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 Formulary Chapter 5: Infections - Full Chapter
Notes:

Only high cost medicines to be supplied within our health economy are listed on BSW Formulary, but patients may also have access to more specialised, high cost medicines via other specialist centres, if eligible.

 

Infections Prescribing Guidance 

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

The Primary care antibiotic guidance can be found here

Management of Infection Quick Ref Guide for Adults can be found here

Management of Infection Quick Ref Guide for Children can be found here

Infections-related Shared Care Agreements

Please see our Shared Care Agreements page for all shared care agreements (SCAs) relating to this chapter

Lyme Disease:

Most up to date information see NICE Guideline NG95  April 2018 and for treatment regimens please see our primary care antibiotic guidance (link above).

Th NICE guideline covers diagnosing and managing Lyme disease. It aims to raise awareness of when Lyme disease should be suspected and ensure that people have prompt and consistent diagnosis and treatment. It does not cover preventing Lyme disease.

For general information www.lymediseaseaction.org.uk/resources/guidelines/ 

Out-patient Antibiotic Therapy (OPAT) services across BaNES/Swindon/Wiltshire:

GWH OPAT service:

OPAT Specialist Nurse - 01793 605032

Or alternatively contact switchboard on 01793 604020 and bleep 1108

OPAT Team working hours:

Monday to Friday 08:30am – 16:30pm

Out of hours contact:

Switchboard – 01793 604020 and bleep:

On call Orthopaedic registrar – 1088

On call Medical registrar – 3333

Other useful contact telephone numbers:

The PICC Team – 01793 605885 or bleep 2615

SEQOL – Swindon Community Nurses – 01793 646466

RUH OPAT service:

Direct line (with answerphone): 01225 821490

OR RUH switchboard and bleep 7467

Service is open Monday to Friday 8am to 4-4:30pm

NHSE Easy read information: Sepsis These easy read documents provide information about how to avoid sepsis, spotting the signs of sepsis, and problems after sepsis. 4/3/2020

Self-care

Many of the products in this chapter are available for purchase over-the-counter, and patients are encouraged to self-care, with the support of their community pharmacist, in the first instance.

For further information on self-care & the NHS, please refer to https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/

Chapter Links...
 Details...
05.01  Antibacterial drugs
 note 

BSW Primary Care Antibiotic Guidance 

05.01.01  Penicillins
05.01.01.01  Benzylpenicillin and phenoxymethylpenicillin
Benzylpenicillin 
(Injection)
View adult BNF View SPC online
Formulary
  •   Green  for emergency treatment of meningitis
  •   Red  for all other indications
  • 600mg vials
  • 1.2g vials
 
   
Benzylpenicillin Benzathine
(Injection)
View adult BNF View SPC online
Formulary
Red
  • GWH use to treat syphilis in HIV patients by the sexual health team.
  • RUH sexual health specialists use this as well for syphilis
  • A long acting form of benzylpenicillin administered by deep intramuscular injection. It is usually given as a single dose or weekly for the treatment of syphilis depending on the disease stage and guidelines used.
  • 600,000 units or 1.2 MU Injection
 
   
Phenoxymethylpenicillin
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablets 250mg
  • Oral solution (SF) 125mg/5ml, 250mg/5ml
 
   
05.01.01.02  Penicillinase-resistant penicillins
Flucloxacillin  
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Capsules 250mg, 500mg.
  • Oral solution 125mg/5ml, 250mg/5ml.
  • Cholestatic jaundice and hepatitis may occur, very rarely,
    up to two months after treatment with flucloxacillin has been stopped.
    Administration for more than 2 weeks and increasing age are risk factors.
    See BNF and SPC for further details.
 
   
Flucloxacillin 
( Injection)
View adult BNF View SPC online
Formulary
Red
  • 250mg
  • 500mg
  • 1g 
  • Cholestatic jaundice & hepatitis may occur, very rarely,
    up to two months after treatment with flucloxacillin has been stopped.
    Administration for more than 2 weeks and increasing age are risk factors.
    See BNF and SPC for further details.

 

 
   
Temocillin 
(Injection)
View adult BNF View SPC online
Formulary
Red
  • Powder for reconstitution 1g vial for IV or iM administration.
  • Microbiologist approval required.
  • Not routinely stocked at GWH
 
   
05.01.01.03  Broad-spectrum penicillins to top
Amoxicillin 
( Oral)
View adult BNF View SPC online
Formulary
Green
  • Capsules 250mg, 500mg.
  • Oral suspension (SF) 125mg/1.25ml, 125mg/5ml, 250mg/5ml
 
   
Amoxicillin  
(Injection)
View adult BNF View SPC online
Formulary
Red
  • 250mg
  • 500mg
  • 1g
 
   
Co-Amoxiclav  
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablets 250/125, 500/125.
  • Oral suspension (SF) 125/31 in 5ml, 250/62 in 5ml.
  • Do not prescribe with metronidazole, unless very significant faecal contamination of abdominal cavity identified during surgery.
  • Cholestatic jaundice can occur either during or shortly after use of
    co-amoxiclav. The risk of acute liver toxicity was about 6 times greater
    with co-amoxiclav than wth amoxicillin. Cholestatic jaundice is more
    common in patients above the age of 65 years and in men.
  • The duration of treatment should not usually exceed 14 days.
 
   
Co-Amoxiclav  
(Injection)
View adult BNF View SPC online
Formulary
Red
  • 500/100
  • 1000/200
  • Do not prescribe with metronidazole, unless very significant faecal contamination of abdominal cavity identified during surgery.
  • Cholestatic jaundice can occur either during or shortly after
    the use of co-amoxiclav. The risk of acute liver toxicity is about
    6 times greater with co-amoxiclav than with amoxicillin.
    Cholestatic jaundice is more common in patients above the
    age of 65 years and in men.
  • The duration of treatment should not usually
    exceed 14 days.
 
   
05.01.01.04  Antipseudomonal penicillins
Piperacillin and Tazobactam
(Injection)
View adult BNF View SPC online
Formulary
Red
  • Piperacillin 2g/ tazobactam 250mg
  • Piperacillin 4g/ tazobactam 500mg
  • Piperacillin/Tazobactam 13500mg via surefuser + device over 24hrs
  • Usual duration is 5-14 days.
 
   
05.01.01.05  Mecillinams
Pivmecillinam 
(Tablet)
View adult BNF View SPC online
Formulary
Green
  • Tablets 200mg
  • Do NOT use if penicillin allergic.
  • See primary care antibiotic guidance for UTI guidance
 
   
05.01.02  Cephalosporins, carbapenems and other beta-lactums
05.01.02  Cephalosporins
Cefalexin 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Capsules 250mg, 500mg
  • Tablets 250mg, 500mg.
  • Oral suspension 125mg/5ml and 250mg/5ml
  • For use in UTIs please see local Primary Care Antibiotic Guidance
 
   
Cefotaxime  
(Injection)
View adult BNF View SPC online
Formulary
  • Green  for meningococcal disease for Penicillin allergic patients
  • Red for all other indications 
  • 500mg
  • 1g
  • 2g

 

 
   
Ceftazidime 
(Injection)
View adult BNF View SPC online
Formulary
Red
  • 250mg
  • 500mg
  • 1g
  • 2g
  • 2000mg surefuser device over 24hrs via local Outpatient Parenteral Antibiotic Treatment (OPAT) services (acute trusts).
 
   
Ceftriaxone 
(Injection)
View adult BNF View SPC online
Formulary
  • Red for use in acute trusts
  • Green for use in primary care as follows:
  • for treatment of cellulitis in the community in BaNES via Virgin Care primary care services 
  • 1g IM STAT used for treatment of pelvic inflammatory disease with high risk of gonococcal infection in conjunction with oral antibiotics as per local primary care antibiotic guidance.
  • 250mg, 1g and 2g
 
   
Cefuroxime  
(Injection)
View adult BNF View SPC online
Formulary
Red
  • 250mg
  • 750mg
  • 1.5g.
 
