Guidelines
Antibiotics should be prescribed according to the following local guidelines:
CDDFT antibiotic formulary (accessible via CDDFT intranet only)
STHFT Antimicrobial Drug Formulary
NICE antimicrobial prescribing guidelines (link to NICE website)
Drug allergy: diagnosis and management of drug allergy in adults, children and young people (CG183)
NICE NG63: Antimicrobial stewardship: changing risk-related behaviours in the general population
NICE NG109: Urinary tract infection (lower): antimicrobial prescribing
NICE NG110: Prostatitis (acute): antimicrobial prescribing
NICE NG111: Pyelonephritis (acute): antimicrobial prescribing
NICE NG112: Urinary tract infection (recurrent): antimicrobial prescribing
NICE NG113: Urinary tract infection (catheter-associated): antimicrobial prescribing
NICE NG114: Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing
NICE NG120: Cough (acute): antimicrobial prescribing
NICE NG125: Surgical site infections: prevention and treatment
NICE NG152: Leg ulcer infection: antimicrobial prescribing
NICE NG153: Impetigo: antimicrobial prescribing
NICE NG165: COVID-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community
NICE NG173: COVID-19 rapid guideline: antibiotics for pneumonia in adults in hospital
NICE NG182: Insect bites and stings: antimicrobial prescribing
The County Durham and Tees Valley APC Do Not Prescribe List and Grey List can be accessed online at: https://medicines.necsu.nhs.uk/download/tees-prescribing-grey-list/
CD&D Patient Decision Aids Resource available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/
NHS England Guidance on “Conditions for which over the counter items should not routinely be prescribed” available at: https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/
Prescribing of medicines available to purchase over the counter for self-care
Antibiotics should be prescribed according to the following local guidelines:
CDDFT antibiotic formulary (accessible via CDDFT intranet only)
STHFT Antimicrobial Drug Formulary
NICE antimicrobial prescribing guidelines (link to NICE website)
Antibiotics should be prescribed according to the following local guidelines:
Management of infection guidance for primary care
CDDFT antibiotic formulary (accessible via CDDFT intranet only)
250mg tablets
125mg in 5ml and 250mg in 5ml oral solutions
Antibiotics should be prescribed according to the following local guidelines:
Management of infection guidance for primary care
CDDFT antibiotic formulary (accessible via CDDFT intranet only)
250mg & 500mg capsules
125mg/5ml and 250mg/5ml oral solutions
Courses longer than 2 weeks increase the risk of cholestatic jaundice. Patients requiring longer courses must have their LFT's monitored
250mg, 500mg & 1g injections
Courses longer than 2 weeks increase the risk of cholestatic jaundice. Patients requiring longer courses must have their LFT's monitored
Antibiotics should be prescribed according to the following local guidelines:
Management of infection guidance for primary care
CDDFT antibiotic formulary (accessible via CDDFT intranet only)
250mg & 500mg capsules
3g sachets
125mg/5ml & 250mg/5ml sugar free syrups
Amoxicillin with clavulanic acid:
250/125 & 500/125 tablets
250/125 dispersible tablets
125/31 & 250/62 sugar-free suspensions
400/57 sugar-free suspension (Augmentin Duo®)
(quantities are indicated in the form co-Amoxiclav x/y where x
= mg amoxicillin and y = mg clavulanic acid)
Avoid broad spectrum antibiotics when narrow spectrum antibiotics remain effective, as they increase risk of Clostridium difficile, MRSA and resistant organisms.
To give 625mg dose as solution give 10ml of 250/62mg solution. It is not possible to give a 375mg dose using solution.
500/100 (600mg) & 1,000/200 (1.2g) injections
(quantities are indicated in the form co-Amoxiclav x/y where x
= mg amoxicillin and y = mg clavulanic acid)
Avoid broad spectrum antibiotics when narrow spectrum antibiotics remain effective, as they increase risk of Clostridium difficile, MRSA and resistant organisms.
Antibiotics should be prescribed according to the following local guidelines:
Management of infection guidance for primary care
CDDFT antibiotic formulary (accessible via CDDFT intranet only)
Antibiotics should be prescribed according to the following local guidelines:
Management of infection guidance for primary care
CDDFT antibiotic formulary (accessible via CDDFT intranet only)
Cephalosporins are associated with an increased risk of causing Clostridium difficile infection especially in the elderly and therefore should only be used when no reasonable alternative is available.
