PROTECTED ANTIMICROBIALS

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The antimicrobials in tables 1 and 2 are restricted. Their use MUST be authorised by a consultant microbiologist or infectious diseases physician.

To ensure timely, appropriate treatment of certain infections, there are specific situations where this authorisation is not immediately required, as detailed in table 1. However, this authorisation must be obtained within 24 hours.

Table 1: Initial prescription allowed for APPROVED INDICATIONS ONLY

DRUG

Approved Indication 

Ambisome®

Neutropenic sepsis, endophthalmitis 

Caspofungin

Neutropenic sepsis, ITU 

Cefotaxime

Meningitis, paediatric sepsis 

Ceftazidime

Cystic fibrosis, endophthalmitis, suspected CAPD peritonitis 

Ceftriaxone

Meningitis, supraglottitis, orbital cellulitis, paediatric sepsis 

Cefuroxime

Paediatrics (LRTI, AOM) 

Clindamycin

Pyrexia in labour, necrotising fasciitis, paediatrics 

Gentamicin

Up to 3 days for all indications 

Linezolid

ITU for S aureus pneumonia \
Current arrangements for supply of linezolid by prescription will remain. 

Meropenem

ITU, cystic fibrosis, neutropenic sepsis, severe sepsis (penicillin allergy), severe diabetic foot (penicillin allergy), necrotising fasciitis 

Piperacillin/tazobactam

Neutropenic sepsis, diabetic food infection

Posaconazole

Haematology prophylaxis 

Teicoplanin

Neutropenic sepsis

Voriconazole

Neutropenic sepsis step down

 

Table 2: Authorisation required BEFORE prescribing

Amikacin
Anidulafungin
Ceftazidime/avibactam
Ceftolozane/tazobactam
Chloramphenicol (systemic)
Colistimethate sodium
Dalbavancin
Daptomycin
Ertapenem
Fidaxomicin
Fosfomycin (injection)
Meropenem/vaborbactam
Moxifloxacin
Posaconazole (other than haematology prophylaxis)
Temocillin
Tigecycline

Highland HSCP (North Highland): In primary and secondary care, in order to obtain authorisation, contact the duty consultant microbiologist in Raigmore via the laboratory on Ext 4206 (out of hours, via switchboard) or the infectious diseases physician via switchboard.

  • Secondary care: a code will be provided and must be written:
    • in the notes as part of the Micro/ID discussion,
    • on the drug chart beside the antimicrobial in question and 
    • on the ward order form before sending to Pharmacy.
    • This code is checked by Pharmacy staff and, if appropriate, the antimicrobial is supplied to the ward.
    • In the absence of a valid authorisation code, no antimicrobial will be supplied, and the ward pharmacist will contact the prescriber who is welcome to discuss with a consultant microbiologist.     
  • Primary care: these antimicrobials should only be used following discussion with, or on the advice of, an infection specialist. This should be recorded in the patient notes.

Argyll & Bute HSCP: Pharmacy stock for in-patient areas is provided by NHS Greater Glasgow and Clyde – please note an equivalent authorisation process is not used by NHS GGC.

For glossary of terms see Glossary   

Process Flowchart

Editorial Information

Last reviewed: 23 April 2020

Next review: 23 April 2023

Author(s): Antimicrobial Management Team

Version: 2

Approved By: TAM Subgroup of ADTC

Reviewer Name(s): Area Antimicrobial Pharmacist

Document Id: AMT147