   
05.01.02  Other beta-lactam antibiotics to top
05.01.02.01  Cephalosporins
Cefixime (Suprax®)
View adult BNF View SPC online
Formulary
  • Red - GWH - For use by Sexual Health team, as a stat dose in combination with azithromycin, for the treatment of gonorrhoea in patients declining IM injection.
  • Non-formulary - Bath & Salisbury.
  •  200mg tablets.
 
   
05.01.02.02  Carbapenems
Ertapenem 
(Injection)
View adult BNF View SPC online
Formulary
  • Red for use in acute trusts
  • Green for treatment of multi-resistant UTI in the community. Only available within the BaNES Health Community. The Virgin Care Community IV team provides and administers IV drugs.
  • IV infusion 1g vial
 
   
Meropenem 
(Injection)
View adult BNF View SPC online
Formulary
Red
  •  500mg
  • 1g
 
   
05.01.02.03  Other beta-lactums antibiotics
Aztreonam 
(Injection)
View adult BNF View SPC online
Formulary
Red
  • 500mg
  • 1g
  • 2g
 
   
Imipenem with Cilastatin
(Injection)
View adult BNF View SPC online
Formulary
Red
  • Used in GWH and SFT 
  • RUH – not routinely stocked
  • 500mg/500mg powder for solution for infusion
 
   
05.01.03  Tetracyclines
 note 

For use of tetracyclines in the treatment of acne see guidance here

Doxycycline 
(Capsule)
View adult BNF View SPC online
Formulary
Green
  • 50mg
  • 100mg

     

 
   
Oxytetracycline 
(Tablet)
View adult BNF View SPC online
Formulary
Green
  • 250mg tablets
 
   
Demeclocycline 
(Capsule)
View adult BNF View SPC online
Formulary
Amber
  • 150mg Capsules
  • Only on formulary to treat Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH). 
  • Not on formulary for treatment of infections.
 
   
Lymecycline 
(Capsule)
View adult BNF View SPC online
Formulary
Green
  • 408mg capsules
  • More expensive option
 
   
05.01.03  Tigecycline to top
Tigecycline  
(IV infusion)
View adult BNF View SPC online
Formulary
Red
  • 50mg vials
 
   
05.01.04  Aminoglycosides
Gentamicin 
(Injection)
View adult BNF View SPC online
Formulary
  • Red Blood level monitoring is mandatory for continued therapy.
  • Used for Non-CF bronchiectasis within RUH (injection nebulised) 
  • Green Primary care IM use for prophylaxis during the insertion
    and removal of catheters. Only use for catheter changes if history of
    catheter change-associated UTI or trauma.
  • 20mg/2ml
  • 40mg/2ml - Not in the Drug Tariff do not prescribe on FP10 
  • 80mg/2ml. 
 
Link  MHRA Nov 2017 Gentamicin: potential for histamine-related adverse drug reactions with some batches
   
Tobramycin 
(Injection)
View adult BNF View SPC online
Formulary
Red
  • Injection 40mg/ml; 1ml (40mg) vial, 2ml (80mg) vial
  • Used for Non-CF bronchiectasis within RUH (injection nebulised) 
 
Link  March 2020 SPS article - Safe administration of tobramycin injection via a nebuliser
   
Tobramycin (Bramitob®)
(Nebuliser solution)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
 
   
Tobramycin inhaler (TOBI Podhaler®)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
 
Link  NICE TA276: Cystic fibrosis (pseudomonas lung infection) - colistimethate sodium and tobramycin
   
05.01.05  Macrolides
Clarithromycin 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablets 250mg, 500mg
  • Oral suspension (SF) 125mg/5ml, 250mg/5ml

 

 
   
Clarithromycin 
(Injection)
View adult BNF View SPC online
Formulary
Red
  •  IV infusion -used by BaNES community IV service
 
   
Erythromycin 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablets 250mg
  • Oral suspension (SF) (ethylsuccinate) 125mg/5ml, 250mg/5ml, 500mg/5ml
 
   
Azithromycin 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablets 250mg
  • Oral suspension 200mg/5ml
  • Included for primary care use only as an option for the treatment of chlamydia, travellers diarrhoea (private prescription) and certain types of Lyme diease.
  • See primary care antibiotic guidance for further advice.
  • Amber For COPD prophylaxis (off-label use), the decision to start azithromycin for several months at a time should be initiated by secondary care once the diagnosis of COPD has been confirmed and all the necessary preliminary investigations (eg CT and sputum cultures) has been done. NOT to be initiated by GPs without specialist input.

 

 
   
05.01.06  Clindamycin
Clindamycin  
(Capsule)
View adult BNF View SPC online
Formulary
Green
  •  75mg
  • 150mg
  • For use in primary care as per local antibiotic guidance for unresolving cellulitis.
  • GWH use as part of treatment protocol for PCP (Pneumocystis jirovecii pneumonia)
  • High risk for clostridium difficile disease. Clindamycin is associated with Clostridium difficile diarrhoea, which limits its use. Patients should discontinue treatment immediately if diarrhoea develops.
 
   
Clindamycin  
(Injection)
View adult BNF View SPC online
Formulary
Red
  •  600mg/4ml
  • GWH use as part of treatment protocol for PCP (Pneumocystis jirovecii pneumonia)
 
   
05.01.07  Some other antibacterials
Rifaximin 
(Tablet)
View adult BNF View SPC online
Formulary
Amber with Shared Care
  • Tablets 550mg
  • All non-NICE indications require an IFR to the CCG.
  • NOTE: Rifaximin 200mg (Xifaxanta®) is NON-FORMULARY, including use for travellers diarrhoea and should not be prescribed on FP10.

 

 
Link  3Ts Rifaximin Shared Care Document
Link  BCAP Rifaximin Shared Care Document
Link  NICE TA337: Rifaximin for preventing episodes of overt hepatic encephalopathy (March 2015)
Link  SFT Rifaximin Shared Care Document
   
Pristinamycin 
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Red
  • RUH only: For bone and joint infections following microbiology recommendation only.
  • Not on formulary at GWH or SFT
 
   
05.01.07  Chloramphenicol to top
Chloramphenicol 
( Injection)
View adult BNF View SPC online
Formulary
Red
  •  1g injection
 
   
05.01.07  Fosfomycin
Fosfomycin  
(Injection)
View adult BNF View SPC online
Formulary
Red
  • For use on consultant microbiologist advice only
  • 2g powder for solution for infusion vials
  • 4g powder for solution for infusion vials 
  • EMA has recommended that fosfomycin medicines given by infusion (drip) into a vein should only be used to treat serious infections when other antibiotic treatments are not suitable. 27/3/2020    
 
Link  CHMP Fosfomycin-containing medicinal products: Recommendations to restrict use of fosfomycin antibiotics​
   
05.01.07  Fusidic acid
Sodium fusidate oral
(Fusidic acid )
(Oral)
Formulary
Amber
  • Tablets 250mg
  • Fusidic acid oral suspension 250mg/5ml (5ml is approx. equivalent to 175mg sodium fusidate).
  • On advice of Consultant Microbiologist when prescribed in primary care

 

 
   
05.01.07  Vancomycin and teicoplanin
Teicoplanin 
(Injection)
View adult BNF View SPC online
Formulary
  • Red 
  • Green only for use by BaNES community nurse team.
  • 200mg
  • 400mg
 
   
Vancomycin  
(Injection )
View adult BNF View SPC online
Formulary
Red
  • 500mg
  • 1g.
  • Blood level monitoring is mandatory for IV use.
 
