Protected Antimicrobials

Antimicrobial prescribing: NHS Fife
NHS Fife

Antimicrobial resistance is increasing and is a serious and worrying problem for patients, staff and healthcare organisations as a whole. Infections caused by resistant bacteria are associated with higher rates of death, illness and prolonged hospital stay. Bacteria often become resistant to antibiotics as a direct consequence of antibiotic use.  The use of these antibiotics is often unnecessary or inappropriate.  

The protected antimicrobial list has been implemented to preserve those antimicrobials that are still active against resistant organisms:

  • Antimicrobials from the table below should only be prescribed for an approved indication as listed
  • For any other indication seek advice from the duty Microbiologist or Infectious Disease Consultant before prescribing. In this case an authorisation code will be given which must be documented in the medical notes and on the prescription chart.

Protected antimicrobials and approved indications

 

Protected Antimicrobial

Approved use

Aciclovir (IV)
  • Given on the advice of a Neurology Consultant
  • Patient under the care of a Consultant in Critical Care
  • Patient being treated for disseminated infection under the Neutropenic Sepsis protocol
  • Encephalitis (NOT uncomplicated viral meningitis)
  • Eczema herpeticum requiring intravenous treatment

Anidulafungin

Microbiologist or Infectious Disease Consultant approval required

Aztreonam

Microbiologist or Infectious Disease Consultant approval required

Caspofungin

Patient under the care of a Consultant Haematologist or Consultant in Critical Care

Cefotaxime

Patient under the care of a Consultant Paediatrician

Ceftazidime

 

1) Patient has a proven/suspected pseudomonal chest infection, has failed to respond to alternative antipseudomonal agents and is under the care of a Consultant in Respiratory Medicine.

2) Patient under the care of a Consultant Paediatrician

Ceftriaxone
  • Suspected meningitis / meningococcal sepsis
  • OPAT (including first dose in ED to facilitate discharge to OPAT)
  • 1st dose for:
    • Peri-orbital cellulitis
    • Pelvic inflammatory disease
    • Acute epiglottitis
    • Pharyngeal abscess

    (further doses require Microbiologist approval)

Cefuroxime

1) Only as per orthopaedic surgery prophylaxis guidelines for a maximum duration of 24 hours

2) Empirical treatment of sepsis in obstetric patients

Daptomycin

Patient under the care of OPAT

Ertapenem

1) Microbiologist or Infectious Disease Consultant approval required

2) Patient under the care of OPAT

Fidaxomicin

Microbiologist or Infectious Disease Consultant approval required

Fosfomycin IV

(oral fosfomycin does not require a code)

Microbiologist or Infectious Disease Consultant approval required

Linezolid

1) Patient under the care of a Consultant in Critical Care

2) Patient with MRSA infection under the care of a Vascular Surgeon

Meropenem

 

1) Patient under the care of a Consultant Haematologist or a Consultant in Critical Care

2) 1st dose for suspected necrotising fasciitis; further doses require Microbiologist approval

3) 1st dose for suspected neutropenic sepsis; further doses require Microbiologist approval

Piperacillin-Tazobactam

 

 

 

1) Neutropenic sepsis

2) Patient under the care of a Consultant in Critical Care

3) Cystic fibrosis or bronchiectasis (when advised by a Consultant in Respiratory Medicine or Paediatrics)

Posaconazole

Patient under the care of a Consultant Haematologist

Rifaximin

 

Patient under the care of a GI Consultant and only for the prevention of hepatic encephalopathy (2nd line agent)

Teicoplanin

1) Patient under the care of OPAT or Hospital at Home

2) Surgical prophylaxis, single dose as per individual protocol

3) Neutropenic sepsis

Tigecycline

Microbiologist or Infectious Disease Consultant approval required

Voriconazole

1) Patient under the care of a Consultant in Respiratory Medicine or a Consultant Haematologist

2) Patient under the care of a Renal Consultant only for fungal PD peritonitis

 

Supply route

 

  • Protected antimicrobials should be requested as urgent and administered without delay.
  • Protected antimicrobials should be requested using the wards’ drug requisition book. Include the patients’ name and the approved indication or authorisation code.  This supply is only for that patient.
  • Do not borrow stock from, or lend stock to, other wards unless authorised by a Pharmacist.
  • Return any unused drugs to the Pharmacy as soon as possible.