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​​​​​​​​Protected Antimicrobials

This is a list of all antimicrobials that are restricted to certain prescribers and/or specific treatment indications. Any use outside of these recommendations will be challenged and may be refused – prescriptions not adhering to the guidelines will be referred to the antimicrobial pharmacists within working hours or Medical Microbiology/Infectious Diseases Consult Team out of hours for specialist advice/authorisation. 

Ward pharmacists have responsibility for checking day-to-day antimicrobial prescriptions on the wards. Queries should be raised with the patient's clinical team in the first instance and escalated to an antimicrobial pharmacist if necessary.

Any antimicrobial not included in this list or the formulary list will not be stocked by Pharmacy.  Use within the Trust will require application to the Antimicrobial Management Group for ratification by the Medicines Management Group. 

To assist in the development of tools for antibiotic stewardship at local, national and global levels and to reduce antimicrobial resistance, the Access, Watch, Reserve (AWaRe) classification of antibiotics was developed – where antibiotics are classified into different groups to emphasize the importance of their appropriate use.

Access group antibiotics: This group includes antibiotics that have activity against a wide range of commonly encountered susceptible pathogens while also showing lower resistance potential than antibiotics in the other groups.

Watch group antibiotics: This group includes antibiotic classes that have higher resistance potential.

Reserve group antibiotics: This group includes antibiotics and antibiotic classes that should be reserved for treatment of confirmed or suspected infections due to multi-drug-resistant organisms. Reserve group antibiotics should be treated as “last resort” options to preserve their effectiveness. These antibiotics should be accessible, but their use should be tailored to highly specific patients and settings, when all alternatives have failed or are not suitable.​


Protected antibiotics​

Antibiotic​​

Authorised Prescribers/Indications

Access, watch or reserve category

Amikacin

Medical Microbiology/ Infectious Diseases

Access

Ampicillin

None – Amoxicillin used in preference

Access

Aztreonam

Medical Microbiology/ Infectious Diseases/Haematology/Neutropenic sepsis

Reserve

Capreomycin

Medical Microbiology/ Infectious Diseases

 

Cycloserine

Medical Microbiology/Infectious Diseases

 

​Ceftazidime/avibactam

​Medical Microbiology/Infectious Diseases

Reserve

Cefiderocol

Medical Microbiology/Infectious Diseases

*Requires AMG chair approval

Reserve

Ceftolozane/tazobactam

Medical Microbiology/Infectious Diseases

*Requires AMG chair approval

Reserve

Cefotaxime

Medical Microbiology/Infectious Diseases

Watch

Ceftazidime

Medical Microbiology/Infectious Diseases/ Respiratory

Watch

Clofazimine

Medical Microbiology/ Infectious Diseases

 

Colistin IV

(Colistemethate sodium)

Medical Microbiology/ Infectious Diseases

Reserve

Co-trimoxazole

Medical Microbiology/ Infectious Diseases/ Haematology/ Respiratory

Access

​Dalbavancin 

​Medical Microbiology/Infectious Diseases

 

*Requires AMG chair approval

Reserve

Dapsone

Medical Microbiology/ Infectious Diseases

 

Daptomycin

Medical Microbiology/ Infectious Diseases

Reserve

​Ertapenem​

​Medical Microbiology/ Infectious Diseases

Watch

Erythromyin

For pro-kinetic use only

Watch

Fidaxomicin

For the management of Clostridium difficile infection as per Trust guidelines

Watch

Fosfomycin (Injection)

Medical Microbiology/ Infectious Diseases

Reserve

Flucytosine

Medical Microbiology/ Infectious Diseases

This is currently unavailable in the UK.

 

Imipenem/Cilastatin (Primaxin)

Medical Microbiology/ Infectious Diseases

Watch

Imipenem/relebactam/cilastatin

Medical Microbiology/ Infectious Diseases

 

*Requires AMG chair approval

Reserve

Levofloxacin

Medical Microbiology/ Infectious Diseases/Ophthalmology (eye drops only)

Watch

Linezolid

Medical microbiology/Infectious Diseases

Reserve

Meropenem

Medical microbiology/Infectious Diseases/Haematology/Critical care/Neurology/Necrotising fasciitis/Ophthalmology (eye drops only)

Watch

Meropenem/vaborbactam

Medical Microbiology/ Infectious Diseases

 

*Requires AMG chair approval

Reserve

Moxifloxacin

Medical Microbiology/ Infectious Diseases/GUM/Ophthalmology (eye drops only)

Watch

Norfloxacin

Medical Microbiology/ Infectious Diseases

Watch

Ofloxacin

Medical Microbiology/ Infectious Diseases/GUM/ epididymo-orchitis

Watch

Rifabutin

Medical Microbiology/ Infectious Diseases

Watch

Rifaximin

Medical Microbiology/ Infectious Diseases/Gastroenterology – pouchitis & hepatic encephalitis

Watch

Sodium fusidate

Medical Microbiology/ Infectious Diseases

Watch

Sulfadiazine

Medical Microbiology/ Infectious Diseases

Access

Streptomycin

Medical Microbiology/ Infectious Diseases

Watch

Temocillin

Medical Microbiology/ Infectious Diseases/ Urosepsis >65 years of age

Watch​

Tobramycin

Medical Microbiology/ Infectious Diseases

Watch

Vancomycin (oral)

Confirmed Clostridium difficile infection – must have Infectious Diseases review 

Watch

Voractiv

Medical Microbiology/ Infectious Diseases

 


*These antimicrobials require AMG chair approval prior to initiation and recommendation. Approval should be documented on PENs and communicated to antimicrobial pharmacists by medical microbiology/ward pharmacist. If required out of hours, discussion between ID consultant and medical microbiology consultant is required and should be documented on PENs prior to supply by pharmacy.




Protected antifungals

Antifungal

Authorised Prescribers/Indications

Anidulafungin

Medical Microbiology/Infectious Diseases

Amphotericin

Medical Microbiology/Haematology /Infectious Diseases/Ophthalmology (eye drops only)

Caspofungin

Medical Microbiology/ Infectious Diseases/ Haematology

Flucytosine

Medical Microbiology/ Infectious Diseases

This is currently unavailable in the UK.

Isavuconazole

Medical Microbiology/ Infectious Diseases

Itraconazole

Medical Microbiology/ Infectious Diseases/Haematology

Ketoconazole

Medical Microbiology/ Infectious Diseases

Micafungin

Medical Microbiology/ Infectious Diseases

Posaconazole

Medical Microbiology/ Infectious Diseases

Tinidazole

Medical Microbiology/ Infectious Diseases/GUM

Voriconazole

Medical Microbiology/ Infectious Diseases/Ophthalmology (eye drops only)





Protected antivirals

Antiviral

Authorised Prescribers/Indications

Cidofovir

Medical Microbiology/ Infectious Diseases/Haematology

Foscarnet

Medical Microbiology/ Infectious Diseases/Ophthalmology (eye drops only)

Ganciclovir

Medical Microbiology/ Infectious Diseases/Ophthalmology (eye drops only)

Valaciclovir

Medical Microbiology/ Infectious Diseases

Valganciclovir

Medical Microbiology/ Infectious Diseases/ Haematology/ Renal Transplant – CMV prophylaxis policy