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Stoke-on-Trent Clinical Commissioning Group
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 Formulary Chapter 5: Infections - Full Chapter
Notes:

Please note that Primary and Secondary Care have separate antimicrobial guidelines; Secondary Care utilises a UHNM Trust-specific antimicrobial formulary (note that the UHNM antimicrobial guidelines [microguide] can also be downloaded on smartphones).

These can be found at:

For Primary Care, the Antimicrobial Guidelines can be accessed on netFormulary link: http://www.northstaffordshirejointformulary.nhs.uk/docs/misc/Antimicrobial%20guidelines%202019%20Final%20version.pdf

For Secondary Care on the UHNM intranet by following: http://uhnm/clinicians/clinical-guidance/clinical-guidelines-and-pathways/antimicrobial/

Patients with HIV are treated according to the NICE accredited British HIV Association (BHIVA) guidelines which can be found at www.bhiva.org

 Details...
05.01  Antibacterial drugs
05.01.01  Penicillins
05.01.01.01  Benzylpenicillin and phenoxymethylpenicillin
05.01.01.02  Penicillinase-resistant penicillins
05.01.01.03  Broad-spectrum penicillins to top
05.01.01.04  Antipseudomonal penicillins
05.01.01.05  Mecillinams
05.01.02  Cephalosporins, carbapenems and other beta-lactums
05.01.02.01  Cephalosporins
05.01.02.02  Carbapenems to top
05.01.02.03  Other beta-lactums antibiotics
Aztreonam lysine powder nebuliser solution
(Cayston®)
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Formulary
Red
High Cost Medicine
NHS England

75 mg powder and solvent for nebuliser solution (with Altera Nebuliser Handset)

Restriction: In accordance with NHS England prescribing policy.

This is an NHS England Specialised Commissioning Drug for Cystic Fibrosis

 
   
05.01.03  Tetracyclines
05.01.04  Aminoglycosides
Tobramycin nebuliser solution

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Formulary
Amber

300mg/5ml nebuliser liquid Amps

Restriction: Non-CF Bronchiectasis. 1st line

 
   
Tobramycin dry powder for inhalation
(Tobi® Podhaler)
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Red
High Cost Medicine
NHS England

28mg Inhalation Powder Capsules with device

Restriction:

  • CF - In line with NICE Guidance. This is an NHS England Specialised Commissioning Drug for Cystic Fibrosis.

 

  • Non-CF Bronchiectasis - 2nd line only. Prior approval is required from CCG. Respiratory consultant prescription only
 
Link  NICE TA276: Cystic fibrosis (pseudomonas lung infection) - colistimethate sodium and tobramycin
   
Gentamicin (nebulised)

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Formulary
Amber

80mg/2ml Solution for Injection Amps

Restriction: Non-CF Bronchiectasis. 3rd line only in patients who do not tolerate colistimethate and tobramycin nebules due to bronchospasm and side effect.

 
   
05.01.05  Macrolides
05.01.06  Clindamycin to top
05.01.07  Some other antibacterials
Colistimethate injection for nebuliser
(Colomycin®)
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Formulary
Amber
High Cost Medicine

Colistimethate Sodium Injection 500,000u Vl (Dry)
Colistimethate Sodium Injection 1,000,000u Vl (Dry) 
Colistimethate Sodium Injection 2,000,000u Vl (Dry) 

Restriction: Non-CF Bronchiectasis. 1st line

Treatment by Inhalation not IV.
Note Colomycin® Injection may be used for nebulisation; administer required dose in 2-4 mL of sodium chloride 0.9%, (or water for injections) or a 1:1 mixture of sodium chloride 0.9% and water for injection.

 
   
Colistimethate (Promixin®)
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Amber
High Cost Medicine

Promixin 1,000,000u powder for nebuliser solution UDV
Promixin 1,000,000u powder for solution for injection vials
 

Restriction: Non-CF Bronchiectasis. 2nd Line only at the recommendation of respiratory consultant

 
   
Colistimethate dry powder for nebuliser
(Colobreathe®)
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Red
High Cost Medicine
NHS England

Colobreathe 1,662,500u inhalation powder capsules.