   
Vancomycin 
(Capsule)
View adult BNF View SPC online
Formulary
Green
  • 125mg
  • 250mg
  • Only for treatment of Clostridium Difficile associated diarrhoea.
 
   
05.01.07  Daptomycin
Daptomycin 
(Injection)
View adult BNF View SPC online
Formulary
Red
  • Use with microbiology advice only
  • GWH/RUH only
 
   
05.01.07  Linezolid to top
Linezolid 
(Oral, infusion)
View adult BNF View SPC online
Formulary
Red
  • Tablets 600mg
  • IV infusion 600mg/300ml
  • FBC monitoring (including platelets) should be performed weekly.
 
   
05.01.07  Quinupristin and dalfopristin
05.01.07  Polymyxins
Colistimethate 
( Injection )
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
CCG
  • Red RUH CF patients (seen at BRI hospital) TLS Red for management of acute and chronic CF infections 
     
  • Amber with Shared Care RUH only: Nebulised- NON-CF patients chronically colonised with P.aeruginosa Prescribe as Colomycin® brand along with sodium chloride ampoules for reconstitution as detailed in SCA (below)

  • Amber GWH for use in bronchiectasis and existing CF patients (usually nebulised).
  • Red  GWH for use in new CF patients (usually nebulised).
  • Red GWH use IV for treatment of carbapenemase-producing Enterobacteriaceae

  • 500,000 units
  • 1 million units
  • 2 million units

 

 
Link  BCAP SCA - nebulised colistimethate Non-CF bronchiectasis
   
Colistimethate  (Colobreathe®)
(Inhaler)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  Dry powder for inhaler and hard capsule 1.66 million units/capsule
 
Link  Clinical Commissioning Policy: Inhaled Therapy for Adults and Children with Cystic Fibrosis NHS England A01/P/b
Link  Colobreathe (colistimethate sodium dry powder for inhalation): risk of capsule breakage - new instructions for use
Link  NICE TA276: Cystic fibrosis (pseudomonas lung infection) - colistimethate sodium and tobramycin
   
05.01.07  Rifaximin
05.01.07  Fidaxomicin
Fidaxomicin 
(Tablet)
View adult BNF View SPC online
Formulary
Amber
  • Tablets 200mg
  • For the treatment of intractable Clostridium Difficile on microbiologist
    advice only.
  • See local primary care antibiotic guidance for treatment advice in
    primary care or acute trust guidance for treatment in secondary care setting.
    See PHE management and treatment of Clostridium guidance on link below.
 
Link  Clostridium difficile: guidance, data and analysis
   
05.01.08  Sulphonamides and trimethoprim to top
Co-trimoxazole 
( Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablets 480mg, 960mg
  • Suspension 240mg/5ml, 480mg/5ml
  • Included in primary care antibiotic guidance as an alternative option for the treatment of acute exacerbations of COPD
  • Otherwise used as recommended by a microbiologist.
 
   
Co-trimoxazole  
(Injection)
View adult BNF View SPC online
Formulary
Red
  • 480mg/5ml
  • 960mg/10ml
 
   
Trimethoprim 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablets 100mg, 200mg
  • Oral suspension (SF) 50mg/5ml
  • Used to treat UTIs as per primary care antibiotic guidance only if there is a low risk of resistance.
  • GWH use for the treatment of PCP (Pneumocystis jirovecii pneumonia)
 
   
05.01.09  Antituberculosis drugs
 note 

Notes:

  • Tuberculosis is treated in two phases – an initial phase using at least three drugs and a continuation phase using two drugs in fully sensitive cases. Please see BNF for further information.
  • Rifampicin should not be used as monotherapy (except in the case of meningococcal prophylaxis as advised by Public Health) and wherever possible, administered orally. 
Ethambutol  
(Tablet)
View adult BNF View SPC online
Formulary
Red
  • 100mg
  • 400mg
 
   
Isoniazid 
(Oral)
View adult BNF View SPC online
Formulary
Red
  • Tablets 50mg, 100mg
  • Elixir (SF) 50mg/5ml (unlicensed)
 
   
Pyrazinamide 
(Tablet)
View adult BNF View SPC online
Formulary
Red
  •  Tablets 500mg
 
   
Rifampicin 
(Oral)
View adult BNF View SPC online
Formulary
Red
  • For treatment of Tuberculosis: RED traffic light status.
  • Capsules 150mg, 300mg
  • Syrup 100mg/5ml
  • Long-term use for orthopaedic infections under review, RED traffic light status currently.

 

 
   
Rifampicin 
(IV Infusion)
View adult BNF View SPC online
Formulary
Red
  •  IV Infusion 600mg (with solvent)

 

 
   
Rifampicin and Isoniazid
(Rifinah® )
(Tablet)
View adult BNF View SPC online
Formulary
Red
  •  Tablets rifampicin 300mg/isoniazid 150mg or rifampicin 150mg/isoniazid 100mg
 
   
Rifampicin and Isoniazid and Pyrazinamide
(Rifater®)
(Tablet)
View adult BNF View SPC online
Formulary
Red
  •  Tablets rifampicin 120mg, isoniazid 50mg, pyrazinamide 300mg
 
   
Rifampicin, isoniazid, pyrazinamide and ethambutol
(Voractiv®)
View adult BNF View SPC online
Formulary
Red
  • RUH only
  • For initial treatment of tuberculosis according to WHO guidelines
  • Tablets rifampicin 150mg, isoniazid 75mg, ethambutol hydrochloride 275mg, pyrazinamide 400mg
 
   
05.01.10  Antileprotic drugs
Dapsone 
(Tablet)
View adult BNF View SPC online
Formulary
  • Amber for the treatment of dermatitis herpetiformis for stable patients.
  • Red for unlicensed indications.
  • GWH use for the treatment of PCP (Pneumocystis jirovecii pneumonia)
  • 50mg
  • 100mg
  • Needs monitoring as per DMARD shared care agreement on link below
 
Link  BCAP Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) March 2018
   
05.01.11  Metronidazole and tinidazole
Metronidazole 
(Oral, rectal)
View adult BNF View SPC online
Formulary
Green
  • Tablets 200mg, 400mg
  • Oral suspension 200mg/5ml
  • Suppositories 500mg, 1g
 
   
Metronidazole  
(Infusion)
View adult BNF View SPC online
Formulary
Red
  •  IV infusion 500mg/100ml
 
   
Tinidazole 
(Tablet )
View adult BNF View SPC online
Formulary
Amber
  • Tablets 500mg
  • If giardia is confirmed or suspected – tinidazole 2g single dose is the treatment of choice and as recommended by NICE.
  • Use with microbiology advice.
 
   
05.01.12  Quinolones
 note 

See EMA safety warning 2018 disabling and potentially permanent side-effects lead to restrictions on use of quinolone and flouroquinolone antibiotics. 

Ciprofloxacin 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Only to be used in line with local primary care antibiotic guidance indications.
  • The EMA’s Pharmacovigilence Risk Assessment Committee has recommended restricting fluoroquinolones following a review of disabling & potentially long-lasting side-effects. See link above for further information. 
  • Tablets 250mg, 500mg
  • Oral suspension 250mg/5ml
 
   
Ciprofloxacin  
(Infusion)
View adult BNF View SPC online
Formulary
Red
  • The EMA’s Pharmacovigilence Risk Assessment Committee has recommended restricting fluoroquinolones following a review of disabling & potentially long-lasting side-effects. See link above for further information. 
  • IV infusion 100mg/50ml, 200mg/100ml, 400mg/200ml
 
   
Levofloxacin 
(IV infusion)
View adult BNF View SPC online
Formulary
Red
  • The EMA’s Pharmacovigilence Risk Assessment Committee has recommended restricting fluoroquinolones following a review of disabling & potentially long-lasting side-effects. See link above for further information. 
  • IV infusion 5mg/ml 100ml bottle, 100ml infusion bag
 
   
Levofloxacin 
(Tablet)
View adult BNF View SPC online
Formulary
Amber
  • The EMA’s Pharmacovigilence Risk Assessment Committee has recommended restricting fluoroquinolones following a review of disabling & potentially long-lasting side-effects. See link above for further information. 
  • 250mg
  • 500mg
  • Consultant microbiologist recommendation ONLY.
 
