5.0 Infections

5.1.1 Penicillins

5.1.2 Cephalosporins, carbapenems and other beta-lactams

5.1.3 Tetracyclines – see section 13.6.2 for use in acne

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. 

5.1.4 Aminoglycosides

5.1.8 Sulphonamides and trimethoprim 

5.1.9 Antituberculous drugs

All cases of suspected tuberculosis or other mycobacterial disease must be discussed with a respiratory physician.

Rifampicin for Non-TB, licensed indications 

           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

5.1.12  Quinolones

5.1.13 Urinary-tract infections

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

5.3.1 HIV Infection

Please refer to Lancashire Formulary for AntiRetroviral Therapy (ART) - click here

Nucleoside reverse transcriptase inhibitors

Protease inhibitors

Non-nucleoside reverse transcriptase inhibitors

Other antiretrovirals

5.3.2 Herpesvirus infections

5.3.2.1 Herpes simplex and varicella-zoster infection

5.3.2.2 Cytomegalovirus infection

Valganciclovir is used in the treatment of reactivated CMV in immunosuppressed patients treated with MabCampath® as per protocols at Manchester Royal Infirmary.

5.3.3    Viral Hepatitis

5.3.3.2  Chronic Hepatitis C       

NHS England have issued a policy statement for treatment of chronic Hepatitis C in patients with cirrhosis which sets out treatments that will be routinely commissioned.  The statement is available here.

5.3.4     Influenza

Oseltamavir and zanamivir are to be used in line with NICE guidance and local emergency planning agreements.  Endorse prescription SLS.

GREEN     Zanamivir inhaler 5mg blisters x 4

5.3.5     Respiratory syncytial virus

Palivizumab is to be used in line with National Joint Committee of Vaccination and Immunisation guidance in the following circumstances:

1. Children under the age of 2 years with chronic lung disease who

• Have recieved oxygen for >28 days after birth;
  
• Are receiving home oxygen therapy

2. Infants less than 6 months of age who have left to right shunt haemodynamically significant congenital heart disease and /or pulmonary hypertension. 

Supply of palivizumab should always be from pharmacy to individual patients; it should never be issued as stock.  This allows recharging of the costs of palivizumab to the CCGs under ‘payment by results’ by allowing the tracing of all supplies.

RED          Palivizumab injection 50mg, 100mg                                                                        (NHS England Commissioned)  

5.4.1 Antimalarials

5.4.2 Amoebicides

5.4.4 Antigiardial drugs

5.4.8 Drugs for pneumocystis pneumonia

RED                              Pentamidine nebuliser Solution 60mg/mL

5.5.1 Drugs for threadworms

5.5.4 Drugs for hookworms