Restriction:

  • CF - In line with NICE Guidance & in accordance with NHS England prescribing policy. This is an NHS England Specialised Commissioning Drug for Cystic Fibrosis.

 

  • Non-CF Bronchiectasis. 3rd line only. Prior approval is required from CCG. Respiratory consultant prescription only.
 
Link  NICE TA276: Cystic fibrosis (pseudomonas lung infection) - colistimethate sodium and tobramycin
   
Rifaximin (Targaxan®)
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Formulary
Amber

Rifaximin Tablets 550mg

Restriction: In line with NICE Guidance. To be initiated by a gastroenterologist only

Specialist use only for reduction in recurrence of hepatic encephalopathy

 
Link  NICE TA337: Rifaximin for preventing episodes of overt hepatic encephalopathy
   
05.01.08  Sulphonamides and trimethoprim
05.01.09  Antituberculosis drugs
05.01.10  Antileprotic drugs
05.01.11  Metronidazole and tinidazole to top
05.01.12  Quinolones
Levofloxacin nebuliser solution
(Quinsair®)Black Triangle
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Red
High Cost Medicine
NHS England

240mg Nebuliser Solution Amps

Restriction: CF - In line with NHSE Commissioning Policy

This is a Specialised Drug which would not be routinely commissioned by CCGs for Cystic Fibrosis. This would go through the CCGs Individual Funding Request (IFR).

MHRA advice- Fluoroquinolones (March 2019):

  • systemic (by mouth, injection, or inhalation) fluoroquinolones can very rarely cause long-lasting (up to months or years), disabling, and potentially irreversible side effects, sometimes affecting multiple systems, organ classes, and senses
  • advise patients to stop treatment at the first signs of a serious adverse reaction, such as tendinitis or tendon rupture, muscle pain, muscle weakness, joint pain, joint swelling, peripheral neuropathy, and central nervous system effects, and to contact their doctor immediately for further advice.
 
Link  Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects
   
05.01.13  Urinary-tract infections
Methenamine Hippurate
(Hiprex®)
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Green

Methenamine Tablets 1gram

1st line therapy for patients presenting with recurrent UTIs to minimise the risk of antibiotic resistance and C. diff infection.

 

BNF (Less suitable for prescribing):
Methenamine (hexamine) hippurate should not generally be used because it requires an acidic urine for its antimicrobial activity and it is ineffective for upper urinary-tract infections; it may, however, have a role in the prophylaxis and treatment of chronic or recurrent uncomplicated lower urinary-tract infections

 
   
Nitrofurantoin 
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Green

Nitrofurantoin Cap 50mg
Nitrofurantoin Tab 100mg
Nitrofurantoin Cap 100mg
Nitrofurantoin Cap 100mg M/R
Nitrofurantoin Oral Susp 25mg/5ml S/F- HCD Significantly expensive item (Applicable in Primary care only)

We advise prescribing the  100mg MR twice daily  as it is more cost effective, associated with better compliance and less gastric side effects than normal release preparations.  

Nitrofurantoin is now recommended over trimethoprim as a first-line choice for uncomplicated urinary tract infections, where clinically appropriate (NICE NG109, Oct 2018). 

 
Link  NICE NG109: Urinary tract infection (lower): antimicrobial prescribing
   
Fosfomycin (Monuril®)
(Prescribe by brand)
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Formulary
Amber

Fosfomycin 3g granules sachets.

Restriction: At the recommendation of microbiologist in line with proforma

 

 

 
   
05.02  Antifungal drugs
05.02.01  Triazole antifungals
05.02.02  Imidazole antifungals to top
05.02.03  Polyene antifungals
05.02.04  Echinocandin antifungals
05.02.05  Other antifungals
05.03  Antiviral drugs
05.03.01  HIV infection to top
 note 

All medicines for the treatment of HIV Infection are funded by NHS England

Tenofovir, cobicistat, elvitegravir & emtricitabine
(Stribild®)
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Formulary
Red
High Cost Medicine
NHS England

Stribild Tablets 150mg/150mg/200mg/245mg

Restriction: In accordance with NHS England prescribing policy

This is an NHS England Specialised Commissioning Drug for HIV in combination with other anti-retroviral drugs.