   
Moxifloxacin 
(Oral)
View adult BNF View SPC online
Formulary
Red
  • GWH only for use by ophthalmology for endophthalmitis and for sexual health indications.
  • The EMA’s Pharmacovigilence Risk Assessment Committee has recommended restricting fluoroquinolones following a review of disabling & potentially long-lasting side-effects. See link above for further information.
  • 400mg tablets
 
   
Ofloxacin 
(Tablet)
View adult BNF View SPC online
Formulary
Green
  • The EMA’s Pharmacovigilence Risk Assessment Committee has recommended restricting fluoroquinolones following a review of disabling & potentially long-lasting side-effects. See link above for further information. 
  • Tablets 200mg
 
   
05.01.13  Urinary-tract infections to top
 note 

Diagnosis of UTIs: quick reference guide for primary care Sept 2019

Nitrofurantoin 
(Oral)
View adult BNF View SPC online
First Choice
Green

Nitrofurantoin may be used with caution if eGFR 30-44ml/min, if potential benefit outweighs risk. 

  • Tablets 50mg or 100mg.
  • Modified release capsules 100mg
  • The SPC for nitrofurantoin has been updated to state that doses should always be taken with food, as this increases absorption and increases dose efficacy.
  • NB Liquid is very high cost. Drug Tariff June 2020: £525 per bottle.
 
Pivmecillinam  
(Tablet)
View adult BNF View SPC online
Formulary
Green
  • Tablets 200mg
  • Use if 1st line nitrofurantoin is unsuitable and eGFR <45ml/min
  • Do NOT use if penicillin allergic

 

 
   
Trimethoprim 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablets 100mg, 200mg.
  • Oral suspension (SF) 50mg/5ml
  • Can be used to treat UTIs where there is LOW risk of resistance.
  • Do not use in the elderly without sensitivity results as resistance is likely.
 
   
Fosfomycin 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • 3g sachets
  • Use if high risk of resistance or penicillin allergy.
  • EMA no longer recommends the use of fosfomycin in under 12s as there are insufficient data available to confirm their benefits to patients.
 
Link  CHMP Fosfomycin-containing medicinal products: Recommendations to restrict use of fosfomycin antibiotics​
   
Methenamine Hippurate
(Tablet)
View adult BNF View SPC online
Formulary
Green
  • Tablets 1g
  • Methenamine can be considered if there is no renal or hepatic impairment.
  • Might be recommended by a urologist for prophylaxis in patients with
    recurrent UTIs.
 
   
05.02  Antifungal drugs
 note 

Dermatophyte infection of the proximal fingernail or toenail

  • Self care where possible (Amorolfine nail lacquer can be purchased)       
  • Consider drug treatment if walking is uncomfortable,
    • abnormal looking nails causing significant distress,
    • the person has diabetes, vascular disease, or connective tissue disorder,
    • the nail is thought to be the source of fungal skin infection,
  • The person is or likely to become severely immunocompromised (e.g, with haematological malignancy or treatment)
Amphotericin 
(IV Infusion )
View adult BNF View SPC online
Formulary
Red
  •  Infusion 50mg
  • The National Patient Safety Agency has advised all healthcare staff involved in the use of intravenous amphotericin of the potentially lethal results if non-lipid and lipid formulations of the drug are confused. Caution: double check.
 
Link  Parenteral amphotericin B: reminder of risk of potentially fatal adverse reaction if formulations confused
   
Amphotericin liposomal
(Ambisome ®)
(IV Infusion)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
  •  Infusion 50mg.
  • The National Patient Safety Agency has advised all healthcare staff involved in the use of intravenous amphotericin of the potentially lethal results if non-lipid and lipid formulations of the drug are confused. Caution: double check.

 

 
Link  Parenteral amphotericin B: reminder of risk of potentially fatal adverse reaction if formulations confused
   
Flucytosine 
(IV Infusion )
View adult BNF View SPC online
Formulary
Red
  • Infusion 10mg/ml
  • Under the guidance of a consultant mycologist ONLY
 
   
Isavuconazole 
(Capsules, Injection)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
BlueTeq
  • Formulary at RUH only
  • Non Formulary GWH SFT

 

  • 100 mg hard capsules
  • 200 mg powder for concentrate for solution for infusion
  • To treat mucormycosis as per Trust Guidelines

 

 
   
Itraconazole 
(10mg/ml oral solution)
View adult BNF View SPC online
Formulary
Amber
  • For use by haematology
  • GWH and SFT only
  • Please note liquid is expensive
 
   
Itraconazole 
(Capsule)
View adult BNF View SPC online
Formulary
Green
  • Capsules 100mg
  • Treatment for most fungal skin and nail infections are a low clinical priority for local CCGs.

 

 
   
Posaconazole 
(Oral)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • Suspension 200mg/5ml
  • 100mg tablet
  • In accordance with prophylaxis/treatment guidance for neutropenic patients
 
Link  Posaconazole (Noxafil): tablets and oral suspension are not directly interchangeable
   
Posaconazole 
(IV)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
  • RUH only as per anti-fungal guidance
 
   
Terbinafine 
(Tablet)
View adult BNF View SPC online
Formulary
Green
  • Tablets 250mg
  • Treatment for most fungal skin and nail infections are a low clinical priority for local CCGs.

 

 
   
Voriconazole 
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
  • 50mg
  • 200mg
  • Used under the guidance of a consultant mycologist only.
  • Test liver function before starting treatment with voriconazole
    and at least weekly during the first month of treatment.
  • Tell patients to avoid sunlight exposure while taking voriconazole

 

 
Link  Voriconazole: reminder of risk of liver toxicity, phototoxicity, and squamous cell carcinoma
   
Voriconazole 
(IV infusion)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
  • IV infusion 200mg
  • Used under the guidance of consultant mycologist only.
  • Test liver function before starting treatment with voriconazole
    and at least weekly during the first month of treatment.
    Tell patients to avoid sunlight exposure while taking voriconazole

 

 

 

 
Link  Voriconazole: reminder of risk of liver toxicity, phototoxicity, and squamous cell carcinoma
   
05.02  Treatment of fungal infections
05.02  Drugs used in fungal infections
Fluconazole 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Capsules 50mg, 150mg, 200mg
  • Oral suspension 50mg/5ml, 200mg/5ml
 
   
Fluconazole 
(IV infusion)
View adult BNF View SPC online
Formulary
Red
  •  IV infusion 2mg/ml, 25ml bottle, 100ml bottle
 
   
05.02.01  Triazole antifungals
05.02.02  Imidazole antifungals to top
05.02.03  Polyene antifungals
05.02.04  Echinocandin antifungals
Anidulafungin 
(IV infusion)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
  • 100mg powder for concentrate for solution for IV infusion
  • Treatment of invasive candidiasis in adult non-neutropaenic patients who are unable to tolerate fluconazole or have invasive candidiasis that is resistant to fluconazole as per acute trust guidance.
 
