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5.1 Antibacterial drugs

5.1 ANTIBACTERIAL DRUGS

The most recent Guidelines for Primary and Secondary Care can be found below:

Antimicrobial Guidelines in Primary Care

Antimicrobial Guidelines for Secondary Care

NICE Visual Summaries: Antimicrobial Prescribing

For further guidance refer to local Consultant Microbiologists or contact your pharmacist.

5.1.1 Penicillins

5.1.1.1 Benzylpenicillin and phenoxymethylpenicillin 
GREEN       Benyzylpenicillin (Penicillin G) injection 600mg, 1.2g 
GREEN       Phenoxymethylpenicillin (PenicillinV)  
                    tablets 250mg
                    oral solution 125mg/5ml, 250mg/5mL
 
5.1.1.2 Penicillinase-resistant penicillins 
GREEN      Flucloxacillin  
                  capsules 250mg, 500mg
                  oral solution 125mg/5ml, 250mg/5mL
RED           Flucloxacillin injection 250mg, 500mg, 1g
RED          Temocillin
                  Powder for solution (1g)
                  Use in urosepsis where use of gentamicin not possible and on advice of 
                  consultant microbiologist for resistant gram negative bacteria.
RED          Ceftazidime-avibactam
                  Powder for solution for infusion  2g/0.5g
                  Treatment of multi-drug resistant organisms in adult patients with limited treatment options.
                  (on advice of consultant microbiologist only, hospital use only)
 
5.1.1.3 Broad-spectrum penicillins  
GREEN      Amoxicillin
                   capsules 250mg, 500mg
                   suspension 125mg/5ml, 250mg/5mL
                   sachet (sugar free) 3g
RED           Amoxicillin injection 500mg, 1g 
GREEN      Co-amoxiclav
                   tablets 250/125, 500/125
                   suspension 250/62, 125/31
RED           Co-amoxiclav injection 500/100, 1000/200
 
5.1.1.4 Antipseudomonal penicillins  
RED           Tazocin injection 4.5g 

5.1.1.5 Mecillinams 
GREEN        Pivmecillinam (alternative 1st line agent in UTI)
                    tablets 200mg  (on advice of Consultant Microbiologist only)
                    Not for prophylaxis. See MicroGuide Adult Antimicrobial Guidelines 
 

5.1.2 Cephalosporins, carbapenems and other beta-lactams

5.1.2.1 Cephalosporins 
GREEN      Cefaclor
                   tablets m/r 375mg
                   suspension 125mg/5mL, 250mg/5mL
GREEN      Cefalexin
                   capsules 250mg, 500mg
                   syrup 125mg/5mL, 250mg/5mL
GREEN      Cefixime tablets 200mg 
 
Cefotaxime may be used in primary care for use when meningococcal disease is suspected and benzylpenicillin cannot be given,
as long as this does not delay the urgent transfer to hospital. (See antimicrobial guidelines) 
GREEN      Cefotaxime (Paediatrics only) Injection 250mg, 500mg,1g 
 
RED           Cefradine injection 1gram 
RED           Ceftazidime injection 500mg, 1g, 2g 
RED           Ceftriaxone injection 250mg, 1g 
RED           Cefuroxime injection 250mg, 750mg, 1.5g  
RED           Ceftolozane/tazobactam (Zerbax®) On advice of Consultant Microbiologist only
 
5.1.2.2 Carbapenems 
RED           Meropenem (on advice of Consultant Microbiologist only injection 500mg, 1g
RED           Meropenem with vaborbactam powder for concentrate for solution for infusion 1g/1g 
                  [consultant microbiologist recommendation only]


5.1.3 Tetracyclines – see section 13.6.2 for use in acne

GREEN     Doxycycline capsules 50mg, 100mg
GREEN     Doxycycline dispersible 100mg (Vibramycin-D)  
                  (an option when swallowing difficulties)
GREEN     Lymecycline capsules 408mg
GREEN     Minocycline tablets 50mg, 100mg 
                  (not for use in acne- see section 13.6.2 for acne)
GREEN     Oxytetracycline tablets 250mg
GREEN     Tetracycline tablets 250mg
 
Tigecycline
Tigecycline should only be initiated on the direct advice of a microbiologist, and should be prescribed at registrar/consultant level 
for the management of complicated skin/soft tissue or intra-abdominal infections.  It should be used to replace the use of more 
costly double/triple combinations where these are inappropriate, ineffective or not tolerated. All prescriptions should be endorsed
‘microbiologist approved’ and given a review date by the microbiologist which initially must be no more than 5 days from 
commencement. 
 