 
   
05.03.02  Herpesvirus infections
05.03.02.01  Herpes simplex and varicella-zoster infection
05.03.02.02  Cytomegalovirus infection
Letermovir (Prevymis®)Black Triangle
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Formulary
Red
High Cost Medicine
NHS England

Restriction: In line with NICE Guidance

Restriction: In accordance with NHS England prescribing policy

 
Link  NICE TA591: Letermovir for preventing cytomegalovirus disease after a stem cell transplant
   
05.03.03  Viral hepatitis
 note 

All medicines for the treatment of viral hepatitis are funded by NHS England

05.03.03.01  Chronic hepatitis B to top
 note 

All medicines for the treatment of viral hepatitis are funded by NHS England

Adefovir Dipivoxil (Hepsera®)
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Red
High Cost Medicine
NHS England

Adefovir Dipivoxil Tablets 10mg

Restriction: In line with NICE Guidance

This is a Specialised Drug which would not be routinely commissioned by CCGs for Hepatitis B. This would go through the CCGs Individual Funding Request (IFR).

 
Link  NICE CG165: Hepatitis B (chronic): diagnosis and management
Link  NICE TA96: Adefovir dipivoxil and peginterferon alfa-2a for the treatment of chronic hepatitis B
   
Entecavir Monohydrate
(Baraclude®)
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Red
High Cost Medicine
NHS England

Entecavir Monohydrate Tablets 500mcg
Entecavir Monohydrate Tablets 1mg

Restriction: In line with NICE Guidance

This is an NHS England Specialised Commissioning Drug for Hepatitis B

 
Link  NICE CG165: Hepatitis B (chronic): diagnosis and management
Link  NICE TA153: Entecavir for the treatment of chronic hepatitis B
   
Tenofovir Disproxil
(Viread®)
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Red
High Cost Medicine
NHS England

Tenofovir Disproxil Tablets 123mg
Tenofovir Disproxil Tablets 163mg
Tenofovir Disproxil Tablets 204mg
Tenofovir Disproxil Tablets 245mg
Tenofovir Disproxil Granules 33mg/g

Restriction: In line with NICE Guidance
This is an NHS England Specialised Commissioning Drug for Hepatitis B +/- other anti-retroviral drugs.

7.5 scoops of granules contains approx. 245 mg tenofovir disoproxil (as fumarate).

 

 
Link  NICE TA173: Tenofovir disoproxil for the treatment of chronic hepatitis B
   
05.03.03.02  Chronic hepatitis C
 note 

All medicines for the treatment of viral hepatitis are funded by NHS England

Boceprevir (Victrelis®)
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Formulary
Red
High Cost Medicine
NHS England

Boceprevir Capsules 200mg

Restriction: In line with NICE Guidance
This is an NHS England Specialised Commissioning Drug for Hepatitis C

Boceprevir is no longer available in the UK 

 
Link  NICE TA253: Boceprevir for the treatment of genotype 1 chronic hepatitis C
   
Daclatasvir  (Daklinza®)Black Triangle
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Red
High Cost Medicine
NHS England

Daclatasvir Tablets 30mg
Daclatasvir Tablets 60mg

Restriction: In line with NICE Guidance

Restriction: In accordance with NHS England prescribing policy
This is an NHS England Specialised Commissioning Drug for Hepatitis C

 

MHRA/CHM advice: Direct-acting antivirals to treat chronic hepatitis C: risk of interaction with vitamin K antagonists and changes in INR (January 2017)

MHRA/CHM advice: Direct-acting antiviral interferon-free regimens to treat chronic hepatitis C: risk of hepatitis B reactivation (January 2017)

MHRA/CHM advice: Direct-acting antivirals for chronic hepatitis C: risk of hypoglycaemia in patients with diabetes (December 2018)

Bristol-Myers Squibb has discontinued daclatasvir (Daklinza)

 
Link  NICE TA364: Daclatasvir for treating chronic hepatitis C
   
Dasabuvir Sodium Monohydrate
(Exviera®)Black Triangle
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Formulary
Red
High Cost Medicine
NHS England

Dasabuvir Tablets 250mg

Restriction: In line with NICE Guidance

Restriction: In accordance with NHS England prescribing policy
This is an NHS England Specialised Commissioning Drug for Hepatitis C

 

