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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. 
05.01.13 Urinary-tract infections
NICE : Urinary tract infection in children NICE CG97: Lower urinary tract symptoms in Men NICE NG15: Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use

Nitrofurantoin
(50mg, 100mg Tablets / Capsules; 100mg modified release capsules)

GREEN
First Choice

First choice for community-acquired infection with no history of recurrent infection.

Nitrofurantoin is contraindicated in patients with an estimated glomerular filtration rate (eGFR) of less than 45 ml/min/1.73m2 this is in accordance with the MHRA.

BNF BNFc SPC
MHRA Drug Safety Update (September 2014) - Nitrofurantoin now contraindicated in most patients with an estimated glomerular filtration rate (eGFR) of less than 45 ml/min/1.73m2 MHRA DSU April 2023 Nitrofurantoin: reminder of the risks of pulmonary and hepatic adverse drug reactions

Estradiol 10microgram pessaries

GREEN
Formulary

Recurrent UTI (off-label)

Issue 24 for a 2 month supply.

Entry update March 2024

BNF BNFc SPC

Methenamine Hippurate

GREEN
Formulary

1g tablets

Recurrent UTI. Review at 6 months.

Entry reviewed March 2025

BNF BNFc SPC

Nitrofurantoin 25mg/5mL
(Oral Suspension)

GREEN
Restricted Drug Restricted
All cases to be discussed with Consultant Microbiologist for alternatives.
Restricted for use in Paediatric outpatients or paediatric TTAs.
(The suspension now costs > £500 per 300mL bottle). Must not be prescribed on FP10 as may cost even more.
BNF BNFc SPC
MHRA DSU April 2023 Nitrofurantoin: reminder of the risks of pulmonary and hepatic adverse drug reactions

Trimethoprim
(100mg & 200mg Tablets. 50mg/5mL Suspension)

GREEN
Formulary

If low risk of resistance.

A lower risk of resistance may be more likely if not used in the past 3 months, previous urine culture suggests susceptibility (but this was not used), and in younger people in areas where local epidemiology data suggest resistance is low. A higher risk of resistance may be more likely with recent use and in older people in residential facilities.

Entry reviewed March 2025

BNF BNFc SPC

Fosfomycin

 
Formulary

Green Granules, 3g oral sachet

Red Fomicyt® Intravenous Infusion, powder for reconstitution, 2g, 4g vials.

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

N.B. this is contraindicated in severe renal impairment (CrCl < 10mL/min).

 

Entry reviewed: April 2025

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.