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 Formulary Chapter 5: Infections - Full Chapter
Notes:
This chapter of the formulary is not an antibiotic prescribing guide and is not intended to guide treatment choice.

Please refer to the relevant Pennine Acute policies (e.g. the Antibiotic Policy for Adult Patients, or Antibiotic Guidelines for Paediatrics) when making treatment choices.
 Details...
05.01  Expand sub section  Antibacterial drugs
05.01.01  Expand sub section  Penicillins
05.01.01.01  Expand sub section  Benzylpenicillin and phenoxymethylpenicillin
Benzylpenicillin
(Penicillin G)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Injection
 
   
Phenoxymethylpenicillin
(Penicillin V)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
Oral Solution 
   
05.01.01.02  Expand sub section  Penicillinase-resistant penicillins
Flucloxacillin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Capsules
Oral Solution
Injection 
Link  UKMI Q&A: Can 2g flucloxacillin be given as a slow IV
   
Temocillin (Negaban®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary

Intravenous injection


For use in hospital-acquired UTIs in paediatrics - see policy


Restricted Item Restricted in adults - contact Microbiology for advice

 
Link  Paediatric Antibiotic policy
   
05.01.01.03  Expand sub section  Broad-spectrum penicillins to top
Amoxicillin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Capsules
Oral Suspension
Sachets
Injection 
   
Co-Amoxiclav
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
Oral Suspension
Injection

Restricted Item Co-amoxiclav is only recommended as first line treatment in specific indications. Refer to Antibiotic Policy.

The risk of acute liver toxicity is 6 times greater with co-amoxiclav than with amoxicillin. Cholestatic jaundice is more common in patients above the age of 65 and in males. The duration of treatment should not normally exceed 14 days.

Co-amoxiclav is a recognised cause of Clostridium difficile infections and its use should be restricted.  
   
05.01.01.04  Expand sub section  Antipseudomonal penicillins
Piperacillin and Tazobactam
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Injection 
   
Ticarcillin with Clavulanic Acid (Timentin®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Injection 
   
05.01.01.05  Expand sub section  Mecillinams
Pivmecillinam Hydrochloride (Selexid®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets 
   
05.01.02  Expand sub section  Cephalosporins, carbapenems and other beta-lactams
05.01.02.01  Expand sub section  Cephalosporins
 note  Cephalosporins can only be prescribed (for adults) following discussion with the Consultant Microbiologist or ID Physician, unless their use is clearly indicated in the Antibiotic Policy.
Cefalexin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Capsules
Tablets
Oral Suspension 
   
Cefixime
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
Oral Suspension 
   
Cefotaxime
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Injection 
   
Ceftazidime
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Injection 
   
Ceftriaxone
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Injection 
   
Cefuroxime (Zinacef®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Injection
Tablets
Oral Suspension 
   
Ceftazidime with avibactam (Zavicefta®)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted

Powder for solution for infusion

 
   
05.01.02.02  Expand sub section  Carbapenems to top
Meropenem
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Injection

Restricted Item Can only be prescribed following discussion with the Consultant Microbiologist or ID Physician 
   
Ertapenem
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Intravenous Infusion

Restricted Item Not for inpatient use 
   
05.01.02.03  Expand sub section  Other beta-lactam antibiotics
Aztreonam
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Injection

Restricted Item Can only be prescribed following discussion with the Consultant Microbiologist or ID Physician 
   
05.01.03  Expand sub section  Tetracyclines
Doxycycline
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Capsules
Dispersible Tablets 
   
Lymecycline
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Capsules 
   
Oxytetracycline
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Formulary Tablets 
   
Tetracycline
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Formulary Tablets 
   
05.01.03  Expand sub section  Tigecycline
Tigecycline
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Intravenous Infusion

Restricted Item Can only be prescribed following discussion with the Consultant Microbiologist or ID Physician 
   
05.01.04  Expand sub section  Aminoglycosides
Gentamicin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Injection
 
   
Amikacin
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Formulary Injection

Restricted Item Can only be prescribed for intravenous use following discussion with the Consultant Microbiologist or ID Physician
 
   
Tobramycin
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Formulary
Red
Injection
Dry powder inhaler ("'Podhaler'")
Nebuliser solution

Restricted Item Can only be prescribed for intravenous use following discussion with the Consultant Microbiologist or ID Physician
Restricted Item Injection solution can be nebulised in non-CF bronchiectasis; at the request of a Consultant Respiratory Physician only
 
Link  NICE TA276: Cystic fibrosis (pseudomonas lung infection) - colistimethate sodium and tobramycin (TA276)
   
Neomycin Sulphate
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets 
   
05.01.05  Expand sub section  Macrolides to top
Clarithromycin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
Oral Suspension
Intravenous Infusion
 