Antibiotics should be prescribed according to the following local guidelines:
Management of infection guidance for primary care
CDDFT antibiotic formulary (accessible via CDDFT intranet only)
200mg tablets
100mg in 5ml paediatric suspension
See indications in CDDFT Antibiotic Formulary.
500mg, 1g & 2g injections
Cefotaxime is reserved for use in neonates or those in whom ceftriaxone is contra-indicated.
250mg, 500mg, 1g & 2g injections
Treatment of Pseudomonas infections or infections caused by proven resistant Gram-negative bacteria.
2g/500mg powder
For use on consultant microbiologist advice within secondary care only in multi-resistant infections with limited treatment options.
500mg powder
For use on consultant microbiologist advice within secondary care only in multi-resistant infections with limited treatment options.
250mg, 1g & 2g injections
Treatment of bacterial meningitis or meningococcal or Haemophilus influenzae(b) septicaemia.
250mg tablets
125mg/5ml oral suspension
Cefuroxime should only be used as in accordance with Antibiotic Formulary
Antibiotics should be prescribed according to the following local guidelines:
Management of infection guidance for primary care
CDDFT antibiotic formulary (accessible via CDDFT intranet only)
1g injection
To be used on the advice of a Consultant Microbiologist for the management of resistant Gram-negative infections.
500mg & 1g injections
For the treatment of Necrotising fasciitis or severe necrotising pancreatitis otherwise to be used only on the advice of a Consultant Microbiologist.
75mg powder for inhalation
Approved in line with NHS England specialised commissioning criteria for the treatment of chronic pulmonary Pseudomona aeruginosa infection in patients with cystic fibrosis.
500 mg/500 mg powder for solution for infusion - Primixin(R)
Each vial contains imipenem monohydrate equivalent to 500 mg imipenem anhydrate and cilastatin sodium equivalent to 500 mg cilastatin.
Infectious diseases or microbiology advice only
In radiology prior to Hepatic Arterial Embolisation and Chemo-Embolisation
Antibiotics should be prescribed according to the following local guidelines:
Management of infection guidance for primary care
CDDFT antibiotic formulary (accessible via CDDFT intranet only)
There are safety concerns associated with minocycline including greater risk of lupus erythematosus-like syndrome and irreversible pigmentation. Minocycline should not routinely be used for the treatment of acne. Oxytetracycline is the current first line treatment choice for acne
The County Durham and Tees Valley APC Do Not Prescribe List and Grey List can be accessed online at: https://medicines.necsu.nhs.uk/download/tees-prescribing-grey-list/
Antibiotics should be prescribed according to the following local guidelines:
Management of infection guidance for primary care
CDDFT antibiotic formulary (accessible via CDDFT intranet only)
80mg in 2ml & 20mg in 2ml injections
MHRA Drug Safety Alert (Nov 2017): Gentamicin: potential for histamine-related adverse drug reactions with some batches
Approved for the long term therapy in non-cystic fibrosis bronchiectasis as per Antibiotic Formulary
80mg in 2ml & 240mg in 6ml injections
Resistant infections on the advice of a Consultant Microbiologist
300mg in 4ml (Bramitob®) nebuliser solution - only for long-term 2nd line use in the management of chronic
pulmonary infection due to Pseudomonas aeruginosa in cystic fibrosis
(CF) patients
300mg in 5ml (Tobi®) - only to be used in existing patients as it is cheaper to use Bramitob.
TOBI Podhaler – 28mg capsule plus podhaler - approved for CF patients in line with NICE
Commissioner: NHS England - NICE TA276, Policy - A01/PS/a
Antibiotics should be prescribed according to the following local guidelines:
Management of infection guidance for primary care
CDDFT antibiotic formulary (accessible via CDDFT intranet only)
Antibiotics should be prescribed according to the following local guidelines:
Management of infection guidance for primary care
CDDFT antibiotic formulary (accessible via CDDFT intranet only)
Antibiotics should be prescribed according to the following local guidelines:
Management of infection guidance for primary care
CDDFT antibiotic formulary (accessible via CDDFT intranet only)
25mg/ml concentrate for solution for infusion in a 40ml vial
Not approved in accordance with the following NICE TAs:
250mg capsules
1g injection
Resistant infections on the advice of a Consultant Microbiologist.
1,000,000 & 2,000,000 unit injections (Colomycin)
1,000,000 unit nebuliser solution (Promixin)
1,000,000 & 2,000,000 unit injections (Colomycin)
Unlicensed indication.
For nebulisation only the Colomycin® brand should be used.