MHRA Advice for healthcare professionals:  
       >   Reformulated tigecycline is incompatible with amphotericin B, amphotericin B lipid complex and diazepam.
        These medicines should not be given simultaneously with the new tigecycline formulation through the same Y- site.
       >   Tigecycline must not be mixed with other products for which compatibility data are not available.
       >   Please remember that the original formulation is also incompatible with some medicines.
 
RED           Tigecycline injection 50mg   

5.1.4 Aminoglycosides

AMBER     Gentamicin injection 10mg/mL, 80mg/2mL 
AMBER     Neomycin tablets 500mg 
RED          Tobramycin (Bramitob®) nebuliser solution 300mg   
                   for cystic fibrosis in children only. 
RED          Tobramycin  dry powder for inhalation for treating pseudomonas lung infections in cystic fibrosis  as per   NICE (TAG276)   
 
NOTE:      Tobramycin is RED Traffic Light where prescribing has been initiated on or after 1st April 2013.
                  Where prescribing was initiated prior to April 1st 2013 the traffic light status may remain AMBER  until 
                  repatriation of patients has been agreed by NHS England, local commissioners and providers.
 

5.1.5 Macrolides

GREEN      Azithromycin
                   tablets 250mgtablets 500mg  
                   capsules 500mg   
                   suspension 200mg/5mL
GREEN      Clarithromycin
                   tablets 250mg
                   suspension 125mg/5ml, 250mg/5mL
RED             Clarithromycin injection 500mg  
GREEN      Erythromycin
                   tablets e/c 250mg
                   suspension 125mg/5mL, 250mg/5mL

5.1.6 Clindamycin

GREEN      Clindamycin
                   capsules 75mg, 150mg 
RED           Clindamycin injection 600mg/4mL 
 

5.1.7 Some other antibacterials

Fosfomycin    
Fosfomycin GP pathway protocol updated 0916 [361 KB]    
 
AMBER     Fosfomycin 3g sachets (prescribe as Monuril®)   
                  Only to be given on advice of consultant microbiologist -Refer to pathway above 
 
RED           Fosfomycin injection (Fomicyt®) 
                  On advice of consultant microbiologist only. 
 
Chloramphenicol   
RED           Chloramphenicol injection 1g  
 
Polymyxins 
Colistimethate sodium DPI is recommended as an option for treating  chronic pseudomonas lung infections in cystic fibrosis as 
per  NICE (TAG276)  only if: 
 
                >       they would clinically benefit from continued colistimethate sodium but do not tolerate it in its nebulised form and
                         thus tobramycin therapy would be considered and
                >       the manufacturer provides colistimethate sodium DPI with the discount agreed as part of the patient access scheme
                         to primary, secondary and tertiary care in the NHS
 
RED           Colistimethate sodium dry powder  
                   (Colobreathe® inhalation powder capsules)
 
        >   Colistimethate is RED Traffic Light where prescribing has been initiated on or after 1st April 2013.
        >   Where prescribing was initiated prior to April 1st 2013 the traffic light status may remain amber until repatriation of patients
                       has been agreed by NHS England, local commissioners and providers  
 
Colomycin in non CF Bronchiectesis – is recommended when long term nebulised therapy is being considered. Delivered 
by nebulisation/inhalation. Specialist initiation. Training and education regarding use of nebuliser to be provided by specialist.  
 
AMBER       Colistimethate injection 1million unit (Colomycin)* 
See Prescribing Information Sheet 
 
AMBER     Gentamicin injection  10mg/mL, 80mg/2mL  (2nd line alternative to colistin) 
                  (delivered by inhalation/nebulisation) 
 
Fidaxomicin   
AMBER       Fidaxomicin 200mg tablets (Consultant Microbiologist Initiation only)  
 
Fusidic acid  
GREEN      Sodium fusidate
                   tablets 250mg
                   suspension (fusidic acid) 250mg/5mL
RED            Sodium fusidate infusion 500mg (on advice of Consultant Microbiologist only)
 
Rifaximin  
AMBER      Rifaximin tablets 550mg ( NICE TAG337)   
 
Vancomycin and teicoplanin  
GREEN       Vancomycin capsules 125mg,
RED            Vancomycin injection 500mg, 1g
AMBER      Teicoplanin injection 200mg, 400mg
 
Dalbavancin
RED            Dalbavancin 500mg powder for concentrate for infusion
 
Linezolid  
AMBER      Linezolid (on advice of Consultant Microbiologist only)
                   tablets 600mg
RED           infusion 2mg/mL (600mg/300mL)
 

5.1.8 Sulphonamides and trimethoprim 

AMBER     Co-trimoxazole
                  tablets 480mg, 960mg
                  suspension 240/5ml, 480/5mL
RED          Co-trimoxazole injection 480mg/5mL, 960mg/10mL
GREEN     Trimethoprim
                  tablets 100mg, 200mg
                  suspension 50mg/5mL 
 