   
Erythromycin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Capsules
Tablets
Oral Suspension
Intravenous Infusion 
Link  UKMI Q&A: Erythromycin and Statin Interaction
   
Azithromycin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Capsules
Tablets
Oral Suspension 
   
05.01.06  Expand sub section  Clindamycin
Clindamycin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Capsules
Injection 
   
05.01.07  Expand sub section  Some other antibacterials
05.01.07  Expand sub section  Chloramphenicol
Chloramphenicol
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Injection
(Oral preparations are non-formulary) 
   
05.01.07  Expand sub section  Fosfomycin
05.01.07  Expand sub section  Fusidic acid to top
Sodium fusidate
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green 1
Tablets
Oral Suspension
Injection Restricted Item ID/microbiologist recommendation only 
   
05.01.07  Expand sub section  Vancomycin and teicoplanin
Vancomycin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green 1
Capsules
Injection


Green Traffic Light  Green1 for severe or recurrent C.diff only. To be used on advice of microbiology for other indications

 
   
Teicoplanin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Injection 
   
05.01.07  Expand sub section  Daptomycin
Daptomycin
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Formulary
Red
Intravenous Infusion
Restricted Item Can only be prescribed following discussion with the Consultant Microbiologist or ID Physician 
   
05.01.07  Expand sub section  Linezolid
Linezolid
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Tablets
Suspension
Intravenous Infusion

Restricted Item Can only be prescribed following discussion with the Consultant Microbiologist or ID Physician 
   
05.01.07  Expand sub section  Polymyxins
Colistimethate
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Intravenous injection
Injection for nebulisation (Colomycin® brand)
Powder for nebuliser solution

GMMMG RAG status when nebulised:

Red Traffic Light  RED for cystic fibrosis patients

Amber Traffic Light  AMBER for non-cystic fibrosis patients

 
   
05.01.07  Expand sub section  Rifaximin to top
Rifaximin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green 3
Restricted Item Gastroenterologists only

Initial 2 weeks supply provided by secondary care. 
Link  NICE TA337: rifaximin for preventing episodes of hepatic encephalopathy
   
05.01.07  Expand sub section  Fidaxomicin
Fidaxomicin (Dificlir®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green 2
Tablets

Restricted Item Can only be prescribed following discussion with the Consultant Microbiologist or ID Physician 
Link  GMMMG IPNTS Recommendation: Fidaxomicin (Dificlir®▼) for the Treatment of Clostridium Difficile Infection
   
05.01.08  Expand sub section  Sulphonamides and trimethoprim
Trimethoprim
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
Oral Suspension

 
   
Co-trimoxazole
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Formulary
Green 2
Tablets
Oral Suspension
Intravenous Infusion

 
   
Sulfadiazine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets

Restricted Item  Can only be prescribed following discussion with ID Physician. See BHIVA Guidelines
 
Link  BHIVA Guidelines for the Treatment of Opportunistic Infection in HIV-seropositive Individuals 2011
   
05.01.09  Expand sub section  Antituberculosis drugs
 note  All TB treatment must be initiated by a specialist in treating TB infection
Rifampicin, isoniazid, pyrazinamide and ethambutol (Voractiv®)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green 3
Tablets 
Rifampicin and Isoniazid and Pyrazinamide (Rifater®)
View adult BNF View SPC online View childrens BNF  Track Changes
Second Choice
Green 3
Tablets

2nd line option with a 4th agent 
   
Ethambutol
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green 3
Tablets 
   
Pyrazinamide
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Formulary
Green 3
Tablets 
   
Rifampicin
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Formulary
Green 3
Capsules
Tablets
Syrup
Intravenous Infusion

No restrictions on use for non-tuberculosis indications.  
   
Rifampicin and Isoniazid (Rifinah®)
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Formulary
Green 3
Tablets

For continuation (maintenance) phase of treatment 
   
Isoniazid
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Formulary
Green 3
Tablets
Injection 
   
Pyridoxine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
 
   
Rifabutin (Mycobutin®)
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Formulary
Green 3
Capsules

Restricted Item Can only be prescribed following discussion with an ID Physician 
   
Bedaquiline (Sirturo®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
Restricted ItemCan only be prescribed after discussion with an ID physician 
Link  NHS England Commissioning Policy
   
Capreomycin (Capastat®)
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Formulary Intramuscular Injection

Restricted Item Can only be prescribed following discussion with an ID physician 
   
Delamanid (Deltyba®)
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Formulary Tablets
Restricted ItemCan only be prescribed following discussion with an ID physician
 
Link  NHS England Commissioning Policy
   
Prothionamide
(Protionamide)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets


unlicensedunlicensed

Restricted Item Can only be prescribed following discussion with an ID physician 
   
Streptomycin Sulphate
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Intramuscular Injection

Restricted Item Can only be prescribed following discussion with an ID physician.  
   