Link  Feb 2020 Letter sent to HCPs - Ecalta 100mg solution for infusion (anidulafungin) must no longer be frozen
   
Caspofungin 
(IV infusion)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
  • 50mg Powder for conc for soln for infusion
  • 70mg Powder for conc for soln for infusion
  • Indicated for the treatment of invasive candidiasis. Treatment of invasive aspergillosis in patients refractory to or intolerant of amphotericin and/or itraconazole. Empirical therapy for presumed fungal infections in febrile neutropenic patients. Used as per microbiology advice only.
 
   
05.02.05  Other antifungals
05.03  Antiviral drugs
Remdesivir 
(Injection)
View adult BNF View SPC online
Formulary
Red
  • 100mg/20ml concentrate for solution for infusion vials
  • 100mg powder for concentrate for solution for infusion vials
 
   
05.03.01  HIV infection to top
 note 

Refer to British HIV Guidelines at http://www.bhiva.org/

For information on drug interactions see the Liverpool University site at http://www.hiv-druginteractions.org/

05.03.01  Nucleoside reverse transcriptase inhibitors
Abacavir 
(Oral)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • Tablets 300mg
  • Oral solution 20mg/ml
 
   
Abacavir and Lamivudine
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  600 mg of abacavir (as sulfate) and 300 mg lamivudine
 
   
Bictegravir, Emtricitabine, Tenofovir alafenamide
(Biktarvy®)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • Tablets containing bictegravir sodium equivalent to 50 mg of bictegravir, 200 mg of emtricitabine, and tenofovir alafenamide fumarate equivalent to 25 mg of tenofovir alafenamide
  • For treatment of HIV-1 in adults in line with NHSE CCP
 
   
Dolutegravir, abacavir & lamivudine
(Triumeq®)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • 50 mg dolutegravir (as sodium), 600 mg of abacavir (as sulfate) and 300 mg of lamivudine
 
Link  MHRA safety update June 2018: Dolutegravir (Tivicay¥, Triumeq¥, Juluca¥): signal of increased risk of neural tube defects
   
Emtricitabine (Emtriva®)
(Oral)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • Capsules 200mg
  • Oral solution 50mg/5ml
 
   
Emtricitabine + tenofovir alafenamide
(Descovy®)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  Emtricitabine/Tenofovir alafenamide 200mg/10mg or 200mg/25mg 
 
   
Emtricitabine 200mg, Rilpivirine 25mg and Tenofovir 245mg
(Eviplera®)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  Emtriciciabine 200mg, rilpivirine 25mg, tenofovir 245mg
 
   
Emtricitabine, rilpivirine, & tenofovir alafenamide
(Odefsey ®)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  Rilpivirine 25mg, emtricitabine 200mg tenofovir alafenamide (TAF) 25mg
 
   
Tenofovir 245mg, Efavirenz 600mg and Emtricitabine 200mg
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  Prescribe generically.
  •  Efavirenz 600mg, emtricitabine 200mg, tenofovir disoproxil 245mg
 
   
Tenofovir alafenamide, elvitegravir, cobicistat & emtricitabine
(Genvoya®)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • Elvitegravir 150mg, cobicistat 150mg, emtricitabine 200mg, tenofovir alafenamide fumerate 10mg
 
Link  MHRA Drug Safety Update (Apr 2019): Elvitegravir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1
Link  Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects Dec 16
   
Tenofovir and Emtricitabine
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  Prescribe generically.
  •  Tenofovir disoproxil 245mg and emtricitabine 200mg
 
   
Tenofovir Disproxil
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  245mg
 
Link  NICE TA173: Hepatitis B (chronic) - tenofovir disoproxil
   
Tenofovir, cobicistat, darunavir & emtricitabine
(Symtuza)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • Each film-coated tablet contains 800 mg of darunavir (as ethanolate), 150 mg of cobicistat, 200 mg of emtricitabine, and 10 mg of tenofovir alafenamide (as fumarate).

 

 
   
Tenofovir, cobicistat, elvitegravir & emtricitabine
(Stribild®)
(Tablet )
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • Eivitegravir 150mg, cobicistat 150mg, emtricitabine 200mg and 245 mg of tenofovir disoproxil (equivalent to 300 mg of tenofovir disoproxil fumarate or 136 mg of tenofovir).
 
Link  MHRA Drug Safety Update (Apr 2019): Elvitegravir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1
Link  MHRA safety warning Dec 2016: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
   
Zidovudine 
(IV Injection)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  10mg/ml, 20ml vial
 
   
Zidovudine 
(Oral)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • Capsules 100mg, 250mg
  • Oral solution 50mg/5ml
 
   
Zidovudine and Lamivudine

(Tablets )
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • Lamivudine 150mg and zidovudine 300mg
  • Prescribe generically
 
   
05.03.01  Protease inhibitors
Atazanavir (Reyataz®)
(Capsules)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • 150mg
  • 200mg
  • 300mg
 
   
Atazanavir + Cobicistat
(Evotaz®)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •   Atazanavir sulphate corresponding to 300 mg atazanavir and 150 mg of cobicistat
 
   
Darunavir (Prezista®)
(Tablets)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • 400mg
  • 600mg
  • 800mg
 
   
Darunavir and Cobicistat
(Rezolsta®)
(Tablet )
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  Tablet contains 800 mg of darunavir (as ethanolate) and 150 mg of cobicistat
 
Link  MHRA safety update July 2018: Darunavir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1
   
Lopinavir and Ritonavir
(Kaletra®)
(Oral)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • Tablets lopinavir/ritonavir 100mg/25mg and 200mg/50mg
  • Oral solution lopinavir 400mg and ritonavir 100mg
 
Link  MHRA safety update Dec 16: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
   
Ritonavir 
(Oral)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • Tablets 100mg
  • Oral solution (SF) 400mg/5ml
  • Prescribe generically
 
Link  MHRA safety update Dec 2016: Cobicistat, ritonavir and coadministration with a steroid: risk of systemic corticosteroid adverse effects
   
05.03.01  Non-nucleoside reverse transcriptase inhibitors
Efavirenz (Sustiva®)
(Oral)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • Capsules 50mg, 100mg, 200mg
  • Tablets 600mg
  • Oral solution (SF) 30mg/ml
 
   
Etravirine (Intelence®)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  Tablets 200mg
 
   
Nevirapine (Viramune®)
(Oral)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • Tablets 200mg
  • Tablets 400mg M/R
  • Suspension 50mg/5ml
 
   
05.03.01  Other antiretrovirals
Dolutegravir 
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  Tablets 50mg
 
Link  MHRA safety update June 2018: Dolutegravir (Tivicay¥, Triumeq¥, Juluca¥): signal of increased risk of neural tube defects
   
Maraviroc (Celsentri®)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  Tablets 150mg
 
   
Raltegravir 
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • 400mg
  • 600mg
 
   
Rilpivirine hydrochloride
(Edurant®)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • Each film-coated tablet contains rilpivirine hydrochloride equivalent to 25 mg rilpivirine
  • Must be taken with a meal
 
   
05.03.02  Herpesvirus infections to top
05.03.02.01  Herpes simplex and varicella-zoster infection
Aciclovir  
(Tablet)
View adult BNF View SPC online
Formulary
  • Green 
  • 200mg
  • 400mg
  • 800mg
  • During Varicella Zoster Immunoglobulin Shortage (Aug 2018):
    • Amber "off label" use during the shortage of Varicella Zoster Immunoglobulin (VZIG)in patients who are 20+ weeks pregnant.Only to be used as AMBER on specialist advice.
    •  Dose 800mg four times a day from day 7 to 14 after exposure
 
Link  Updated restrictions on use of Varicella Zoster Immunoglobulin (VZIG) during supply shortage: advice to health professionals August 2018
   
