice on colestatic jaundice and hepatic dysfunction with flucloxacillin

Injection = Red Traffic Light  

 
   
Temocillin injection
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Formulary
Red
 
   
05.01.01.03  Broad-spectrum penicillins to top
Amoxicillin caps, oral suspension, injection
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Formulary Injection = Red Traffic Light  
   
Co-amoxiclav tabs, oral suspension, injection
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Formulary Injection = Red Traffic Light  
   
05.01.01.04  Antipseudomonal penicillins
Piperacillin with tazobactam injection
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Formulary
Red
 
   
Ticarcillin with clavulanic acid injection (Timentin®)
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Formulary
Red
 
   
05.01.01.05  Mecillinams
Pivmecillinam tabs
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Formulary
Green
 
   
05.01.02  Cephalosporins, carbapenems and other beta-lactums
05.01.02.01  Cephalosporins
Cefalexin capsules, oral suspension
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Formulary  
   
Cefazolin injection
Restricted Drug Restricted
Red

INFECTIOUS DISEASES/MICROBIOLOGY SPECIALIST RECOMMENDATION ONLY

For proven MSSA bloodstream infection in haemodialysis patients only

Dose = 2g three days per week after haemodialysis sessions

 
   
Cefotaxime injeciton
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Formulary
Red
 
   
Ceftazidime injection
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Formulary
Red
 
   
Ceftazidime with avibactam injection
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Formulary
Red

Restricted to:

  • Microbiology recommendation only
  • Infections caused by carbapenem resistant organisms where sensitivity to ceftazidime avibactam has been confirmed

Approved for infections caused by aerobic Gram negative organisms in adults with limited treatment options (including off-label indications)

 
   
Ceftolozane with tazobactam injection
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Formulary
Red

Restricted to:

  • Microbiology recommendation only
  • Infections caused by carbapenem resistant organisms where sensitivity to ceftolozane tazobactam has been confirmed

Approved for infections caused by multidrug resistant Pseudomonas aeruginosa in adults (including off-label indications)

Note: for respiratory infections double dose may be required (i.e. ceftolozane 2g & tazobactam 1g every 8 hours in normal renal function)

 
   
Ceftriaxone injection
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Formulary
Red
 
   
Cefuroxime injection
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Formulary
Red
 
   
Cefixime tablets
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Restricted Drug Restricted

Uncomplicated anogential gonorrhoea only (off-label)

400 mg as a single dose

 
   
Cefoxitin injection
Unlicensed Drug Unlicensed
Red
2nd generation cephalosporin for parenteral administration 
   
05.01.02.02  Carbapenems to top
Ertapenem injection
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Formulary
Red
 
   
Imipenem with cilastatin injection
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Formulary
Red
 
   
Meropenem injection
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Formulary
Red
 
   
05.01.02.03  Other beta-lactums antibiotics
Aztreonam injection
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Formulary
Red
 
   
Aztreonam nebuliser solution
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Formulary
Red
High Cost Medicine
 
Link  SE London APC Shared Care Agreement: Nebulised mucolytic and antibiotic solutions for treatment of Cystic Fibrosis in existing paediatric patients
   
05.01.03  Tetracyclines
Doxycycline caps
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Formulary  
   
Oxytetracycline tabs
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Formulary  
   
Tetracycline tabs
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Formulary
Green

Approved as per NICE guidance for H pylori eradication in combination with a proton pump inhibitor and bismuth and metronidazole. (See link to NICE guidance below for full detail)

 
Link  NICE CG184: Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management
   
Doxycycline injection
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Unlicensed Drug Unlicensed
Red

Available on ID/Micro recommendation only

For use in managing infections where doxycycline is clear first choice agent (e.g. Lyme disease, Brucella, Q fever) and the oral route is unavailable or inappropriate

Dose: 400 mg IV stat, then 200 mg IV once daily

 
   
05.01.03  Tigecycline
Tigecycline injection
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Formulary
Red
Treatment of complicated skin and soft tissue infections and complicated intra-abdominal infections, especially multi-resistant Acinetobacter infections 
   
05.01.04  Aminoglycosides
Amikacin injection
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Formulary
Red
 
   
Gentamicin injection
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Formulary
Red
 
   
Gentamicin injection (off-label intratympanic use in ENT surgery)
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Formulary
Red

Approved off-label indication:

Intra-tympanic injection in unilateral vestibular failure (e.g. Meniere’s Disease, Vestibular Schwannoma).

