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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
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Restricted to Microbiology Consultants use only
  • RFL:
    • Microbiology 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
 
   
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:
    • Non-formulary
    • See MHRA Drug Safety Updates
  • 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
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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:
    • Non-formulary
    • See MHRA Drug Safety Updates
  • RFL:
    • Microbiology approval required 
  • RNOH:
    • Microbiology approval required
  • UCLH:
  • WH:
    • Check with Microbiology
 
   
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
 
Isavuconazole

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Non Formulary
 
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
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
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

GP - 1st

Medicines suitable for first-line use within primary care.

Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.

  

GP - 2nd

Medicines suitable for second-line use within primary care.

Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.

  

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.

  

GP - Grey

Medicines on hospital formularies which have not been reviewed for suitability in primary care.  

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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