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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 5 - Infections 
Notes:

For full details on UKHSA guidance for managing common infections with local amendments please see:

BLMK Primary Care Antimicrobial Guidelines hosted via: https://blmkantibioticspubliclive.azurewebsites.net/

Secondary care antimicrobial guidelines:

Bedfordshire Hospitals Foundation Trust: Antimicrobial guidelines are hosted on:  EOLAS Medical App. 
05.01.07 Some other antibacterials
NICE NG15: Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use
05.01.07 Chloramphenicol
05.01.07 Fusidic acid
05.01.07 Vancomycin and teicoplanin
05.01.07 Daptomycin
05.01.07 Linezolid
05.01.07 Quinupristin and dalfopristin
05.01.07 Polymyxins
NICE NG15: Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use

Colistimethate inhaler (Colobreathe®)

RED
Restricted Drug Restricted
FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

Restricted - Consultant Microbiology and Respiratory authorisation required before initiating treatment.

BNF BNFc SPC
MHRA Drug Safety Update (November 2014) - Colobreathe (colistimethate sodium dry powder for inhalation): risk of capsule breakage - new instructions for use NICE TA276: Cystic fibrosis (pseudomonas lung infection) - colistimethate sodium and tobramycin

Colistimethate Sodium 1 & 2 million units ( Colomycin®)
(Injection which can be nebulised)

 
Restricted Drug Restricted

Red Restricted - prescribing by Respiratory Physicians, Consultant Paediatricians and Consultant Microbiologists for use in cystic fibrosis only.
NOTE: Colomycin® injection is licensed for nebulisation and may be given by inhalation as a nebulised solution as an adjunct to standard antibacterial therapy in cystic fibrosis patients with severe pseudomonal chest infections.

Amber SPIS Non-cystic Fibrosis Bronchiectasis (Adult patients only) – Specialist initiation with GP to continue. No dose titration necessary. The specialists will undertake the test dose and provide first month supply. Blueteq or High cost drug form required – see link from Formulary homepage.

BNF BNFc SPC
JPC Bulletin: Use of Nebulised Tobramycin and Nebulised Colistimethate sodium as Antibiotic Prophylaxis to prevent exacerbations of Non- Cystic Fibrosis Bronchiectasis in Adult Patients

Colistimethate Sodium 1 million units (generic brands)
(Injection)

RED
Restricted Drug Restricted
Restricted - for multi-drug resistant infections where there is no alternative.
Must be recommended by a consultant Microbiologist.

Funding cannot be claimed for these indications.
BNF BNFc SPC
05.01.07 Rifaximin
05.01.07 Fidaxomicin
Classifications
GREEN
May be initiated in any care setting
Amber SPA
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Amber SPIS
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
SCG
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
RED
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
DNP
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
SELF
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.