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5.2 Bacterial infection

First line drugs Second line drugs Specialist drugs Secondary care drugs

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.

 

 

Aminoglycosides

(Low risk for C. difficile disease)

 

Amikacin 

  • Injection 100mg/2mL, 500mg/2mL

Note: 

  • Amikacin is included for resistant infections under Consultant Microbiologist's recommendation.

 

Gentamicin

  • Injection 20mg/2mL,  80mg/2mL

Notes:

  • Use the Gentamicin Calculator
  • To avoid excessive dosage in obese patients, use ideal weight for height to calculate dose.

 

Neomycin sulfate

  • Tablet 500mg

 

 

Streptomycin

    • Injection 1g

 

 

Tobramycin 

  • Injection 40mg/1mL

Notes

 

 

 

Carbapenems

 

Ertapenem 

  • Injection 1g

Notes:

  • Ertapenem is restricted for use for the Outpatient Parenteral Antibiotic Therapy (OPAT) service after approval from consultant microbiologist.

 

Imipenem with cilastatin

  • Injection 500mg

 

Meropenem 

  • Injection 500mg, 1gram

 

 

 

Cephalosporins

(High risk for C. difficile disease)

 

Cefalexin 

  • Capsules 250mg, 500mg
  • Oral suspension 125mg, 250mg

 

 

Cefixime (Amber 2)

    • Tablets 200mg

Notes:

  • Cefixime has been included for the treatment of urogenital gonorrhoea only and is not considered reliable for the treatment of pharyngeal disease.

 

 

Cefotaxime

  • Injection 500mg, 1gram, 2gram

 

 

Ceftazidime 

  • Injection 500mg, 1gram, 2gram, 3gram

 

 

Ceftriaxone 

  • Injection 250mg, 1gram, 2gram

Notes:

  • Ceftriaxone has been included for the emperical treatment of bacterial meningitis.
  • MHRA Drug Safety Update (October 2009): Ceftriaxone should not be given simultaneously with calcium containing solutions (other than total parenteral nutrition solutions) for IV administration because of the risk of calcium precipitation. Ceftriaxone is contraindicated in newborns up to age 28 days who need IV treatment with any calcium containing solution. Calcium and ceftriaxone may be infused sequentially in patients aged 28 days or older provided that either the infusion line is rinsed or flushed between solutions, or the infusions are given via different infusion lines at different sites. 

 

 

Cefuroxime

  • Injection 250mg, 750mg, 1.5 grams

Notes:

  • Cefuroxime is restricted to maternity and Paediateric wards 

 

 

 

 

Glycopeptide antibacterials

 

Teicoplanin

  • Injection 200mg, 400mg

 

 

Vancomycin

  • Capsules 125mg, 250mg
  • Injection 500mg, 1gram

Notes:

  • Capsules are used to treat C. diff  in patients being discharged only. 

 

  • The injection is used orally for in-patients for c.diff infection

 

  • Monitor blood levels

 

  • Preparation of Vancomycin Solution:

At the time of use, add 10 ml of sterile Water for Injections BP to a 500 mg vial of Vancomycin Hydrochloride 500 mg Powder for Concentrate for Infusion. Similarly, add 20 ml of sterile Water for Injections BP to a 1 g vial of Vancomycin Hydrochloride 1 g Powder for Concentrate for Infusion. Vials reconstituted in this manner will give a solution of 50 mg/ml.

 

 

 

Lincosamides

(High risk for C. difficile disease)

Clindamycin

  • Capsules 75mg, 150mg
  • Injection 150mg/mL

Notes: 

  • Clindamycin’s principal indication is second line for gram-positive soft tissue, bone and joint infections.
  • It is associated with Clostridium difficile diarrhoea, which limits its use.
  • Patients should discontinue treatment immediately if diarrhoea develops

 

 

 

 

Macrolides and Related drugs

 

Azithromycin

  • Capsules 250mg
  • Tablets   250mg, 500mg

 

Clarithromycin

  • Tablets 250mg, 500mg
  • Oral suspension 125mg/5mL, 250mg/5mL
  • Intravenous infusion 500mg

 

Erythromycin

  • Tablets 250mg
  • Oral suspension sugar free (ethylsuccinate) 125mg/5mL, 250mg/5mL 500mg/5mL
  • Injection 1gram

 

 

 

Monobactams

Aztreonam (nebulised) 

Powder and solvent for nebuliser solution 75mg

 

 

 

Nitroimidazole derivatives

 

Metronidazole

  • Tablets 200mg, 400mg
  • Oral Suspension 200mg/5mL
  • Suppositories 500mg, 1gram
  • Intravenous Infusion 500mg/100mL

 

 

 

 

Penicillins, antipseudomonal with beta-lactamase inhibitor 

 

Piperacillin/tazobactam 

  • Injection 2.25g (piperacillin 2g/tazobactam250mg)
  • Injection 4.5g   (piperacillin 4g/tazobactam500mg)

 

 

 

Penicillins, Beta-lactamase sensitive

 

Phenoxymethylpenicillin (Penicillin V)

  • Tablets 250mg
  • Oral solution Sugar free 125mg/5mL, 250mg/5mL

 

 

Benzylpenicillin sodium (Penicillin G) (Amber 2)

  • Injection

 

 

Benzathine benzylpenicillin   (Unlicensed)

  • Injection 2,400,00 units 

 

 

Procaine benzylpenicillin   (Unlicensed)

  • Injection 1,200,00 units

Note:

  • Benzathine benzylpenicillin and procaine benzylpenicillin are included for the treatment of syphilis infection only.