MHRA/CHM advice: Direct-acting antivirals to treat chronic hepatitis C: risk of interaction with vitamin K antagonists and changes in INR (January 2017)

MHRA/CHM advice: Direct-acting antiviral interferon-free regimens to treat chronic hepatitis C: risk of hepatitis B reactivation (January 2017)

MHRA/CHM advice: Direct-acting antivirals for chronic hepatitis C: risk of hypoglycaemia in patients with diabetes (December 2018)

 
Link  NICE TA365: Ombitasvir–paritaprevir–ritonavir with or without dasabuvir for treating chronic hepatitis C
   
Elbasvir & Grazoprevir
(Zepatier®)Black Triangle
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Formulary
Red
High Cost Medicine
NHS England

Elbasvir & Grazoprevir Tablets 50/100mg

Restriction: In line with NICE Guidance
This is an NHS England Specialised Commissioning Drug for Hepatitis C

 
Link  NICE TA413: Elbasvir–grazoprevir for treating chronic hepatitis C
   
Glecaprevir & Pibrentasvir
(Maviret®)Black Triangle
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Formulary
Red
High Cost Medicine
NHS England

Glecaprevir & Pibrentasvir Tablets 100/40mg

Restriction: In line with NICE Guidance
NHS England Commissioned

 
Link  NICE TA499: Glecaprevir–pibrentasvir for treating chronic hepatitis C
   
Ledipasvir & Sofosbuvir
(Harvoni®)Black Triangle
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Formulary
Red
High Cost Medicine
NHS England

Ledipasvir & Sofosbuvir Tablets 90/400mg

Restriction: In line with NICE Guidance
This is an NHS England Specialised Commissioning Drug for Hepatitis C

 
Link  NICE TA363: Ledipasvir–sofosbuvir for treating chronic hepatitis C
   
Ombitasvir, paritaprevir & ritonavir
(Viekirax®)Black Triangle
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Formulary
Red
High Cost Medicine
NHS England

Ombitasvir, paritaprevir & ritonavir Tablets 12.5/75/50mg

Restriction: In line with NICE Guidance

Restriction: In accordance with NHS England prescribing policy
This is an NHS England Specialised Commissioning Drug for Hepatitis C

 
Link  NICE TA365: Ombitasvir–paritaprevir–ritonavir with or without dasabuvir for treating chronic hepatitis C
   
Ribavirin 
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Formulary
Red
High Cost Medicine
NHS England

Ribavirin Tablets 200mg
Ribavirin Tablets 400mg
Ribavirin Capsules 200mg
Ribavirin Oral Solution 40mg/ml
Ribavirin Injection 1.2g/12ml vials

Restriction: In line with NICE Guidance
This is an NHS England Specialised Commissioning Drug for Hepatitis C

 
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 TA300: Peginterferon alfa and ribavirin for treating chronic hepatitis C in children and young people
Link  NICE TA75: Hepatitis C - pegylated interferons, ribavirin and alfa interferon
   
Simeprevir (Olysio®)
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Formulary
Red
High Cost Medicine
NHS England

Simeprevir Capsules 150mg

Restriction: In line with NICE Guidance

Restriction: In accordance with NHS England prescribing policy
NHS England commissioned

Simeprevir Discontinued

 
Link  NICE TA331: Simeprevir with peginterferon alfa & ribavirin for hepatitis C
   
Sofosbuvir (Sovaldi®)Black Triangle
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Formulary
Red
High Cost Medicine
NHS England

Sofosbuvir Tablets 400mg

Restriction: In line with NICE Guidance

Restriction: In accordance with NHS England prescribing policy
NHS England commissioned

 
Link  NICE TA330: Sofosbuvir for treating chronic hepatitis C
   
Sofosbuvir & Velpatasvir
(Epclusa®)Black Triangle
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Formulary
Red
High Cost Medicine
NHS England

Sofosbuvir & Velpatasvir Tablets 400/100mg

Restriction: In line with NICE Guidance

Restriction: In accordance with NHS England prescribing policy
This is an NHS England Specialised Commissioning Drug for Hepatitis C

 

 
Link  NICE TA430: Sofosbuvir–velpatasvir for treating chronic hepatitis C
   
Sofosbuvir, velpatasvir & voxilaprevir
(Vosevi®)Black Triangle
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Formulary
Red
High Cost Medicine
NHS England

