5. Infections

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First line drugs	Second line drugs	Specialist drugs	Secondary care drugs
Recommended in both primary and secondary care	Alternatives (often in specific conditions) in both primary and secondary care;	Where a specialist input is needed (see introduction for definition)	Prescribing principally within secondary care only

Traffic light status (TLS) explained:

Green: Routine prescribing within licensed indication
Amber 1: specialist recommendation followed by GP initiation and continuation
Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
Amber 3: specialist initiation and stabilisation followed by GP continuation
Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
Red: Hospital or specialist prescribing only
Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.

5.2 Bacterial infection

5.3 Fungal infection

5.4 Helminth infection

5.5 Protozoal infection

5.6 Viral infection

Useful Sources of information:

2) Empirical Guidance on the Management of Infection in Primary Care in Adults – Short Form (March 2019) - To be read in conjunction with the full guidance in the link above)

3) Secondary Care Adult Antimicrobial Guidelines (Milton Keynes University Hospital NHS Foundation Trust)

Notes:

1. Wherever possible antibiotics should be prescribed orally

2. Antibiotics should be:

Administered only for as long as necessary to treat the infection
Changed from IV to oral as soon as possible

3. Sugar free liquids are preferred where available, and SF identifies where a sugar free product is available.

4. For young children requiring doses of less than 5ml an oral syringe will be dispensed

Suspected Meningitis

Pre-admission management for suspected meningitis can be found here: http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1194947389261

Notes:

1. All GPs should carry benzylpenicillin for injection and administer it whilst arranging the transfer of the case to hospital, unless there is a history of immediate allergic reactions after previous penicillin administration.

2. GPs do not need to carry an alternative antibiotic. However, if other antibiotics are available, a 3rd generation cephalosporin may be used. If there is a history of immediate allergic reactions to penicillin or cephalosporins, chloramphenicol may be used.

3. Immediate dose of IV/IM benzylpenicillin for suspected meningococcal infection