 

 

 

 

Penicillins, Broad-Spectrum

 

Amoxicillin

  • Capsules 250mg, 500mg
  • Oral suspension Sugar free 125mg/5mL, 250mg/5mL
  • Oral sachet 3gram
  • Injection 250mg, 500mg, 1gram

 

Co-amoxiclav

  • Tablets 250/125, 500/125
  • Oral Suspension 125/31 in 5mL, 250/62 in 5mL
  • Injection 500/100, 1000/200 (Hospital only)

 

 

 

Penicillins, Mecillinam-type

Pivmecillinam hydrochloride

  • Tablets 200ng

 

 

 

Penicillins, Penicillinase-Resistant

 

Flucloxacillin

  • Capsules 250mg, 500mg
  • Oral solution 125mg/5mL, 250mg/5mL
  • Injection 250mg, 500mg, 1gram

 

 

 

Polymixins

 

Colistimethate Sodium   

  • Colomycin® Injection 1million-unit vial - Powder for solution for injection, infusion or inhalation
  • Colomycin® Injection 2million-unit vial - Powder for solution for injection, infusion or inhalation
  • Promixin® 1million-units - Powder for Nebuliser Solution
  • Promixin® 1million-units - Powder for Solution for Infusion (available via Homecare only)

 

For treatment of pseudomonal lung infection in cystic fibrosis

 

 

 

Quinolones

(High risk for C. difficile disease)

                

 

Ciprofloxacin

  • Tablet 250mg,500mg
  • Oral suspension 250mg/5mL
  • Intravenous infusion 100mg/50mL, 200mg/100mL

Notes:

Important Safety Information:

 

 

 

Ofloxacin

  • Tablets 200mg, 400mg

Notes:

Important Safety Information:

 

 

 

Levofloxacin (Amber 2)

  • Tablets 250mg, 500mg
  • Intravenous Infusion, 500mg/100mL infusion
  • Solution for infusion, 500mg/100mL vials
  • Solution for infusion, 500mg/100mL bottles

Notes:

Important Safety Information:

 

 

 

Moxifloxacin (Amber 2) 

  • Tablet 400mg
  • Solution for infusion 1.6mg/1mL`

Notes:

Important Safety Information:

 

 

 

Sulfonamides

 

Sulfadiazine (Amber 2)

      • Tablet 500mg

Note: Restricted to use by the HIV specialist team for the management of toxoplasmic encephalitis secondary to HIV/AIDS only [unlicensed]

 

Co-trimoxazole 

(Trimethoprim plus sulfamethoxazole)

      • Tablets 480mg, 960mg
      • Suspension 240m/5mL, 480mg/5mL
      • Injection 480/5ml (Hospital only)

Note:

  • CSM recommends that co-trimoxazole should be limited to treatment and prevention of pneumocystis pneumonia.

 

 

 

Tetracyclines and related drugs

 

Doxycycline

  • Capsules 50mg, 100mg

 

 

Tetracycline

  • Tablets 250mg

 

 

Demeclocycline (Amber 2) 

  • Capsules 250mg

 

 

Lymecycline (Amber 2) 

  • Capsules 480mg

 

 

Minocycline 

    • Tablets    50mg, 100mg
    • Capsules  50mg, 100mg
    • Modified-release capsules 100mg

 

 

Tigecycline

  • Tagycil® Intravenous Infusion, powder for reconstitution, 50mg vials

Note:

  • Tigecycline is restricted for penicillin allergic patients under Consultant Microbiologist's recommendation.

 

 

Other antibacterials

 

Trimethoprim

  • Tablets 100mg, 200mg
  • Oral suspension Sugar free 50mg/5mL

 

Fosfomycin (Amber 2) 

  • Monuril® Granules, 3g oral sachet
  • Fomicyt® Intravenous Infusion, powder for reconstitution,  2g, 4g vials

Notes:

  • For the Treatment of Uncomplicated Cystitis with ESBL producing Organisims
  • Fosfomycin is a phosphonic acid derivative and has predominatly bactericidal action. Fosfomycin is indicated for lower UTI in adult men and non-pregnant women (no fever or flank pain) where multiresistant bacteria that show sensitivity to fosfomycin are identified. 
  • Suitable for prescribing in primary care after specialist recommendation

 

 

Fusidic acid (Amber 2) 

  • Tablets 250mg
  • Fusidic acid oral suspension 250mg/5mL (5mL is approx. equivalent to 175mg sodium fusidate)
  • Infusion 500mg  (Hospital only)

Note: 

  • Sodium fusidate should not be given as a single agent but should be given in combination with another agent for serious staphylococcal infections. It should not be used intravenously, unless there is no alternative after discussion with a microbiologist.