Dose: 60 mg to 80 mg gentamicin buffered with 0.5 mL of sodium bicarbonate 8.4% to fill the middle ear

This procedure is repeated again (at least two hours apart) on the same day. Pretreatment vestibular function testing (caloric testing) must be performed to ensure a normally functioning contralateral labyrinth

 
   
Gentamicin injection (off-label use for soaking penile implants)
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Formulary
Red

Approved off-label indication:

For soaking penile implants, in combination with rifampicin, before insertion

Rifampicin 10 mg/ml and gentamicin 1.2 mg/ml solution made from using 50ml sodium chloride 0.9%, rifampicin 600 mg injection and gentamicin 80 mg injection

 
   
Gentamicin injection (off-label use in pacemaker surgery)
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Formulary
Red

Approved off-label indication:

Topical use into the pocket during pacemaker surgery

 
   
Neomycin tabs
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Formulary  
   
Netilmicin injection
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Formulary
Red
 
   
Tobramycin injection
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Formulary
Red
 
   
Tobramycin nebuliser solution
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Formulary
Red
High Cost Medicine

 
Link  SE London APC Shared Care Agreement: Nebulised mucolytic and antibiotic solutions for treatment of Cystic Fibrosis in existing paediatric patients
   
Tobramycin dry powder for inhalation  (Tobi® Podhaler)
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Formulary
Red
High Cost Medicine
 
Link  NICE TA276: Colistimethate sodium and tobramycin dry powders for inhalation for treating pseudomonas lung infection in cystic fibrosis
   
05.01.05  Macrolides to top
Azithromycin caps, tabs, oral suspension
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Formulary  
   
Clarithromycin tabs, oral suspension, injection
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Formulary Injection = Red Traffic Light  
   
Erythromycin tabs, oral suspension, injection
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Formulary Injection = Red Traffic Light  
   
Erythromycin tabs, oral suspension, injection
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Formulary

Approved off-label indication:

Improve gastric motility

 
   
Azithromycin tabs, caps, oral suspension
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Formulary

Approved off-label indication:

Second-line drug for treatment of Mycobacterium avium complex or M. avium-intracellulare infection in HIV positive patients

 
   
Azithromycin tabs, caps, oral suspension
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Formulary

Approved off-label indication:

Second-line drug for treatment of toxoplasmosis

 
   
Spiramycin tablets
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Unlicensed Drug Unlicensed Treatment of toxoplasmosis and susceptible bacterial infections under specialist advice 
   
05.01.06  Clindamycin
Clindamycin caps, injection
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Formulary Injection = Red Traffic Light  
   
05.01.07  Some other antibacterials
Fosfomycin injection
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Formulary
Red
For treatment of cystic fibrosis pulmonary exacerbations in patients with multiple drug allergies or multiresistant organisms when no other satisfactory licensed alternative is available 
   
Fosfomycin sachets
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Formulary
Amber 1

Treatment of complicated ESBL producing urinary tract infections

Dose: 3g followed by another 3g 72 hours later (PIL available on GTi)

 
   
Spectinomycin 2g injection
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Unlicensed Drug Unlicensed
Red

Treatment of gonorrhoea caused by penicillin-resistant organisms or in patients allergic to penicillin and unable to receive oral ciprofloxacin.

Dose: 2 g as a single dose. Up to 4 g in difficult-to-treat cases and in areas of resistance.

Administer by IM injection

 
   
05.01.07  Chloramphenicol
Chloramphenicol caps, injection
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Formulary Injection = Red Traffic Light  
   
05.01.07  Fusidic acid
Sodium fusidate tabs
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Formulary  
   
05.01.07  Vancomycin and teicoplanin to top
Teicoplanin injection
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Formulary
Red
 
   
Vancomycin caps, injection
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Formulary Injection = Red Traffic Light  
   
Vancomycin injection
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Formulary
Red

Approved for licensed use and the following off-label indications:

  • Continuous infusion administration in critical care (accordance with local guidelines)
  • For pre-soaking hamstring tendons once removed from the knee during ACL repair surgery, to prevent infection
 
   
05.01.07  Daptomycin
Daptomycin injection
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Formulary
Red
Second-line option to vancomycin for patients who have MRSA or VRE infections, when other agents cannot be used and when bactericidal activity is required, for example, for severe infection in highly compromised patients 
   
05.01.07  Linezolid
Linezolid tabs, suspension, injection
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Formulary
Amber 1
Refer to BNF for CHM advice for monitoring for optic neuropathy and blood dyscrasias 
   
05.01.07  Polymyxins
Colistimethate sodium injection & nebuliser solution (Colomycin®)
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Formulary
Red
 
Link  SE London APC Shared Care Agreement: Nebulised mucolytic and antibiotic solutions for treatment of Cystic Fibrosis in existing paediatric patients
   