Colobreathe – 125mg capsule plus Turbospin inhaler – approved for CF patients in line with NICE
To be used on Specialist Respiratory Advice
Commissioner: NHS England - NICE TA276, Policy - A01/PS/a
MHRA Drug Safety Update (Nov’ 2014): risk of capsule breakage from inhaler device
350mg injection & 500mg injection
To be used on the advice of a Consultant Microbiologist for the management of resistant Gram-positive infections or as recommended within the Antibiotic Formulary.
200mg tablets
To be used for the treatment of Clostridium difficile on the advice of a Consultant Microbiologist.
3g sachets
To be used on the advice of a Consultant Microbiologist for the management of resistant Gram-negative infections.
250mg film coated tablets
250mg in 5ml suspension (Fusidic Acid) - equivalent in therapeutic effect to 175mg sodium fusidate
600mg tablets
100mg in 5ml suspension
To be used on the advice of a Consultant Microbiologist for resistant Gram-positive infections.
RED drug for courses greater than >14 days.
Patients must have weekly bloods taken to monitor for haematological side effects if receiving treatment for more than 10 to 14 days. In those receiving treatment for more than 4 weeks a pre-treatment eye assessment is recommended followed by monthly assessments. Patients should be warned to report any visual symptoms promptly (see BNF for CSM warning).
See Appendix 8 CDDFT antibiotic guidelines: Linezolid Information Leaflet which gives information for the prescriber and the patient on side effects and how the drug will be supplied and monitored when given to non admitted patients. A copy of the leaflet must be given to the patient on discharge from the hospital.
Linezolid is a MAO inhibitor and so potentially life threatening interactions can occur. Check before prescribing. MAOI interactions
600mg tablets
100mg in 5ml suspension
To be used on the advice of a Consultant Microbiologist for resistant Gram-positive infections.
Patients must have weekly bloods taken to monitor for haematological side effects if receiving treatment for more than 10 to 14 days. In those receiving treatment for more than 4 weeks a pre-treatment eye assessment is recommended followed by monthly assessments. Patients should be warned to report any visual symptoms promptly (see BNF for CSM warning).
See Appendix 8 CDDFT antibiotic guidelines: Linezolid Information Leaflet which gives information for the prescriber and the patient on side effects and how the drug will be supplied and monitored when given to non admitted patients. A copy of the leaflet must be given to the patient on discharge from the hospital.
Linezolid is a MAO inhibitor and so potentially life threatening interactions can occur. Check before prescribing. MAOI interactions
600mg in 300ml IV infusion
Linezolid is a MAO inhibitor and so potentially life threatening interactions can occur. Check before prescribing. MAOI interactions
550mg tablets
Rifaximin (Targaxan): Hepatic Encephalopathy NICE TA337
200mg & 400mg injections
Drug protocol: teicoplanin loading dose (CDDFT intranet access only)
125mg capsules
500mg injection (when used orally)
When used orally each vial can be used for 24 hours after reconstitution (if stored in fridge)
Antibiotics should be prescribed according to the following local guidelines:
Management of infection guidance for primary care
CDDFT antibiotic formulary (accessible via CDDFT intranet only)
(Sulphamethoxazole 5 parts & trimethoprim 1 part)
480 mg tablets (plain or dispersible)
960mg tablets
240mg in 5ml & 480mg in 5ml suspensions
Reserved for the treatment of TB.
1g injection
Infectious diseases, microbiology or respiratory advice only
Only in patients with MDR-TB intolerant of other medication
250mg capsules
Infectious diseases, microbiology or respiratory advice only
50mg in 2ml injection
Unlicensed injection not routinely stocked at STHFT. If required contact pharmacy as soon as possible to prevent delay
250mg tablets - Unlicensed
Infectious diseases, microbiology or respiratory advice only
500mg tablets u
- licensed formulation discontinued, consider using Rifater where appropriate
500mg/5ml liquid
Rifinah 150 tablets – rifampicin 150mg + isoniazid 100mg
Rifinah 300 tablets – rifampicin 300mg + isoniazid 150mg
Antibiotics should be prescribed according to the following local guidelines:
Management of infection guidance for primary care
CDDFT antibiotic formulary (accessible via CDDFT intranet only)
200mg & 400mg tablets
200mg in 5ml suspension
500mg & 1g suppositories
Liquid should not be used to treat C. diff as sufficient absorption may not occur. In these patients tablets should be crushed
Quinolone antibiotics are associated with an increased risk of Clostridium difficile infection, only to be used if no alternative.