 

 

Rifaximin (Amber 3)

  • Targaxan® Tablets 550mg 

Notes:

 

 

Chloramphenicol

  • Capsules 250mg
  • Intravenous Infusion, powder for reconstitution, 1g

 

 

Daptomycin

  • Intravenous Infusion, powder for reconstitution, 350mg, 500mg

 

Fidaxomicin (Amber 1) 

  • Tablets 200mg

Note:

  • On recommendation of a consultant microbiologist only
  • patients who experience a relapse of Clostridium difficile infection (CDI)
  • patients who are experiencing an episode (CD toxin positive) that are at high risk of developing it with no prior history of C.diff
  1. >75 years of age
  2. CD toxin positive
  • Multiple risk factors such as cancer, likely to have recurrent antibiotics (COPD etc) or continuing high risk antibiotics, long hospital stay, frequent re-admissions and continuation of PPI. Such cases will be discussed and a decision will be made by the Consultant Microbiologist and Gastroenterologist to treat the first episode

 

 

Linezolid

  • Tablets 600mg
  • Intravenous Infusion, 600mg/300mL infusion bags

Notes:

  1. It is only available from a hospital pharmacy following advice from microbiology.
  2. CSM Warning for Linezolid: Haematopoietic disorders have been reported in patients receiving linezolid. It is recommended that full blood counts be monitored weekly. Close monitoring is recommended in patients who:
    • Receive treatment for more than 10-14 days
    • Are receiving drugs that may have adverse effects on haemoglobin, blood counts, or platelet function
    • Have pre-existing myelosuppression
    • Have severe renal impairment.
  3. If significant myelosuppression occurs treatment should be stopped unless it is considered essential. Intensive monitoring of blood counts and appropriate management should be implemented.

 

Tedizolid 

  • Sivextro® Tablets 200mg 
  • Sivextro® Intravenous Infusion, powder for reconstitution, 200mg vials

Notes: 

  • For hospital use only on micro recommendation
  • Under 18 years, not recommended

 

 

5.2.2 Leprosy

Antimycobacterials

 

Dapsone (Amber 3)

  •  Tablets 50mg, 100mg

Note:

For long-term treatment, patients and their carers should be told how to recognise the signs of blood disorders and advised to seek immediate medical attention if symptoms such as fever, sore throat, rash, mouth ulcers, purpura, bruising or bleeding develop.

 

 

5.2.5 Tuberculosis

Antimycobacterials Rifamycins 

 

Rifampicin

    • Capsules 150mg, 300mg
    • Syrup 100mg/5mL
    • Infusion 600mg (with solvent)

 

 

Combination products:

 

Rifinah®  150/100 (Amber 2)

    • Tablets rifampicin 150mg, isoniazid 100mg 

 

 

Rifinah®  300/150 (Amber 2)

    • Tablets rifampicin 300mg, isoniazid 150mg 

 

 

 

Rifater® (Amber 2)

    • Tablets rifampicin 120mg, isoniazid 50mg, pyrazinamide 300mg 

 

 

 

Voractiv® 

    • Tablets f/c rifampicin 150mg, isoniazid 75mg, pyrazinamide 400mg, ethambutol hydrochloride 275mg

Notes:

  • Tuberculosis is treated in two phases – an initial phase using at least three drugs and a continuation phase using two drugs in fully sensitive cases. Please see BNF for further information.
  • Rifampicin should not be used as monotherapy (except in the case of meningococcal prophylaxis as advised by Public Health) and wherever possible, administered orally.

 

 

 

Other

 

Ethambutol (Amber 2)

    • Tablets 100mg, 400mg
    • Suspension 400mg in 5ml, unlicensed; prescribers are to restrict prescribing to this strength

 

 

Isoniazid (Amber 2)

    • Tablets 100mg
    • Injection 50mg/2mL 
    • Elixir 50mg in 5ml, unlicensed; prescribers are to restrict prescribing to this strength

 

 

Pyrazinamide (Amber 2) 

    • Tablets 500mg
  • Injection 50mg/2mL, unlicensed
  • Suspension 500mg in 5ml, unlicensed; prescribers are to restrict prescribing to this strength

 

 

 

5.2.6 Urinary tract infections 

Antibacterials

 

Nitrofurantoin

  • Modified Release Capsules 100mg
  • Tablets 50mg, 100mg (for prophylaxis only)
  • Oral Suspension 25mg/5mL, 300ml bottle £260 Expensive; use alternative

 

 

Methenamine Hippurate (Amber 2)

  • Hiprex® Tablets 1g

Notes:

  • For recurrent UTI in women i.e. women who have 2 UTIs in 6 months or 3 or more infections per year
  • Used according to “Primary Care Antimicrobial Guidelines” 
     

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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.

 

 

 

Return to Chapter: 5. Infections

Last updated by: Dupe Fagbenro on 09-04-2019 17:09