NHS Logo
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. 
05.01.12 Fluoroquinolones

MHRA DSU Aug 2023 Fluoroquinolone antibiotics: reminder of the risk of disabling and potentially long-lasting or irreversible side effects

MHRA DSU Sept 2023 Fluoroquinolone antibiotics: suicidal thoughts and behaviour

MHRA DSU Jan 2024 Fluoroquinolones must now only be prescribed when other commonly prescribed antibiotics are inappropriate

 

NICE NG15: Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use

Ciprofloxacin
(Oral)

GREEN
Restricted Drug Restricted
250mg, 500mg & 750mg Tablets
250mg/5mL Suspension

Must only be prescribed in accordance with the Luton & Dunstable Trust's Antimicrobial Guidelines or by recommendation from a Consultant Microbiologist.

Oral bioavailability of ciprofloxacin is approximately 70%. For treatment of gram negative sepsis recommended IV dose is 400 mg 12 hourly. Food delays the rate but not the extent of absorption. Early switch to oral therapy is encouraged.
BNF BNFc SPC
L&D Memo: Antibiotic Prescribing for UTI’s MHRA DSU Dec 2020: small risk of heart valve regurgitation MHRA DSU March 19: Fluoroquinolones new restrictions MHRA DSU Nov 2018: Systemic and inhaled fluoroquinolones: small increased risk of aortic aneurysm and dissection; advice for prescribing in high-risk patients

Ciprofloxacin
(Intravenous infusion)

RED
Restricted Drug Restricted
100mg/5mL, 200mg/100mL & 400mg/200mL IV Infusion

Must only be prescribed in accordance with the Luton & Dunstable Trust's Antimicrobial Guidelines or by recommendation from a Consultant Microbiologist.

Oral bioavailability of ciprofloxacin is approximately 70%. For treatment of gram negative sepsis recommended IV dose is 400 mg 12 hourly. Food delays the rate but not the extent of absorption. Early switch to oral therapy is encouraged.
BNF BNFc SPC
L&D Memo: Antibiotic Prescribing for UTI’s MHRA DSU Dec 2020: small risk of heart valve regurgitation MHRA DSU March 19: Fluoroquinolones new restrictions MHRA DSU Nov 2018: Systemic and inhaled fluoroquinolones: small increased risk of aortic aneurysm and dissection; advice for prescribing in high-risk patients

Levofloxacin
(Oral)

Amber SPA
Formulary

250mg & 500mg Tablets

Primary care: For use in line with NICE Guidelines and the BLMK Antimicrobial Prescribing Guidelines.

Secondary care: For use in line with Trust guidelines or by recommendation from the Consultant Microbiologist.

Oral bioavilability is >90%. The dose for IV and oral preparations is equivalent. Early switch to oral therapy is encouraged.

 

Entry reviewed: Dec 2021

BNF BNFc SPC
MHRA DSU Dec 2020: small risk of heart valve regurgitation MHRA DSU March 19: Fluoroquinolones new restrictions MHRA DSU Nov 2018: Systemic and inhaled fluoroquinolones: small increased risk of aortic aneurysm and dissection; advice for prescribing in high-risk patients

Moxifloxacin 400mg
(Tablets)

Amber SPA
Formulary

Primary care: For use in line with NICE Guidelines and the BLMK Antimicrobial Prescribing Guidelines.

Secondary care: Prescribing by Respiratory Consultants for TB patients, Ophthalmologist for the treatment of endophthalmitis or Microbiology consultants for any other indication.

 

Entry reviewed: Dec 2021

BNF BNFc SPC
MHRA DSU Dec 2020: small risk of heart valve regurgitation MHRA DSU March 19: Fluoroquinolones new restrictions MHRA DSU Nov 2018: Systemic and inhaled fluoroquinolones: small increased risk of aortic aneurysm and dissection; advice for prescribing in high-risk patients

Moxifloxacin 400mg/ 250mL
(Intravenous infusion)

RED
Restricted Drug Restricted
Restricted - prescribing by Microbiology or Respiratory Consultants for TB patients only.
BNF BNFc SPC
MHRA DSU Nov 2018: Systemic and inhaled fluoroquinolones: small increased risk of aortic aneurysm and dissection; advice for prescribing in high-risk patients MHRA DSU Dec 2020: small risk of heart valve regurgitation MHRA DSU March 19: Fluoroquinolones new restrictions

Levofloxacin
(IV Infusion)

RED
Restricted Drug Restricted

500mg/100mL IV Infusion

These must only be prescribed in accordance with the approved indications for use listed in Luton & Dunstable Trust's antimicrobial guideline or by recommendation from the Consultant Microbiologist.

Oral bioavilability is >90%. The dosing for IV preparation and oral preparation is equivalent. Early switch to oral therapy is encouraged.

BNF BNFc SPC
MHRA DSU Dec 2020: small risk of heart valve regurgitation MHRA DSU March 19: Fluoroquinolones new restrictions MHRA DSU Nov 2018: Systemic and inhaled fluoroquinolones: small increased risk of aortic aneurysm and dissection; advice for prescribing in high-risk patients

Ofloxacin 200mg, 400mg
(Tablets)

GREEN
Formulary
BNF BNFc SPC
MHRA DSU Dec 2020: small risk of heart valve regurgitation MHRA DSU March 19: Fluoroquinolones new restrictions MHRA DSU Nov 2018: Systemic and inhaled fluoroquinolones: small increased risk of aortic aneurysm and dissection; advice for prescribing in high-risk patients

Delafloxacin (Quofenix®)
(powder for concentrate for solution for infusion)

RED
Restricted Drug Restricted

300mg powder for concentrate for solution for infusion

Restricted to prescribing only when recommended by a Consultant Microbiologist for the following where sensitivities known (Adult patients only):

- Second line treatment for ABSSSI

- Second line treatment for CAP

 

DTC Approved August 2023

BNF BNFc SPC

Delafloxacin (Quofenix®)
(Tablets)

RED
Restricted Drug Restricted

450mg Tablets

Restricted to prescribing only when recommended by a Consultant Microbiologist for the following where sensitivities known (Adult patients only):

- Second line treatment for ABSSSI

- Second line treatment for CAP

 

DTC Approved August 2023

BNF BNFc SPC
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.