Cycloserine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Capsules

Restricted Item Can only be prescribed following discussion with an ID physician 
   
P-aminosalicylic acid (Paser®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Sachets

unlicensedunlicensed

Restricted Item Can only be prescribed following discussion with an ID physician 
Link  A UK based resource to support the monitoring and safe use of anti-tuberculosis drugs and second line treatment of multidrug-resistant tuberculosis
   
Thioacetazone
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary unlicensedunlicensed

Restricted Item Can only be prescribed following discussion with an ID physician
 
Link  A UK based resource to support the monitoring and safe use of anti-tuberculosis drugs and second line treatment of multidrug-resistant tuberculosis
   
05.01.10  Expand sub section  Antileprotic drugs
Clofazimine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Capsules

Restricted Item Can only be prescribed following discussion with an ID physician 
   
Dapsone
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green 2
Tablets 
   
Thalidomide
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Formulary
Red
Tablets

Restricted Item Approved for use by ID physicians only for patients who have steroid dependent Immune Reconsitution Syndrome (IRIS) secondary to HIV related opportunistic infection or meningeal tuberculosis in a non-HIV patient. unlicensedunlicensed use 
   
05.01.11  Expand sub section  Metronidazole and tinidazole to top
Metronidazole
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
Oral suspension
Suppositories
Intravenous Infusion
 
   
Tinidazole (Fasigyn®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets 
   
05.01.12  Expand sub section  Quinolones
 note  Quinolones should be used with caution in patients with a history of epilepsy or conditions that predispose to seizures.

Tendon damage (including rupture) has been reported in patients receiving quinolones. Tendon rupture may occur within 48 hours of starting treatent; cases have also been reported several months after stopping a quinolone. (BNF)
Ciprofloxacin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
Oral Suspension
Intravenous Infusion: Restricted Item requires microbiology/ID consultant approval, unless use is in line with antibiotic policy 
   
Levofloxacin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
Intravenous Infusion 
   
Moxifloxacin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
Intravenous Infusion

Restricted Item Can only be prescribed following discussion with Microbiology or an ID physician  
   
Ofloxacin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets

(Intravenous infusion is non-formulary) 
   
05.01.13  Expand sub section  Urinary-tract infections
Nitrofurantoin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
Capsules
M/R capsules
Oral Suspension

 
Link  MHRA Drug Safety Update: Nitrofurantoin in GFR<45mls/min
   
Trimethoprim
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary See section 5.1.8. 
   
Fosfomycin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green 2
Granules for oral suspension
Injection

Restricted Item Injection - Microbiology / ID recommendation only; for the treatment of carbapenemase-producing enterobacteriaceae

 
   
 ....
 Non Formulary Items
Ampicillin

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Aztreonam nebuliser solution  (Cayston®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Red
 
Cefaclor

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cefadroxil

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Non Formulary
 
Cefpodoxime

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Non Formulary
 
Cefradine

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Non Formulary
 
Ceftaroline  (Zinforo®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Co-Fluampicil

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Colistimethate  (Promixin®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Amber
 
Colistimethate inhaler  (Colobreathe®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Link  NICE TA276: Cystic fibrosis (pseudomonas lung infection) - colistimethate sodium and tobramycin (TA276)
 
Demeclocycline

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary Non-formulary for treatment of infection.
For hyponatraemia (SIADH), see section 6.5.2.
 
Doripenem

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Imipenem with Cilastatin  (Primaxin®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Methenamine Hippurate  (Hiprex®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Minocycline

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Nalidixic Acid  (Uriben®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Netilmicin  (Netillin®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Norfloxacin

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ofloxacin
(intravenous)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Piperazine

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary DISCONTINUED
 
Rifampicin and Isoniazid  (Rimactazid® 300)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Telithromycin  (Ketek®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
  
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

Traffic Light Status Information

Status Description

Amber

Drugs designated amber are suitable for shared care arrangements under a shared care protocol. Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.   

Black

These products have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults in primary or secondary care within Greater Manchester. These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the products.  

Green

Not used   

Green 1

Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.   

Green 2

Drugs designated green2 can be initiated by primary care following written or verbal advice from a specialist and then be subsequently safely prescribed in primary care with little or no monitoring required.  

Green 3

Drugs designated green3 are suitable for on-going prescribing within primary care after specialist initiation and an initial review (unless specified) in secondary care. Little or no monitoring is required.  

Grey

Not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient.   

Red

Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.   

netFormulary