Colistimethate sodium dry powder for inhalation (Colobreathe®)
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Formulary
Red
High Cost Medicine
 
Link  NICE TA276: Cystic fibrosis (pseudomonas lung infection) - colistimethate sodium and tobramycin
   
05.01.07  Rifaximin
Rifaximin tabs (Targaxan®)
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Formulary
Amber 3

Initiation by gastroenterology only

Prescribing responsibility to remain with secondary care for the first 6 months GPs can be requested to take over prescribing after 6 months using the SE London Transfer of Care Agreement

 
Link  NICE TA337: Rifaximin for preventing episodes of overt hepatic encephalopathy
Link  SE London APC Transfer of Care: Rifaximin for preventing overt hepatic encephalopathy
   
05.01.07  Fidaxomicin to top
Fidaxomicin tabs
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Formulary
Amber 1
Restricted to treatment of laboratory-confirmed clostridium difficile infection (CDI) in the following groups:
  • Recurrence following vancomycin treatment
  • Patients who require ongoing concomitant antibiotic treatment
  • Patients who are immunocompromised and who are at risk of a recurrence 
  •    
    05.01.08  Sulphonamides and trimethoprim
    Co-trimoxazole tabs, oral suspension, injection
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    Formulary Injection = Red Traffic Light  
       
    Trimethoprim tabs, oral suspension
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    Formulary  
       
    Sulfadiazine tabs
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    Unlicensed Drug Unlicensed Toxoplasmic encephalitis 
       
    05.01.09  Antituberculosis drugs
    Rifampicin caps, syrup
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    Formulary

    Red Traffic Light For treatment of tuberculosis

    Amber Traffic Light For treatment of non-tuberculosis infections

     
       
    Rifampicin injection
    View adult BNF View SPC online
    Formulary
    Red
     
       
    Rifampicin injection  (off-label use for soaking penile implants)
    View adult BNF View SPC online
    Formulary
    Red

    Approved off-label indication:

    For soaking penile implants, in combination with gentamicin before insertion. Rifampicin 10 mg/ml and gentamicin 1.2 mg/ml solution made from using 50ml sodium chloride 0.9%, rifampicin 600 mg injection and gentamicin 80 mg injection

     
       
    Bedaquiline tabs (Sirturo®)
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    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Specialist TB respiratory consultant use only

    Approved for use in accordance with NHS England Clinical Commissioning Policy F04/P/a

     
    Link  NHS England F04/P/a: Bedaquiline and Delamanid for defined patients with MDR-TB and XDR-TB
       
    Delamanid tabs (Deltyba®)
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    Formulary
    Red
    High Cost Medicine
    BlueTeq

    Specialist TB respiratory consultant use only

    Approved for use in accordance with NHS England Clinical Commissioning Policy F04/P/a

     
    Link  NHS England F04/P/a: Bedaquiline and Delamanid for defined patients with MDR-TB and XDR-TB
       
    Ethambutol injection
    View adult BNF View SPC online
    Formulary
    Red

    Approved for use in place of ethambutol tabs for treatment of tuberculosis; only if the oral route is not available or appropriate.

     
       
    Ethambutol tabs
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    Formulary
    Red
     
       
    Isoniazid tabs, injection
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    Formulary
    Red
     
       
    Pyrazinamide tabs
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    Formulary
    Red
    Treatment of tuberculosis in combination with other drugs 
       
    Rifabutin caps
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    Formulary
    Red
     
       
    Rifater® tabs
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    Formulary
    Red
    Each tablet contains:
  • Rifampicin 120 mg
  • Isoniazid 150 mg
  • Pyrazinamide 300 mg 
  •    
    Rifinah® 150/100 tabs
    View adult BNF View SPC online
    Formulary
    Red
    Each tablet contains:
  • Rifampicin 150 mg
  • Isoniazid 100 mg  
  •    
    Rifinah® 300/150 tabs
    View adult BNF View SPC online
    Formulary
    Red
    Each tablet contains:
  • Rifampicin 300 mg
  • Isoniazid 150 mg  
  •    
    Azithromycin tabs
    View adult BNF View SPC online
    Formulary
    Red

    Approved off-label indication:

    Treatment of tuberculosis in HIV patients

     
       
    Protionamide tabs, injection
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed
    Red
    Drug resistant tuberculosis 
       
    Streptomycin injection
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed
    Red
    Treatment of tuberculosis in combination with other drugs 
       
    05.01.10  Antileprotic drugs
    Dapsone tabs (licensed indications)
    View adult BNF View SPC online
    Formulary
    Red

    Approved for licensed uses:

    • Leprosy
    • Dermatitis herpetiformis and other dermatoses
    • Prophylaxis of malaria
    • Prophylaxis of Pneumocystis carinii pneumonia in immunodeficient subjects
     
       
    Dapsone tabs (dermatology off-label indications)
    View adult BNF View SPC online
    Formulary
    Red

    Approved off-label indications:

    • Erythema elevatum diutinum
    • Sweet's syndrome
    • Bullous systemic lupus erythematosus
    • Bullous pemphigoid and mucous membrane pemphigoid
    • Hidradenitis suppurativa
    • Pyoderma gangrenosum
    • Subcorneal pustular dermatosis
    • Granuloma faciale
    • Eosinophilic pustular folliculitis
    • Leukocytoclastic vasculitis including Henoch Schonlein purpura
    • Linear IgA disease and chronic bullous disease of childhood

    Prescribing must be initiated and continued by a specialist

    Dose: 50-200 mg daily

     
       
    Clofazimine caps
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    Unlicensed Drug Unlicensed  
       
    Sulfapyridine caps
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    Unlicensed Drug Unlicensed

    Alternative option for mucous membrane pemphigoid when dapsone has caused haemolysis or other side effects.

    Dose: up to 750 mg twice a day

     
       
    05.01.11  Metronidazole and tinidazole
    Metronidazole tabs, oral suspension, injection
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    Formulary Injection = Red Traffic Light  
       
    Tinidazole tabs
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    Formulary  
       
    05.01.12  Quinolones to top
    Ciprofloxacin injection
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    Formulary
    Red
     
       
    Ciprofloxacin tabs, oral suspension
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    Formulary  
       
    Levofloxacin injection
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    Formulary
    Red
     
       
    Levofloxacin tabs
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    Formulary  
       
    Moxifloxacin tabs
    View adult BNF View SPC online
    Formulary
    Red
     
    Link  MHRA Jan 2011: Moxifloxacin: increased risk of life-threatening liver reactions and other serious risks
       
    Levofloxacin nebuliser solution
    View adult BNF View SPC online
    Formulary
    Red

    Approved for chronic Pseudomonas lung infection in cystic fibrosis (adults) as per NHSE Policy 170078P

     
    Link  NHSE 170078P: Levofloxacin nebuliser solution for chronic pseudomonas lung infection in cystic fibrosis (adults)
       
    Moxifloxacin tabs
    View adult BNF View SPC online
    Formulary
    Red
    Approved off-label indications:
  • Endogenous and postoperative endophthalmitis and bleb related endophthalmitis in glaucoma (Consultant Ophthalmologists only)
  • Multi-Drug Resistant Tuberculosis (MDRTB) or if the patient is intolerant of standard regimens (Respiratory Consultants only)
  • Recurrent/persistent nongonoccocal urethritis (NGU) as recommended in the British Association for Sexual Health and HIV guidelines (GUM Consultants only) 
  •    
    Nalidixic acid tabs
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    Formulary  
       
    Norfloxacin tabs
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    Formulary  
       
    Ofloxacin tabs
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    Formulary  
       
    05.01.13  Urinary-tract infections
    Methenamine hippurate tabs
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    Formulary
    Green

    Can be considered third line use for prevention of recurrent UTI in non-pregnant women (if no renal or hepatic impairment) after simple measures for symptom relief and stand-by or post-coital antibiotics have been ineffective.

    Refer to local antimicrobial guidance

     
       
    Nitrofurantoin tabs, caps, oral suspension
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    Formulary  
       
    05.02  Antifungal drugs
    05.02.01  Triazole antifungals
    Fluconazole caps, oral suspension, injection
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    Formulary Injection = Red Traffic Light  
       
    Isavuconazole tabs, injection
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    Formulary
    Red
    High Cost Medicine

    Microbiology consultant recommendation only

    Approved for use in invasive aspergillosis and mucormycosis

    For the treatment of invasive aspergillosis, use is restricted to patients with impaired renal function [CrCl<60mL/min], or in those intolerant or voriconazole

    For use in mucormycosis, use is restricted to patients where amphotericin B is inappropriate

    Refer to local antifungal guidelines

     
       
    Itraconazole caps, oral liquid, injection
    View adult BNF View SPC online
    Formulary

    Refer to BNF for CSM advice on itraconazole and heart failure

    Injection = Red Traffic Light 

     
       
    Posaconazole suspension, tabs
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    Formulary
    Red
    High Cost Medicine

    NOTE – tablet and liquid formulations are not directly interchangeable and have differing dosing regimens for the licensed indications

    Use in accordance with local antifungal guidelines

    Approved for:

    • Invasive fungal infections refractory to standard antifungals
    • Primary prophylaxis in patients who are at high risk of invasive fungal infections
    • Secondary prophylaxis in patients successfully treated with posaconazole for an invasive fungal infection
     
    Link  MHRA Sept 2016: Posaconazole (Noxafil): tablets and oral suspension are not directly interchangeable
       
    Voriconazole tabs, injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    05.02.02  Imidazole antifungals
    05.02.03  Polyene antifungals to top
    Abelcet® injection (amphotericin lipid complex)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    AmBisome® injection (liposomal amphoteracin)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Use in accordance with local antifungal guidelines 
       
    Fungizone® injection (amphotericin)
    View adult BNF View SPC online
    Formulary
    Red
     
       
    Nystatin oral suspension 100,000 units/ml
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    Formulary  
       
    05.02.04  Echinocandin antifungals
    Anidulafungin injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

    Use in accordance with local antifungal guidelines

     
       
    Caspofungin injection
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    Formulary
    Red
    High Cost Medicine
    Use in accordance with local antifungal guidelines for:
  • Treatment of invasive candidiasis in adults
  • Treatment of invasive aspergillosis in adults refractory to or intolerant of amphoterocin, lipid formulations of amphoterocin B and/or itraconazole
  • Emperical therapy for presumed fungal infections in febrile, neutropenic adult patients who are refractory to or intolerant of amphoterocin and lipid formulations of amphoterocin 
  •    
    05.02.05  Other antifungals
    Flucytosine injection
    View adult BNF View SPC online
    Formulary
    Red
     
       
    Griseofulvin tabs
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    Formulary  
       
    Terbinafine tabs
    View adult BNF View SPC online
    Formulary  
       
    Flucytosine tabs
    View adult BNF
    Unlicensed Drug Unlicensed Severe and resistant systemic fungal infections 
       
    05.03  Antiviral drugs
    05.03.01  HIV infection
    05.03.01  Nucleoside reverse transcriptase inhibitors to top
    Abacavir tabs, oral solution
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Abacavir with lamiviudine (generic - Kivexa® brand no longer stocked)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Atripla® tabs  (tenofovir disoproxil with emtricitabine and efavirenz)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    No longer stocked. Prescribe Truvada® (tenofovir disoproxil and emtricitabine) and efavirenz as separate preparations 
       
    Combivir® tabs (zidovudine and lamivudine)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Descovy® tabs (emtricitabine with tenofovir alafenamide)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  NHSE 16043/P: Clinical Commissioning Policy: Tenofovir Alafenamide for treatment of HIV 1 in adults and adolescents
       
    Didanosine tabs, caps
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Emtricitabine caps, oral solution
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Eviplera® (tenofovir disoproxil with emtricitabine and rilpivirine)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Genvoya® tabs (elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  MHRA Dec 2016: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
    Link  NHSE 16043/P: Clinical Commissioning Policy: Tenofovir Alafenamide for treatment of HIV 1 in adults and adolescents
       
    Lamivudine tabs, oral solution
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Odefsey® tabs (emtricitabine with rilpivirine and tenofovir alafenamide)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  NHSE 16043/P: Clinical Commissioning Policy: Tenofovir Alafenamide for treatment of HIV 1 in adults and adolescents
       
    Stavudine caps, oral solution
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Stribild® tabs (tenofovir disoproxil with cobicistat, elvitegravir and emtricitabine)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  MHRA Dec 2016: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
       
    Tenofovir disoproxil tabs (Viread®)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  NICE CG165: Hepatitis B (chronic) - incorporates TA173
    Link  NICE TA173: Hepatitis B (chronic) - tenofovir disoproxil
       
    Triumeq® tabs (dolutegravir, abacavir & lamivudine)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  MHRA Jun 18: Dolutegravir (Tivicay▼, Triumeq▼, Juluca▼): signal of increased risk of neural tube defects; do not prescribe to women seeking to become pregnant; exclude pregnancy before initiation and advise use of effective contraception
       
    Trizivir® tabs (abacavir, lamivudine and zidovudine)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Truvada® tabs  (tenofovir disoproxil with emtricitabine)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Zidovudine caps, oral solution
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    05.03.01  Protease inhibitors
    Atazanavir caps
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Darunavir tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Evotaz tablets® (atazanavir with cobicistat)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  MHRA Dec 2016: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
       
    Fosamprenavir tabs, oral suspension
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Kaletra® tabs, oral solution (lopinavir and ritonavir)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  MHRA Dec 2016: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
       
    Rezolsta® tabs (darunavir with cobicistat)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  MHRA Dec 2016: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
    Link  MHRA Jul 2018: Darunavir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1
       
