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 Formulary Chapter 5: Infections - Full Chapter
Notes:

Prescribing of systemic antimicrobials is 'protected'. All prescribing MUST be in accordance with the Trust Antimicrobial Policy and in conjunction with local antimicrobial guideline:

 Details...
05.02  Expand sub section  Antifungal drugs
Amphotericin infusion
(Fungizone)
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Not for intravenous use
    • Microbiology/ID approval only
  • RNOH:
    • Non-formulary
  • UCLH:
    • Approved for:
      • Cryptococcosis – treatment (Restricted to Microbiology approval)
      • Serious fungal infections (Restricted to Microbiology approval for intraventricular disease)
  • WH:
    • Non-formulary
 
Amphotericin liposomal infusion
(AmBisome)
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Restricted Drug Restricted
High Cost Medicine
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Provider notes

  • NMUH:
    • As per Trust Guidelines
  • RFL:
    • Restricted to OLT prophylaxis (2nd transplant/hepatic artery thrombosis)
    • Microbiology/ID approval required for all other indications
  • RNOH:
    • Microbiology approval only
  • UCLH:
  • WH:
    • Microbiology approval only
 
Fluconazole
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Infusion restricted to Microbiology Consultants use only
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Restricted antifungal. Microbiology approval only
 
Flucytosine infusion
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Restricted to Microbiology Consultants use only
  • RFL:
    • Microbiology / ID approval required 
  • RNOH:
    • Non-formulary  
  • UCLH:
  • WH:
    • Microbiology approval only
 
Griseofulvin
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary  
  • UCLH:
  • WH:
    • No restriction stated
 
Isavuconazole capsules/infusion
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Formulary
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Approved for treatment of proven or probable invasive aspergilosis or mucomycosis where other antifungals are not appropriate (JFC August 2020)

Provider notes

  • NMUH:
    • As per JFC decision above
    • On microbiology recommendation ONLY
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Itraconazole
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Oral: Restricted to Dermatology; HIV; Haematology. ID/Microbiology approval for all other indications.
    • Intravenous: Microbiology/ID approval
  • RNOH:
    • Microbiology approval only
  • UCLH:
  • WH:
    • For restricted indications as per Trust guidelines or Microbiology advice
 
Posaconazole
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Restricted Drug Restricted
GP - Red
High Cost Medicine
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Provider notes

  • NMUH:
    • Liquid: Restricted to Haematology and Oncology for prophylaxis; Microbiology approval required for treatment doses and all other indications
    • Tablets: Microbiology/ID approval required
  • RFL:
    • Liquid: Restricted to Haematology and Oncology for prophylaxis; Microbiology approval required for treatment doses and all other indications
    • Tablets: Microbiology/ID approval required
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Terbinafine tabs
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Restricted to Dermatology use only
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Voriconazole
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Restricted Drug Restricted
GP - Red
High Cost Medicine
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Provider notes

  • NMUH:
    • Microbiology approval required
    • See MHRA Drug Safety Updates
  • RFL:
    • Microbiology approval required 
  • RNOH:
    • Microbiology approval required
  • UCLH:
  • WH:
    • Check with Microbiology
 
Flucytosine tablets
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Unlicensed Drug Unlicensed
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Microbiology / ID approval required
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • 500mg tablets
 
05.02  Expand sub section  Treatment of fungal infections
05.02  Expand sub section  Drugs used in fungal infections
05.02.01  Expand sub section  Triazole antifungals
05.02.02  Expand sub section  Imidazole antifungals to top
05.02.03  Expand sub section  Polyene antifungals
05.02.04  Expand sub section  Echinocandin antifungals
Anidulafungin
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Restricted Drug Restricted
GP - Red
High Cost Medicine
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Approved for invasive candidiasis, subject to local Antimicrobial Committee approval (JFC February 2019).

Provider notes

  • NMUH:
    • To be used as per Trust antifungal guidelines
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Microbiology approval only
 
Caspofungin
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Restricted Drug Restricted
GP - Red
High Cost Medicine
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Provider notes

  • NMUH:
    • Microbiology consultant approval only
  • RFL:
    • See Microguide for agreed indications
    • Restricted to Haematology / Oncology as per policy
    • Microbiology approval required for all other indications.
  • RNOH:
    • Microbiology approval only
    • Store in a fridge
  • UCLH:
  • WH:
    • Reserved for prescribing by paediatric consultants only
 
05.02.05  Expand sub section  Other antifungals
 ....
 Non Formulary Items
Amphotericin lipid complex infusion
(Abelcet)

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Non Formulary
High Cost Medicine
Ketoconazole tablets
(Antifungal)

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Non Formulary

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

License withdrawn for this indication

Micafungin

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Non Formulary
GP - Red
High Cost Medicine
  
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
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
Homecare
Homecare

Traffic Light Status Information

Status Description

GP - Amber

Medicines that should be initiated by a specialist. Prescribing can be transferred to primary care once the patient has been stabilised.

Shared care: For drugs with regular, ongoing need for monitoring and/or assessment of efficacy or toxicity. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the North Central London JFC.

Fact sheet: For drugs with some concerns surrounding safety or efficacy but do not require regular monitoring and/or monitoring of effectiveness/toxicity.

  

GP - Red

Medicines which should normally be prescribed by specialists only (hospital only).

For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.

See link for the complete NCL Red List https://www.ncl-mon.nhs.uk/wp-content/uploads/2017/08/ncl_red_list.pdf

  

Black

Medicines not recommended for routine use in primary or secondary care.

Medicines, which the North Central London JFC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.

  

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