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Bedfordshire and Luton Joint Formulary
Bedford Hospital NHS Trust
Bedfordshire CCG
Luton & Dunstable University Hospital NHS Foundation Trust
Luton CCG
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 Formulary Chapter 5: Infections - Full Chapter
Notes:

When a bacterial pathogen is isolated from a clinical specimen and sensitivities are known, treatment should be adjusted to use the narrowest-spectrum antibiotic.The oral route of administration will be appropriate either on initiation or after 2 to 3 days of intravenous therapy. Certain infections e.g. severe sepsis, bacterial meningitis and neutropenic sepsis require intravenous antibiotics for the full period of treatment. All intravenous therapy should be reviewed at 48 hours (ideally daily). A switch from IV to oral therapy should be considered as soon as it is clinically appropriate with the exception of patients with osteomyelitis, necrotising fasciitis, septic arthritis and infections mentioned above. Initially when the infecting organism or the source of infection is unknown, 'broad-spectrum' antibiotics are appropriate. Once clarified (laboratory results), therapy should be altered to a 'narrow spectrum' agent to help minimise the risk of development of antimicrobial resistance. REFER TO TRUST/COMMUNITY ANTIMICROBIAL GUIDELINES , or the Antimicrobial Microguide app.

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing

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 Details...
05.03.04  Expand sub section  Influenza
Oseltamivir (Tamiflu)
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Restricted Drug Restricted
Green
First Choice where indicated
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.

Prescribing for children over 12 months and adults who are not able to swallow capsules should be at the appropriate dose. The contents of the capsule should be added to a suitable sugary diluent. Where possible oseltamivir powder for suspension should be restricted for children under 1 year of age. This will ensure that there are adequate stocks in the supply chain, for this vulnerable group of patients (from recent CMO alert 19/12/17).

It is important that adults and children 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 of age or over.

Restricted - to be initiated on Consultant authorisation in accordance with NICE TA 158/168 or on Microbiologist advice. 
Zanamivir 5mg/blister for inhalation (Relenza)
(Dry powder for inhalation disks)
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Restricted Drug Restricted
Green
Restricted - to be initiated on Consultant Microbiology approval only and in accordance with NICE TA 158/168

 
Link  Prescribing for flu
Link  UKMI Q&A - Oseltamivir or zanamivir - can mothers breastfeed after treatment for influenza?
Link  Zanamivir Patient Request Form
   
Zanamivir
(Aqueous solution for nebulisation or injection)
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Restricted Drug Restricted
Red
unlicensedunlicensed. Available on a named patient basis from GlaxoSmithKline for patients who fit the Public Health England criteria.
Must get advice from Consultant Microbiologist. Contact Pharmacy to order. 
Link  Prescribing for flu
Link  UKMI Q&A - Oseltamivir or zanamivir - can mothers breastfeed after treatment for influenza?
Link  Zanamivir Patient Request Form
   
 ....
 Non Formulary Items
Amantadine Hydrochloride  (Symmetrel)

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Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

RED - Hospital only to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment  

Amber

Amber medicines are considered suitable for GP prescribing following specialist initiation.  

Green

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations   

Amber SCG

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.   

Black

A decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications. Do not prescribe.   

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