    Ritonavir caps, oral solution
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  MHRA Dec 2016: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
       
    Saquinavir caps, tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    05.03.01  Non-nucleoside reverse transcriptase inhibitors
    Efavirenz caps, tabs, oral soultion
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Etravirine tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Nevirapine tabs, m/r tabs, oral suspension
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Confirm correct tablet formulation 
       
    Rilpivirine tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    05.03.01  Other antiretrovirals
    Cobicistat tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine

     
    Link  MHRA Dec 2016: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
       
    Dolutegravir tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  MHRA Jun 18: Dolutegravir (Tivicay▼, Triumeq▼, Juluca▼) - signal of increased risk of neural tube defects, do not prescribe to women seeking to become pregnant
       
    Enfuvirtide injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Maraviroc tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Raltegravir tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    Both once daily (1200 mg daily) and twice daily (400 mg twice daily) regimens are approved 
       
    Delavirdine tabs
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed
    Red
    Antiretroviral: 400 mg three times a day. Alternatively 600 mg twice daily 
       
    Didanosine powder
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed
    Red
    Antiretroviral 
       
    Mylanta extra strength liquid cherry flavour
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed
    Red
    Antacid, used as a constituent of didanosine solution  
       
    05.03.01  Pharmacokinetic enhancers of antiretrovirals
    05.03.01  Combination Products to top
    Symtuza (Darunavir/cobicistat/emtricitabine/tenofovir alafenamide)
    View adult BNF View SPC online
    Formulary
    Red
    NHS England

    Approved for use as per NHSE Policy FO3/P/b

     
    Link  MHRA Jul 2018: Darunavir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1
    Link  NHSE F03/P/b: Use of cobicistat as a booster in treatment of HIV infection (all ages)
       
    05.03.02  Herpesvirus infections
    05.03.02.01  Herpes simplex and varicella-zoster infection
    Aciclovir tabs, dispersible tabs, oral suspension, injection
    View adult BNF View SPC online
    Formulary Injection = Red Traffic Light  
       
    Valaciclovir tabs
    View adult BNF View SPC online
    Formulary  
       
    05.03.02.02  Cytomegalovirus infrection
    Cidofovir injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Foscarnet sodium injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Ganciclovir injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    Valganciclovir tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
       
    05.03.03  Viral hepatitis
    05.03.03.01  Chronic hepatitis B to top
    Adefovir dipivoxil tablets
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  NICE CG165: Hepatitis B (chronic) - incorporates TA96
    Link  NICE TA96: Hepatitis B (chronic) - adefovir dipivoxil and pegylated interferon alpha-2a
       
    Entecavir tabs, oral solution
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  NICE CG165: Hepatitis B (incorporates TA153)
    Link  NICE TA153: Hepatitis B (chronic) - etecavir
       
    Lamivudine tabs, oral solution
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  NICE CG165: Hepatitis B
       
    Peginterferon alfa-2a injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  NICE TA96: Adefovir and peginterferon alfa-2a for the treatment of chronic hepatitis B
       
    Tenofovir disoproxil tabs
    View adult BNF View SPC online
    Formulary
    Red
    Use in accordance with local guidelines:
  • First line for chronic hepatitis B
  • An option for substitution for adefovir in those patients on combination lamivudine/adefovir
  • Add-on in those patients with suboptimal response/resistance to lamivudine or entecavir 
  • Link  NICE TA173: Tenofovir disoproxil for the treatment of chronic hepatitis B
       
    05.03.03.02  Chronic hepatitis C
    Daclatasvir tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

     
    Link  NICE TA364: Daclatasvir for treating chronic hepatitis C
       
    Dasabuvir tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

     
       
    Epclusa® tabs (sofosbuvir and velpatasvir)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

     
    Link  NICE TA430: Sofosbuvir–velpatasvir for treating chronic hepatitis C
       
    Harvoni® tabs (sofosbuvir and ledipasvir)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

     
    Link  NICE TA363: Ledipasvir–sofosbuvir for treating chronic hepatitis C
       
    Maviret® tabs (glecaprevir and pibrentasvir)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

     
    Link  NICE TA99: Glecaprevir–pibrentasvir for treating chronic hepatitis C
       
    Peginterferon alfa-2a injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  NICE TA106: Peginterferon alfa and ribavirin for the treatment of mild chronic hepatitis C
    Link  NICE TA200: Peginterferon alfa and ribavirin for the treatment of chronic hepatitis C
    Link  NICE TA75: Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of chronic hepatitis C
       
    Peginterferon alfa-2b injection
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
     