5.1.9 Antituberculous drugs

All cases of suspected tuberculosis or other mycobacterial disease must be discussed with a respiratory physician.
RED           Capreomycin 1g powder for solution                                                                                           (NHS England Commissioned)       
RED           Cycloserine capsules 250mg                                                                                                          (NHS England Commissioned)  
RED           Ethambutol tablets 100mg, 400mg                                                                                               (NHS England Commissioned)  
RED           Isoniazid    tablets 100mg,  elixir 50mg/5mL                                                                                (NHS England Commissioned) 
RED           Isoniazid injection 50mg/2mL
RED           Pyrazinamide tablets 500mg                                                                                                         (NHS England Commissioned)
RED            Rifampicin injection 600mg
RED           Rifater® tablets (rifampicin 120mg, isoniazid 50mg, pyrazinamide 300mg)                             (NHS England Commissioned)
RED           Rifinah® tablets 150 (rifampicin 150mg, isoniazid 100mg),                                                       (NHS England Commissioned)
                  tablets 300 (rifampicin 300mg, isoniazid 150mg)   
RED           Voractiv® tablets (Rifampicin150mg, isoniazid 75mg, pyrazinamide 400mg, ethambutol 275mg)
 
Rifampicin for Non-TB, licensed indications 
AMBER      Rifampicin                                                                                                                                        (NHS England Commissioned)
                   capsules 150mg, 300mg, syrup 100mg/5mL     (Rifadin®, Rimactane®)      
                   Prescribing should routinely be retained by specialists within secondary care to ensure optimal treatment.


5.1.10 Antileprotic drugs

AMBER      Dapsone tablets 50mg

5.1.11 Metronidazole and tinidazole

GREEN        Metronidazole  
                    tablets 200mg, 400mg
                    suspension 200mg/5mL
                    suppositories 500mg, 1gram
RED            Metronidazole infusion 500mg/100mL

5.1.12  Quinolones

GREEN      Ciprofloxacin
                   tablets 250mg, 500mg
                   suspension 125mg/5ml, 250mg/5mL
RED           Ciprofloxacin infusion 100mg/50mL, 200mg/100mL, 400mg/200mL
GREEN      Ofloxacin tablets 200mg


5.1.13 Urinary-tract infections

Please consult Antimicrobial Guidelines in Primary Care
NICE Visual Summaries: Antimicrobial Prescribing
 

Information Leaflet - Uncomplicated Urinary Tract Infection

Urinary Tract Infections in Adults
GREEN      Nitrofurantoin*
                  100 mg M/R capsules (1st Line choice)
                  50mg capsules**   
                  100mg tablets
                  50mg tablets
GREEN      Trimethoprim tablets (alternative 1st line agent, if low risk of resistance)
GREEN      Pivmecillinam (alternative 1st line agent)
GREEN      Methenamine Hippurate 
                   (Recurrent UTI, 3rd line use ONLY in recurrent UTI in non-pregnant women - 2 in 6 months or > 3 in a year;) 
                   1g tablets
                 
To help avoid an upset stomach, give nitrofurantoin with some food or milk. Tablets may be swallowed whole, 
    If using the long- acting capsule, it should be swallowed whole. Do not open, crush, or chew the long-acting/Modified Release  
    capsule(ref: Newt guidelines). 
     The non-MR capsule can  be opened in swallowing difficulties
 
Urinary Tract Infections in Paediatrics 
GREEN      1st line   Trimethoprim liquid
GREEN      2nd line Nitrofurantoin tablets 50mg*
GREEN      3rd line Cefalexin liquid
NB In order to allow the correct dose to be administered nitrofurantoin liquid maybe used in paediatrics if sensitivities confirm.
       
AMBER      Nitrofurantoin Liquid 25mg/5ml- only if confirmed in paediatric patients

 
To help avoid an upset stomach, give nitrofurantoin with some food or milk. Tablets may be swallowed whole, 
    If using the long- acting capsule, it should be swallowed whole. Do not open, crush, or chew the long-acting/Modified Release  
    capsule(ref: Newt guidelines). 
    The non-MR capsule can  be opened in swallowing difficulties
 

 

**SEE 'MICROGUIDE' FOR MOST UP TO DATE INFORMATION** 

 

All material in this section is aimed at health care professionals, but is information currently held in the public domain, members of the  

public seeking advice on medicine-related matters are advised to speak with their GP, pharmacist, nurse or contact NHS111 Service.
  Email: info.elmmb@nhs.net
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