Aciclovir  
(IV infusion)
View adult BNF View SPC online
Formulary
Red
  • 250mg/10ml IV infusion
  • 500mg/20ml IV infusion
  • 1g/40ml IV infusion
 
   
Famciclovir 
(Oral)
View adult BNF View SPC online
Formulary
Red
  • SFT only for ophthalmology treatment protocol for keratitis
  • 125mg/250mg/500mg tablets
 
   
Valaciclovir 
(Tablet)
View adult BNF View SPC online
Formulary
  • Green 
  • Tablets 500mg (do not use 250mg tablets due to cost)
  • 2nd line treatment for herpes zoster (shingles) as per primary care antibiotic guidance. For patients with compliance problems with aciclovir.
  • During Varicella Zoster Immunoglobulin Shortage (Aug 2018):
    • Amber Second line "off label" use during the shortage of Varicella Zoster Immunoglobulin (VZIG)in patients who are 20+ weeks pregnant. Only to be used as per specialist advice.
    • Dose 1000mg three times a day from days 7 to 14 after exposure
 
Link  Updated restrictions on use of Varicella Zoster Immunoglobulin (VZIG) during supply shortage: advice to health professionals (August 2018)
   
05.03.02.02  Cytomegalovirus infection
Cidofovir 
(IV infusion)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
  •  IV infusion 75mg/ml, 5ml vial
 
   
Ganciclovir 
(IV infusion)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
  •  IV infusion 500mg
 
   
Valganciclovir 
(Oral)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
  • Tablets 450mg
  • Powder for oral solution 50mg/ml
 
   
05.03.03  Viral hepatitis
05.03.03.01  Chronic hepatitis B
Adefovir Dipivoxil (Hepsera®)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
  •  Tablets 10mg
 
Link  NICE CG165: Hepatitis B (chronic) - incorporates TA96
Link  NICE TA96: Hep B - adefovir dipivoxil and pegylated interferon alpha-2a
   
Entecavir (Baraclude®)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
  •   500 micrograms
  •   1mg
 
Link  NICE CG165: Hepatitis B (incorporates TA153)
Link  NICE TA153: Hepatitis B (chronic) - etecavir
   
Lamivudine 
(Oral)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • Tablets 100mg, 150mg, 300mg
  • Oral solution 10mg/ml

 

 
Link  NICE CG165: Chronic Hepatitis B
   
Tenofovir Disproxil
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine

 

  • Tablets 245mg
 
Link  NICE TA173: Hepatitis B (chronic) - tenofovir disoproxil
   
05.03.03.02  Chronic hepatitis C to top
 note 

Please note prescribing for patients with chronic hepatitis C is via NHSE approved tertiary centres ONLY.

Daclatasvir  (Daklinza®)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  Tablets 30mg/60mg
 
Link  NICE TA364: Daclatasvir for treating chronic hepatitis C
   
Dasabuvir (Exviera®)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  Tablets 250mg
 
Link  NICE TA365: Ombitasvir–paritaprevir–ritonavir with or without dasabuvir for treating chronic hepatitis C
   
Elbasvir/Grazoprevir
(Zepatier®)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  Tablets 50mg/100mg
 
   
Glecaprevir / Pibrentasvir
(Maviret)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • 100mg/40mg tablet
  • Chronic hepatitis C genotypes 2,3 and 5/6 non-cirrhotic or with compensated cirrhosis
 
Link  NICE TA499: Glecaprevir–pibrentasvir for treating chronic hepatitis C
   
Ledipasvir and Sofosbuvir
(Harvoni®)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  Tablets 90mg/400mg
 
Link  NICE TAG63: Ledipasvir–sofosbuvir for treating chronic hepatitis C
Link  NICE TA430 : Sofosbuvir–velpatasvir for treating chronic hepatitis C
   
Ombitasvir/ paritaprevir/ ritonavir
(Viekirax®)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  Tablets 12.5mg/75mg/50mg
 
Link  NICE TA365: Ombitasvir–paritaprevir–ritonavir with or without dasabuvir for treating chronic hepatitis C
   
Ribavirin 
(Oral)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  • Tablets 200mg
  • Capsules 200mg
 
Link  NICE TA106: Hepatitis C - peginterferon alfa and ribavirin
Link  NICE TA200: Hepatitis C - peginterferon alfa and ribavirin
Link  NICE TA75: Hepatitis C - pegylated interferons, ribavirin and alfa interferon
   
Sofosbuvir (Sovaldi®)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  Tablets 400mg
 
Link  NICE TA330: Sofosbuvir for treating chronic hepatitis C
   
Sofosbuvir/Velpatasvir
(Epclusa)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  Tablets 400mg/100mg
 
Link  NICE TA330: Sofosbuvir for treating chronic hepatitis C
Link  Sofosbuvir–velpatasvir for treating chronic hepatitis C
   
Sofosbuvir+Velpatasvir +Voxilaprevir
(Vosevi®)
(Tablet)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
NHS England
  •  Tablets 400mg/100mg/100mg
 
Link  NICE TA507: Sofosbuvir–velpatasvir–voxilaprevir for treating chronic hepatitis C
   
05.03.04  Influenza
 note 

Influenza vaccination remains the first-line preventative treatment for influenza. Vaccination programmes should be promoted to all at risk patients and programmes should be initiated in residential settings as a priority.

For more information see Public Health England: Complete routine immunisation schedule

NICE guidance for the use of antivirals for seasonal influenza does not apply in an influenza pandemic, other guidelines will be issued.

Updated (2019) PHE guidance on use of antiviral agents for the treatment and prophylaxis of seasonal influenza

Oseltamivir (Tamiflu®)
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Endorse SLS
  • Capsules 30mg, 45mg, 75mg
  • Suspension (SF) 6mg/ml
  • Some drugs are restricted to prescribing in certain circumstances under the NHS and a list can be found under Part XVIIIA of the Drug Tariff. The prescriber must endorse any prescription with 'SLS' if the patient and purpose complies with that specified in the list. An example of such is where specific patient criteria are set. The drugs affected are highlighted throughout the formulary and the explanatory notes provide further guidance.

    Where prescribing falls outside of the regulations, the drug may not be prescribed on the NHS.
 
Link  Oseltamivir or zanamivir – can they be used in breastfeeding mothers for the treatment or prophylaxis of influenza?
   
Zanamivir  (Relenza)
( Inhalation)
View adult BNF View SPC online
Formulary
Green
  • Endorse SLS
  • Dry powder for inhalation 5mg/blister
  • Some drugs are restricted to prescribing in certain circumstances under the NHS and a list can be found under Part XVIIIA of the Drug Tariff. The prescriber must endorse any prescription with 'SLS' if the patient and purpose complies with that specified in the list. An example of such is where specific patient criteria are set. The drugs affected are highlighted throughout the formulary and the explanatory notes provide further guidance.

    Where prescribing falls outside of the regulations, the drug may not be prescribed on the NHS.
 
Link  Oseltamivir or zanamivir – can they be used in breastfeeding mothers for the treatment or prophylaxis of influenza?
   
Zanamivir IV 
View adult BNF View SPC online
Formulary
Red
  • For use in line with PHE Influenza guidelines (link below).
  • 200mg in 20ml 
 
   
05.03.05  Respiratory syncytial virus
Palivizumab 
(Injection)
View adult BNF View SPC online
Formulary
Red
High Cost Medicine
  •  50mg vial Injection
  • 100mg vial Injection
  • Note: use in line with JCVI guidance
 
Link  Respiratory syncytial virus: the green book, chapter 27a Sept 2015
   
Ribavirin 
(Capsules)
View adult BNF View SPC online
Formulary
Red
  •  Capsules 200mg
 
Link  NICE TA106: Hepatitis C - peginterferon alfa and ribavirin
Link  NICE TA200: Hepatitis C - peginterferon alfa and ribavirin
Link  NICE TA300 Peginterferon alfa and ribavirin for treating chronic hepatitis C in children and young people November 2013
Link  NICE TA75: Hepatitis C - pegylated interferons, ribavirin and alfa interferon
   
05.04  Antiprotozoal drugs
05.04.01  Antimalarials
 note 

Drugs for malarial prophylaxis cannot be prescribed on FP10 on the NHS.