    Link  NICE TA106: Peginterferon alfa and ribavirin for the treatment of mild chronic hepatitis C
    Link  NICE TA200: Peginterferon alfa and ribavirin for the treatment of chronic hepatitis C
    Link  NICE TA75: Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of chronic hepatitis C
       
    Ribavirin caps, tabs
    View adult BNF View SPC online
    Formulary
    Red
     
    Link  NICE TA106: Peginterferon alfa and ribavirin for the treatment of mild chronic hepatitis C
    Link  NICE TA200: Peginterferon alfa and ribavirin for the treatment of chronic hepatitis C
    Link  NICE TA75: Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of chronic hepatitis C
       
    Ribavirin caps, tabs (off-label use in chronic hepatitis E)
    View adult BNF View SPC online
    Formulary
    Red

    Approved off-label indication:

    Treatment of chronic hepatitis E virus infection in transplant recipients patients. 

    Daily Ribavirin dose = 1,000 mg (patients <75kg) or 1,200mg (patients ≥75kg). For patients with a creatinine clearance less than or equal to 50ml/min please refer to the SPC (link below) for recommended dose adjustments. 

     
    Link  Ribavirin 200 mg film-coated tablets (section 4.2 Table 3)
       
    Simeprevir caps
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

     
    Link  NICE TA331: Simeprevir in combination with peginterferon alfa and ribavirin for treating genotypes 1 and 4 chronic hepatitis C
       
    Sofosbuvir tabs
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

     
    Link  NICE TA330: Sofosbuvir for treating chronic hepatitis C
       
    Viekirax® (ombitasvir with paritaprevir and ritonavir)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

     
    Link  NICE TA 365: Ombitasvir–paritaprevir–ritonavir with or without dasabuvir for treating chronic hepatitis C
    Link  MHRA Dec 2016: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
       
    Vosevi® tabs (sofosbuvir, velpatasvir and voxilaprevir)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

     
       
    Zepatier® tabs (elbasvir and grazoprevir)
    View adult BNF View SPC online
    Formulary
    Red
    High Cost Medicine
    BlueTeq

     
    Link  NICE TA413: Elbasvir–grazoprevir for treating chronic hepatitis C
       
    05.03.04  Influenza
    Oseltamivir caps, oral suspension
    View adult BNF View SPC online
    Formulary Please refer to local guideline at GSTFT 
       
    Zanamivir dry powder inhalation
    View adult BNF View SPC online
    Formulary Please refer to local guideline at GSTFT 
       
    05.03.05  Respiratory syncytial virus
    05.04  Antiprotozoal drugs
    05.04.01  Antimalarials to top
    Artesunate injection
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed
    Red

    At GSTFT, use in accordance with the guideline “Management of Malaria in Adults”

    First-line therapy for severe falciparum malaria in non-pregnant adults

     
       
    05.04.01  Artemether with lumefabtrine
    Artemether with lumefantrine tabs (Riamet®)
    View adult BNF View SPC online
    Formulary  
       
    05.04.01  Chloroquine
    Chloroquine tabs, syrup, injection
    View adult BNF View SPC online
    Formulary Injection = Red Traffic Light  
       
    05.04.01  Mefloquine
    Mefloquine tabs
    View adult BNF View SPC online
    Formulary  
       
    05.04.01  Primaquine
    Primaquine tabs
    View adult BNF View SPC online
    Formulary  
       
    Primaquine tabs
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed

    Prevention of subsequent relapse of non-falciparum malaria

    Dose: Orally 15 mg daily for 14 days following the treatment of P. vivax and P. ovale malaria.

    Please seek expert advice for G6PD deficient individuals and cases where relapse occurs despite primaquine therapy

     
       
    Primaquine tabs
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed

    PCP treatment in accordance with BHIVA guidelines

    Dose: 15-30 mg once daily

     
       
    05.04.01  Proguanil to top
    Proguanil hydrochloride tabs
    View adult BNF View SPC online
    Formulary  
       
    Proguanil hydrochloride with atovaquone tabs
    View adult BNF View SPC online
    Formulary  
       
    05.04.01  Pyrimethamine
    Fansidar® tabs (pyrimethamine and sulfadoxine)
    View adult BNF View SPC online
    Formulary  
       
    05.04.01  Quinine
    Quinine dihydrochloride injection
    View adult BNF View SPC online
    Formulary
    Red
     
       
    Quinine sulphate tabs
    View adult BNF View SPC online
    Formulary  
       
    05.04.01  Tetracyclines
    Doxycycline caps
    View adult BNF View SPC online
    Formulary  
       
    05.04.02  Amoebicides
    Metronidazole tabs, oral suspension, suppositories, injection
    View adult BNF View SPC online
    Formulary Injection = Red Traffic Light  
       
