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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. 
05.03.04 Influenza
Influenza: treatment and prophylaxis using anti-viral agents - GOV.UK NICE TA 158 Influenza prophylaxis (NICE 2008) NICE TA 168 Amantadine, oseltamivir and zanamivir for the treatment of influenza

Oseltamivir (Tamiflu®)

GREEN
Restricted Drug Restricted

First Choice where indicated

Prescribers in primary care may prescribe antivirals at NHS expense when surveillance data indicates an increase in influenza cases in the community. Prescribers are notified about this via the Department of Health CAS alert.

30mg, 45mg & 75mg Capsules
30mg/5mL oral suspension - only for children under 1 year.

For enteral tube administration the capsules can be opened and mixed with a little water. The dispersion will flush down an 8 Fr tube without blockage. Flush well.

Children over 12 months and adults who are not able to swallow capsules should use capsules, which are opened and mixed with a small amount (1tsp) of an appropriate sweetened food, eg. honey, yogurt, condensed milk, etc.

It is important that:

• people start taking oseltamivir within 48 hours of onset of symptoms.

• For zanamivir, treatment should begin within 48 hours of onset of symptoms for adults and within 36 hours of onset of symptoms for children who are 5 years old or over.

• Children over 12 months and adults who are not able to swallow capsules can be prescribed oral oseltamivir suspension.

Prescribe in accordance with UKHSA guidance.

 

Entry reviewed: October 2024

BNF BNFc SPC
Influenza: treatment and prophylaxis using anti-viral agents

Zanamivir 5mg/blister for inhalation (Relenza®)
(Dry powder for inhalation disks)

GREEN
Restricted Drug Restricted

Restricted - to be initiated on Consultant Microbiology approval or in accordance with NICE TA 158/168

Entry reviewed: November 2024

BNF BNFc SPC

Baloxavir tablets (Xofluza®)

Amber SPA
Restricted Drug Restricted

40mg, 80mg

Third line choice after oseltamivir and zanamivir, restricted to be used only following microbiologist advice.

NB: Xofluza is not currently stocked in wholesalers therefore there may be a delay in obtaining the product in Primary Care.

Entry reviewed: December 2025

BNF BNFc SPC
UKHSA Guidance 2025: Guidance on use of antiviral agents for the treatment and prophylaxis of seasonal influenza

Zanamivir
(Aqueous solution for injection)

RED
Restricted Drug Restricted

Must get advice from Consultant Microbiologist. Contact Pharmacy to order.

Entry updated: November 2024

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.