| Formulary Chapter 5: Infections - Full Chapter
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| 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:
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| Details... |
| 05.02 |
Antifungal drugs |
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Amphotericin infusion (Fungizone®)
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Formulary
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Provider notes
- NMUH:
- RFL:
- Not for intravenous use
- Microbiology/ID approval only
- RNOH:
- UCLH:
- Approved for:
- Cryptococcosis – treatment (Restricted to Microbiology approval)
- Serious fungal infections (Restricted to Microbiology approval for intraventricular disease)
- WH:
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Amphotericin liposomal infusion (AmBisome®)
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 Restricted
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Provider notes
- NMUH:
- 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
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Fluconazole
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Restricted
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Provider notes - NMUH:
- Infusion restricted to Microbiology Consultants use only
- RFL:
- RNOH:
- UCLH:
- WH:
- Restricted antifungal. Microbiology approval only
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Flucytosine infusion
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Restricted
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Provider notes
- NMUH:
- Restricted to Microbiology Consultants use only
- RFL:
- Microbiology / ID approval required
- RNOH:
- UCLH:
- WH:
- Microbiology approval only
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Griseofulvin
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Formulary
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Provider notes
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Itraconazole
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Restricted
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Provider notes
- NMUH:
- 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
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Posaconazole
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Restricted
 
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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:
- UCLH:
- WH:
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Terbinafine tabs
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Restricted
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Provider notes
- NMUH:
- Restricted to Dermatology use only
- RFL:
- RNOH:
- UCLH:
- WH:
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Voriconazole
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Restricted
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Provider notes - NMUH:
- Non-formulary
- See MHRA Drug Safety Updates
- RFL:
- Microbiology approval required
- RNOH:
- Microbiology approval required
- UCLH:
- WH:
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Flucytosine tablets
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 Unlicensed
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Provider notes
- NMUH:
- RFL:
- Microbiology / ID approval required
- RNOH:
- UCLH:
- WH:
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| 05.02 |
Treatment of fungal infections |
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| 05.02 |
Drugs used in fungal infections |
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| 05.02.01 |
Triazole antifungals |
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| 05.02.02 |
Imidazole antifungals |
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| 05.02.03 |
Polyene antifungals |
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| 05.02.04 |
Echinocandin antifungals |
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Anidulafungin
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Restricted
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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:
- RNOH:
- UCLH:
- WH:
- Microbiology approval only
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Caspofungin
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Restricted
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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
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| 05.02.05 |
Other antifungals |
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| .... |
| Non Formulary Items |
Amphotericin lipid complex infusion (Abelcet®)
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Non Formulary
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Isavuconazole
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Non Formulary
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Ketoconazole tablets
(Antifungal)
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Non Formulary
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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 |
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Micafungin
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Non Formulary
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Key |
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
| Status |
Description |
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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. |
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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. |
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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. |
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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. |
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Medicines on hospital formularies which have not been reviewed for suitability in primary care. |
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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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