Sofosbuvir, velpatasvir & voxilaprevir Tablets 400/100/100mg

Restriction: In line with NICE Guidance
NHS England commissioned

 

 
Link  NICE TA507: Sofosbuvir–velpatasvir–voxilaprevir for treating chronic hepatitis C
   
Telaprevir (Incivo®)Black Triangle
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Formulary
Red
High Cost Medicine
NHS England

Telaprevir Tablets 375mg

Restriction: In line with NICE Guidance

Restriction: In accordance with NHS England prescribing policy
This is an NHS England Specialised Commissioning Drug for Hepatitis C

Telaprevir no longer has a marketing authorisation in the UK 

 
Link  NICE TA252: Telaprevir in hepatitis C
   
05.03.04  Influenza
Oseltamivir (Tamiflu®)
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Formulary
Green

Oseltamivir Phosphate Capsules 30mg 
Oseltamivir Phosphate Capsules 45mg 
Oseltamivir Phosphate Capsules 75mg
Oseltamivir Phosphate Oral Suspension 6mg/ml

Only to be prescribed on the recommendation of Public Health England

Restriction: In line with NICE Guidance

Recommended to only prescribe when official notification that influenza is circulating in the Community: to patients in "At Risk" groups, if they present within 36 hours of first symptoms and who can start treatment within 48 hours of the onset of symptoms.

 
Link  NICE TA158: Oseltamivir, amantadine (review) and zanamivir for the prophylaxis of influenza
Link  NICE TA168: Amantadine, oseltamivir and zanamivir for the treatment of influenza
   
Zanamivir inhalation
(Relenza®)
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Formulary
Red

Zanamivir Powder For Inhalation 5mg blister + Diskhaler device

Only to be prescribed on the recommendation of Public Health England

Restriction: In line with NICE Guidance

Recommended to only prescribe when official notification that influenza is circulating in the Community: to patients in "At Risk" groups, if they present within 36 hours of first symptoms and who can start treatment within 48 hours of the onset of symptoms.

 
   
05.03.05  Respiratory syncytial virus
05.04  Antiprotozoal drugs
05.04.01  Antimalarials to top
05.04.02  Amoebicides
05.04.03  Trichomonacides
05.04.04  Antigiardial drugs
05.04.05  Leishmaniacides
05.04.06  Trypanocides to top
05.04.07  Drugs for toxoplasmosis
05.04.08  Drugs for pneumocystis pneumonia
05.05  Anthelmintics
05.05.01  Drugs for threadworms
05.05.02  Ascaricides to top
05.05.03  Drugs for tapeworm infections
05.05.04  Drugs for hookworms
05.05.05  Schistosomicides
05.05.06  Filaricides
05.05.07  Drugs for cutaneous larva migrans to top
05.05.08  Drugs for strongyloidiasis
 ....
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 children's 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
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Red

Medicines that can only be prescribed within Secondary Care. Examples of medicines which fall into this category are: Certain new medicines and new indications for older medicines where there is at present no experience of use in Primary Care. Medicines or dressings not available or prescribable in Primary Care. Where a medicine has been classified as Amber E, but an approved shared-care guideline is not yet available   

Amber

Medicines which can be prescribed within Secondary Care, but are only suitable for prescribing in Primary Care after specialist referral. There is no need for approved shared care guidelines for medicines in this category. This replaces Amber 2 on the North Staffs Formulary.   

Amber E

Medicines which can be prescribed within Secondary Care, but are only considered suitable for prescribing in Primary Care under an approved shared-care agreement (ESCA) or Rationale for Initiation, Continuation and Discontinuation (RICaD). This replaces Amber 1 on the North Staffs Formulary  

Green

Medicines which can be prescribed in either Primary or Secondary Care.  

Grey

These medicines have been reviewed by the New Medicines Committee and the Area Prescribing Committee and found not to be suitable for inclusion in the Joint Formulary. Inadequate or weak evidence for efficacy No clearly defined local need Lack of long term safety data No perceived benefit over established formulary alternatives Prescribers can consider these medicines where formulary alternatives are unsuitable, ineffective or not tolerated.  

netFormulary