South East London Joint Medicines Formulary Formulary

	South East London Joint Medicines Formulary
	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.

Details...

05.01.04

Aminoglycosides

Amikacin injection

Formulary

Gentamicin injection

Formulary

Gentamicin injection (off-label intraperitoneal use)

Formulary

Approved off-label indication:

Intraperitoneal administration for peritoneal dialysis associated infections (in accordance with local guidelines)

Gentamicin injection (off-label intratympanic use in ENT surgery)

Formulary

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)

Formulary

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)

Formulary

Approved off-label indication:

Topical use into the pocket during pacemaker surgery

Gentamicin injection (nebulised) (bronchiectasis in non-CF patients - off-label)

Formulary

Approved off-label indication:

Bronchiecstasis in non-cystic fibrosis patients

Refer to BTS guidance for the management bronchiectasis in adults

Dose: 80 mg twice a day day via nebuliser

Neomycin tabs

Formulary

Netilmicin injection

Formulary

Tobramycin injection

Formulary

Tobramycin nebuliser solution

Formulary

Note: for existing patients only, shared care can be requested (link below)

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)

Formulary

NICE TA276: Colistimethate sodium and tobramycin dry powders for inhalation for treating pseudomonas lung infection in cystic fibrosis

Gentamicin bladder instillation (prophylaxis of recurrent UTI)

Unlicensed

Approved for prophylaxis of complicated recurrent UTI

Dose = 80 mg daily via bladder instillation for a course of up to 3 months. Can be reduced to a weekly dose after 2 weeks treatment if appropriate.

Restricted to use where:

Failed treatment with at least one 3 month course of oral prophylactic antibiotics
Failed treatment with at least one 3 month course of methenamine hippurate (if suitable)
More than two urinary tract infections in the past six months
Positive mid-stream urine sensitive to gentamicin within the last three months

Follow local guideline for use. Patients to be assessed for compentence for preparing the instillation prior to prescribing.

MHRA Jan 2021: Aminoglycosides (gentamicin, amikacin, tobramycin, and neomycin): increased risk of deafness in patients with mitochondrial mutations

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Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG

Traffic Light Status Information

Status	Description
	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.
	Treatment can be initiated in primary care after a recommendation from an appropriate specialist
	Specialist initiation followed by maintenance prescribing in primary care
	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
	Specialist and non-specialist initiation
	Not recommended for prescribing