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NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Royal United Hospitals Bath NHS Foundation Trust
Great Western Hospitals NHS Foundation Trust
Salisbury NHS Foundation Trust
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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...
05.02  Expand sub section  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  Expand sub section  Treatment of fungal infections
05.02  Expand sub section  Drugs used in fungal infections
Fluconazole 
(IV infusion)
View adult BNF View SPC online
Formulary
Red
  •  IV infusion 2mg/ml, 25ml bottle, 100ml bottle
 
   
Fluconazole 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Capsules 50mg, 150mg, 200mg
  • Oral suspension 50mg/5ml, 200mg/5ml
 
   
05.02.01  Expand sub section  Triazole antifungals
05.02.02  Expand sub section  Imidazole antifungals to top
05.02.03  Expand sub section  Polyene antifungals
05.02.04  Expand sub section  Echinocandin antifungals
Anidulafungin 
(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  Expand sub section  Other antifungals
 ....
 Non Formulary Items
Amphotericin (Amphocil®)

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

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
 
Micafungin (Mycamine)

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

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.

 

 
  
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

Not currently used. We intend to include this TLS in future to highlight where a decision has been made by either or both the local or national NHS 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.  

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