The department of health advises GPs that private prescription forms should be used to prescribe drugs for malaria prophylaxis. Chloroquine and proguanil are available "Over The Counter" (OTC) whereas mefloquine and Malarone® require a private prescription.

Cost of treatment can vary between community pharmacies. Advise patients to obtain information of cost of dispensing private prescriptions for malaria prophylaxis from their community pharmacy.

For advice on malaria prophyaxis the following resources are available:

Please also note that doxycycline can be used for the treatment of falciparum malaria and is listed in section 5.1.3 (tetracyclines).

05.04.01  Treatment of malaria to top
Atovaquone with proguanil hydrochloride
(Malarone®)
(Malaria treatment)
View adult BNF View SPC online
Formulary
Red
  • Proguanil 100mg/ atovaquone 250mg tablets
  • Treatment for Malaria is available on the NHS.
  • Patients requiring Malaria prevention must acquire this on a private prescription
 
   
05.04.01  Chloroquine
Chloroquine phosphate

(Malaria treatment)
View adult BNF View SPC online
Formulary
Red
  • Treatment of non-falciparum malaria is available on the NHS.
  • Patients requiring Malaria prevention must acquire this on a private prescription or can buy it OTC
  • Tablets 250mg (equivalent to 155mg chloroquine base)
  • Syrup 68mg/5ml (equivalent to 50mg chloroquine base per 5ml)

 

25th March 2020 - MHRA statement on chloroquine for COVID-19 - Chloroquine is not licensed to treat COVID-19 related symptoms or prevent infection. Clinical trials are ongoing to test chloroquine  as an agent in the treatment of COVID-19 or to prevent COVID-19 infection. These clinical trials are still not completed, so no conclusions have been reached on the safety and effectiveness of this medicine to treat or prevent COVID-19. Until we have clear, definitive evidence that these treatments are safe and effective for the treatment of COVID-19, chloroquine should only be used for this purpose within a clinical trial.

 
   
05.04.01  Mefloquine
Mefloquine (Lariam®)
(Malaria treatment)
View adult BNF View SPC online
Formulary
Red
  • Treatment for Malaria is available on the NHS.
  • Patients requiring Malaria prevention must acquire this on a private prescription
  • BNF caution: mefloquine and driving - dizziness or a disturbed sense of balance may affect performance of skilled tasks e.g. driving; effects may occur and persist upto several months after stopping mefloquine.
  • Tablets 250mg
 
   
05.04.01  Primaquine
Primaquine 
(Tablets)
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Red
  • Treatment of non-falciparum malaria is available on the NHS.
  • Patients requiring Malaria prevention must acquire this on a private prescription
  • Tablets 7.5mg
  • GWH use as an option for treatment of PCP infection (Pneumocystis jirovecii pneumonia) if patients intolerant of co-trimoxazole/constituents/ first line treatment failure.
 
   
05.04.01  Proguanil
Proguanil Hydrochloride
(Paludrine®)
(Oral)
View adult BNF View SPC online
Formulary
Red
  • Treatment for Malaria is available on the NHS.
  • Patients requiring Malaria prevention must acquire this on a private prescription or can buy it OTC
  • 100mg tablets
 
   
05.04.01  Pyrimethamine to top
Pyrimethamine with Sulfadoxine
(Fansidar®)
(Malaria treatment)
View adult BNF View SPC online
Formulary
Red
  • Treatment for Malaria is available on the NHS.
  • Patients requiring Malaria prevention must acquire this on a private prescription
  • Available from 'Special order' manufacturers or specialist-importing companies.
  • Pyrimethamine 25mg/ sulfadoxine 500mg tablets
 
   
05.04.01  Quinine
Quinine sulphate 
(Malaria treatment)
View adult BNF View SPC online
Formulary
Red
  • Treatment for Malaria is available on the NHS.
  • Patients requiring Malaria prevention must acquire this on a private prescription  
  • 200mg tablet
  • 300mg tablet
 
Link  Quinine: reminder of dose-dependent QT-prolonging effects; updated medicine interactions
   
Quinine dihydrochloride
(Malaria treatment)
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Red
  • Injection 300mg/ml, 600mg/2ml. For infusion only.
  • Unlicensed.
 
Link  Quinine: reminder of dose-dependent QT-prolonging effects; updated medicine interactions
   
05.04.01  Tetracyclines
05.04.02  Amoebicides
Metronidazole 
(Tablet)
View adult BNF View SPC online
Formulary
Green
  •  400mg
 
   
05.04.03  Trichomonacides
05.04.04  Antigiardial drugs to top
Metronidazole 
(Tablet)
View adult BNF View SPC online
Formulary
Green
  •  400mg
 
   
Tinidazole 
(Tablet)
View adult BNF View SPC online
Formulary
Amber
  • Tablets 500mg
  • If giardia is confirmed or suspected – tinidazole 2g single dose is the treatment of choice and as recommended by NICE.
  • Use with microbiology advice.

 

 
   
05.04.05  Leishmaniacides
05.04.06  Trypanocides
05.04.07  Drugs for toxoplasmosis
Pyrimethamine 
(Tablet)
View adult BNF View SPC online
Formulary
Red
  • On recommendation by Consultants in Sexual Health, Ophthalmology or Microbiology for treatment of toxoplasmosis.
  •  25mg
 
   
05.04.08  Drugs for pneumocystis pneumonia
 note 

NOTE: Other drugs are also treatment options in the pathway for PJP treatment, such as trimethoprim, clindamycin, Primaquine and Dapsone. These drugs can be found in non-PJP specific sections.

Atovaquone 
View adult BNF View SPC online
Formulary
Red
  • GWH use for the treatment of PJP (Pneumocystis jirovecii pneumonia)
 
   
Co-trimoxazole 
(Injection)
View adult BNF View SPC online
Formulary
Red
  • 480mg/5ml
  • 960mg/10ml

 

 
   
Pentamidine Isetionate
(Injection)
View adult BNF View SPC online
Formulary
Red
  • 300mg Powder for Solution for Injection/Infusion
  • Powder for injection (dissolved in water for injection) may be used for nebulisation. Not licensed for primary prevention of Pneumocystis jirovecii (Pneumocystis carinii) pneumonia by inhalation of nebulised solution.
 
   
05.04.08  Treatment to top
05.04.08  Prophylaxis
05.05  Anthelmintics
05.05.01  Drugs for threadworms
Mebendazole 
(Oral)
View adult BNF View SPC online
Formulary
Self
  • Tablets (chewable) 100mg
  • Suspension 100mg/5ml.
  • Recommended for all children >6 months and adults. Repeat in 2/52 if infestation persists.
  • A prescription for treatment of threadworm should not routinely be offered in primary care as the condition is appropriate for self-care.

 

 
Link  Bumps best use of medicine in pregnancy Treatment of threadworms during pregnancy January 2018
Link  Conditions for which over the counter items should not routinely be prescribed in primary care:
   
05.05.02  Ascaricides
Mebendazole 
(Oral)
View adult BNF View SPC online
Formulary
Green
  •  Chewable tablets 100mg
 
   
05.05.03  Drugs for tapeworm infections to top
05.05.03  Taenicides
Praziquantel 
(Tablet)
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Red
  •  Tablets 500mg.
 