    Tinidazole tabs
    View adult BNF View SPC online
    Formulary  
       
    Metronidazole 10% ointment (perianal Crohn's disease and pilonidal sinus disease)
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed
    Red

    Approved off-label indications:

    • Perianal Crohn’s disease complicated by multiple fissures and/or ulcers.
    • Chronic non-healing pilonidal sinus disease wounds; where initial surgery has been unsuccessful.
    • Dose = a 4-6 week course of twice or three times daily treatment 

     
       
    05.04.03  Trichomonacides to top
    05.04.04  Antigiardial drugs
    Mepacrine tabs
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed
    Red

    Giardiasis

    Dose: 100 mg every 8 hours for 5-7 days

     
       
    05.04.05  Leishmaniacides
    Sodium stibogluconate injection
    View adult BNF View SPC online
    Formulary
    Red

    Treatment of visceral and cutaneous leishmaniasis

    All cases of leishmaniasis (including any at GSTFT) should be referred to the infectious disease clinic for skin disease at KCH

     
       
    Paromomycin tabs
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed Leishmaniasis 
       
    05.04.06  Trypanocides
    05.04.07  Drugs for toxoplasmosis
    Pyrimethamine tabs
    View adult BNF View SPC online
    Formulary
    Red

    Use in accordance with protocol for the treatment of Toxoplasma gondii at GSTFT

    Dose: 200 mg loading dose followed by 50 mg once daily (60 kg), for 6 weeks

    Should be co-prescribed with calcium folinate 15 mg once daily to counteract myelosuppressive effects of pyrimethamine

     
       
    05.04.08  Drugs for pneumocystis pneumonia to top
    Atovaquone oral suspension
    View adult BNF View SPC online
    Formulary  
       
    Co-trimoxazole tabs, injection
    View adult BNF View SPC online
    Formulary Injection = Red Traffic Light 
       
    Dapsone tabs (treatment of pneumocystis pneumonia)
    View adult BNF View SPC online
    Formulary

    Approved off-label indication:

    Treatment of pneumocystis pneumonia

     
       
    Pentamidine isetionate nebuliser solution, injection
    View adult BNF View SPC online
    Formulary Injection = Red Traffic Light 
       
    05.05  Anthelmintics
    05.05.01  Drugs for threadworms
    Mebendazole tabs, oral suspension
    View adult BNF View SPC online
    Formulary  
       
    05.05.02  Ascaricides
    Mebendazole tabs, oral suspension
    View adult BNF View SPC online
    Formulary  
       
    05.05.03  Drugs for tapeworm infections
    Praziquantel tabs
    View adult BNF
    Unlicensed Drug Unlicensed

    Tapeworm infection

    Dose: single dose of 10-20 mg/kg after a light breakfast

     
       
    05.05.04  Drugs for hookworms to top
    Mebendazole tabs, oral suspension
    View adult BNF View SPC online
    Formulary  
       
    05.05.05  Schistosomicides
    Praziquantel tabs
    View adult BNF
    Unlicensed Drug Unlicensed

    Bilharziasis

    Dose: 40 mg/kg in 2 divided doses 4-6 hours apart on one day (60 mg/kg in 3 divided doses on one day for S. japonicum infections)

     
       
    05.05.06  Filaricides
    05.05.07  Drugs for cutaneous larva migrans
    Albendazole tabs
    View adult BNF
    Unlicensed Drug Unlicensed Multiple infections 
       
    Ivermectin tabs
    View adult BNF
    Unlicensed Drug Unlicensed Cutaneous larva migrans 
       
    05.05.08  Drugs for strongyloidiasis
    Ivermectin tabs
    View adult BNF
    Unlicensed Drug Unlicensed

    Strongyloidiasis

    Dose: 200 micrograms/kg daily, for 2 days

     
       
    Tiabendazole tabs
    View adult BNF View SPC online
    Unlicensed Drug Unlicensed

    Strongyloidiasis

    Dose: 25 mg/kg (max. 1.5 g) 12 hourly, for 3 days

     
       
     ....
    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 SPCs
    SMC
    Scottish Medicines Consortium
    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

    Red

    Specialist or hospital prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist or hospital. In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.   

    Amber 1

    Treatment can be initiated in primary care after a recommendation from an appropriate specialist  

    Amber 2

    Specialist initiation followed by maintenance prescribing in primary care  

    Amber 3

    Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation  

    Green

    Specialist and non-specialist initiation  

    Grey

    Not recommended for prescribing  

    netFormulary