   
05.05.03  Hydatid disease
05.05.04  Drugs for hookworms
Mebendazole 
(Oral)
View adult BNF View SPC online
Formulary
Green
  •  100mg chewable tablets
 
   
05.05.05  Schistosomicides
05.05.06  Filaricides to top
Ivermectin 
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Red
  • GWH only for filaricide infections
 
   
05.05.07  Drugs for cutaneous larva migrans
05.05.08  Drugs for strongyloidiasis
Albendazole 
(Tablet)
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Red
  • Eskazole 400mg tablets (Imported (France)
  • Zentel 200mg chewable tablets (Imported (Australia)
  • Zentel 400mg chewable tablets (Imported (United States)
  • Dermatology use for cutaneous larva migrans
 
   
 ....
 Non Formulary Items
Aciclovir lauriad (Sitavig)

View adult BNF View SPC online
Non Formulary
 
Aminosalicylic acid
(Granupas®)

View adult BNF View SPC online
Non Formulary
 
Amphotericin (Amphocil®)

View adult BNF View SPC online
Non Formulary
 
Amphotericin (Fungilin®)

View adult BNF View SPC online
Non Formulary
 
Ampicillin 

View adult BNF View SPC online
Non Formulary
 
Ampicillin (Penbritin®)

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

View adult BNF View SPC online
Non Formulary
High Cost Medicine
 
Bedaquiline (Sirturo® )

View adult BNF View SPC online
Non Formulary
High Cost Medicine
 
Bezlotuxumab (Zinplava®)

View adult BNF View SPC online
Non Formulary
 
Capreomycin (Capastat®)

View adult BNF View SPC online
Non Formulary
 
Cefaclor 

View adult BNF View SPC online
Non Formulary
 
Cefaclor 

View adult BNF View SPC online
Non Formulary
 
Cefadroxil 

View adult BNF View SPC online
Non Formulary
 
Cefadroxil 

View adult BNF View SPC online
Non Formulary
 
Cefpodoxime 

View adult BNF View SPC online
Non Formulary
 
Cefpodoxime (Orelox®)

View adult BNF View SPC online
Non Formulary
 
Cefradine 

View adult BNF View SPC online
Non Formulary
 
Cefradine (Velosef®)

View adult BNF View SPC online
Non Formulary
 
Ceftaroline (Zinforo®)

View adult BNF View SPC online
Non Formulary
 
Ceftazidime (Fortum®)

View adult BNF View SPC online
Non Formulary
 
Ceftazidime (Kefadim®)

View adult BNF View SPC online
Non Formulary
 
Ceftazidime/ avibactam
(Zavicefta®)

View adult BNF View SPC online
Non Formulary
 
Ceftobiprole (Zevtera®)

View adult BNF View SPC online
Non Formulary
 
Ceftolozane & tazobactam
(Zerbaxa®)

View adult BNF View SPC online
Non Formulary
 
Cefuroxime 

View adult BNF View SPC online
Non Formulary
 
Cerament® 

Non Formulary
 
Clofazimine 

View adult BNF View SPC online
Non Formulary
 
Co-Fluampicil 

View adult BNF View SPC online
Non Formulary
 
Collatamp EG Sponge


View adult BNF View SPC online
Non Formulary
 
Cycloserine 

View adult BNF View SPC online
Non Formulary
 
Dalbavancin 

View adult BNF View SPC online
Non Formulary
 
Delamanid (Deltyba®)

View adult BNF View SPC online
Non Formulary
High Cost Medicine
 
Diloxanide 

View adult BNF View SPC online
Non Formulary
 
Griseofulvin 

View adult BNF View SPC online
Non Formulary
 
Griseofulvin (Fulsovin®)

View adult BNF View SPC online
Non Formulary
 
Herafill® beads G 

View adult BNF View SPC online
Non Formulary
 
Micafungin (Mycamine®)

View adult BNF View SPC online
Non Formulary
High Cost Medicine
 
Miconazole (Daktarin®)

View adult BNF View SPC online
Non Formulary
 
Minocycline 

View adult BNF View SPC online
Non Formulary
  • Prescribers in primary care should not initiate minocycline for any new patient with acne.
  • Minocycline is not recommended for use in acne as it is associated with an increased risk of adverse effects such as drug induced lupus, skin pigmentation and hepatitis.
  • Any patients on minocycline for acne should be reviewed and changed to an alternative treatment option.
Link  Items which should not routinely be prescribed in primary care ; guidance for CCGs
 
Nalidixic Acid (Uriben®)

View adult BNF View SPC online
Non Formulary
 
Neomycin Sulphate 

View adult BNF View SPC online
Non Formulary
 
Niclosamide 

View adult BNF View SPC online
Non Formulary
 
Norfloxacin 

View adult BNF View SPC online
Non Formulary
 
Norfloxacin (Utinor®)

View adult BNF View SPC online
Non Formulary
 
Oritavancin (Orbactiv®)

View adult BNF View SPC online
Non Formulary
 
Piperazine 
(With sennosides)

View adult BNF View SPC online
Non Formulary
 
Piperazine (Pripsen)

View adult BNF View SPC online
Non Formulary
Green

 

 

DISCONTINUED

 
Procaine Penicillin G Injection


View adult BNF View SPC online
Non Formulary
 
Proguanil Hydrochloride with Atovaquone


View adult BNF View SPC online
Non Formulary
 
Prothionamide 

View adult BNF View SPC online
Non Formulary
 
Pyrimethamine and Dapsone


View adult BNF View SPC online
Non Formulary
 
Quinine Bisulphate 

View adult BNF View SPC online
Non Formulary
 
Quinupristin and dalfopristin
(Synercid®)

View adult BNF View SPC online
Non Formulary
 
Rifabutin (Mycobutin®)

View adult BNF View SPC online
Non Formulary
 
Rifaximin (Targaxan®)
(Encephalopathy)

View adult BNF View SPC online
Non Formulary
 
Saquinavir (Invirase®)
(Oral)

View adult BNF View SPC online
Non Formulary
 
Sinecatechins (Veregen)

View adult BNF View SPC online
Non Formulary
 
Sodium fusidate (Fucidin®)

View adult BNF View SPC online
Non Formulary
 
Sodium Stibogluconate
(Pentostam®)

View adult BNF View SPC online
Non Formulary
 
SPL7013 (VivaGel®)

View adult BNF View SPC online
Non Formulary
 
Stavudine 

View adult BNF View SPC online
Non Formulary
High Cost Medicine
 
Streptomycin Sulphate


View adult BNF View SPC online
Non Formulary
 
Sulfadiazine 

View adult BNF View SPC online
Non Formulary
 
Sulfadiazine 

View adult BNF View SPC online
Non Formulary
 
Tedizolid (Sivextro®)

View adult BNF View SPC online
Non Formulary
 
Telavancin 

View adult BNF View SPC online
Non Formulary
 
Terbinafine (Lamisil®)

View adult BNF View SPC online
Non Formulary
  • Self Patients should be asked to buy this themselves OTC.
  • Topical treatment for most fungal skin and nail infections are a low clinical priority for local CCGs and is suitable for self-care.

 

 
Tetracycline 

View adult BNF View SPC online
Non Formulary
 
Thalidomide 
(Dermatology)

View adult BNF View SPC online
Non Formulary
 
TIABENDAZOLE 500mg tabs


View adult BNF View SPC online
Non Formulary
 
Ticarcillin with clavulanic acid
(Timentin®)

View adult BNF View SPC online
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 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

RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Amber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Amber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Green

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Self

Suitable for patient to be directed to buy themselves  

Grey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Black

(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.   

Red Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

netFormulary