MHRA Drug Safety Update (Nov 2018): Systemic and inhaled fluoroquinolones: small increased risk of aortic aneurysm and dissection; advice for prescribing in high-risk patients
MHRA Drug Safety Update (Mar 2019): Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects
Antibiotics should be prescribed according to the following local guidelines:
Management of infection guidance for primary care
CDDFT antibiotic formulary (accessible via CDDFT intranet only)
400mg tablets
Infectious diseases or microbiology advice only
MDR-TB on respiratory advice
Antibiotics should be prescribed according to the following local guidelines:
Management of infection guidance for primary care
CDDFT antibiotic formulary (accessible via CDDFT intranet only)
1g Tablets
Should not generally be used because it requires an acidic urine for its antimicrobial activity and it is ineffective for upper urinary-tract infections; it may have role in in the prophylaxis and treatment of chronic or recurrent uncomplicated lower urinary-tract infections.
PHE recommend 3rd line only in recurrent UTI in non-pregnant women if no renal/hepatic impairment.
The County Durham and Tees Valley APC Do Not Prescribe List and Grey List can be accessed online at: https://medicines.necsu.nhs.uk/download/tees-prescribing-grey-list/
Antibiotics should be prescribed according to the following local guidelines:
CDDFT antibiotic formulary (accessible via CDDFT intranet only)
STHFT Antimicrobial Drug Formulary
NICE antimicrobial prescribing guidelines (link to NICE website)
50mg injection (Fungizone®)
50mg liposomal injection (Abelcet®)
MHRA Drug Safety Update (July 2018): Parenteral amphotericin B: reminder of risk of potentially fatal adverse reaction if formulations confused
MHRA Drug Safety Update (July 2020): Liposomal and lipid-complex formulations: name change to reduce medication errors
100mg injection
To be used on the advice of a Consultant Microbiologist only for resistant Candida infections.
50mg & 70mg injections
Only to be used on the advice of a Consultant Microbiologist.
Commissioner: NHS England
2.5 g/250 ml Solution for Infusion
Infectious diseases or microbiology advice only
See Letter Sent to Healthcare Professionals (March 2015) - Ketoconazole HRA: information about the risk of hepatotoxicity – sent by HRA Pharma on 24 March 2015
The County Durham and Tees Valley APC Do Not Prescribe List and Grey List can be accessed online at: https://medicines.necsu.nhs.uk/download/tees-prescribing-grey-list/
100mg tablets
40mg/ml oral suspension
300mg infusion
Infectious diseases or microbiology advice only
50mg & 200mg capsules
200mg vials for IV infusion
Voriconazole - MHRA Safety Alert (May 2014): reminder of liver toxicity, phototoxicity and squamous cell carcinoma
Only to be used on the advice of a Consultant Microbiologist.
Commissioner: NHS England
Antibiotics should be prescribed according to the following local guidelines:
CDDFT antibiotic formulary (accessible via CDDFT intranet only)
STHFT Antimicrobial Drug Formulary
NICE antimicrobial prescribing guidelines (link to NICE website)
MHRA Drug Safety Update (Dec 2015): Antiretroviral medicines: updated advice on body-fat changes and lactic acidosis
150mg & 300mg tablets (treatment of HIV)
50mg in 5ml oral solution (HIV)
150mg & 300mg tablets
For use in the treatment of patients with HIV infections that are resistant to standard therapy in accordance with British HIV Association and EACS guidelines
400mg tablets
For use in the treatment of patients with HIV infections that are resistant to standard therapy in accordance with British HIV Association and EACS guidelines.
Tablets containing efavirenz 600 mg, emtricitabine 200 mg
& tenofovir disoproxil (as fumarate) 245 mg
Each film-coated tablet contains bictegravir sodium equivalent to 50 mg of bictegravir, 200 mg of emtricitabine, and tenofovir alafenamide fumarate equivalent to 25 mg of tenofovir alafenamide.
Emtricitabine 200mg, and Tenofovir Alafenamide Fumarate 25mg film coated tablets
Emtricitabine 200mg, Rilpivirine 25mg and Tenofovir 245mg film coated tablets
Emtricitabine 200mg, Rilpivirine 25mg and Tenofovir Alafenamide Fumarate 25mg film coated tablets
Tablets containing Elvitegravir with Cobicistat, Emtricitabine and Tenofovir
Commissioner: NHS England - Policy - B06/PS/a
MHRA Drug Safety Update (Apr 2019): Elvitegravir boosted with cobicistat: avoid use in pregnancy due to risk of treatment failure and maternal-to-child transmission of HIV-1
Abacavir 600mg, Dolutegravir 50mg and Lamivudine 300mg film coated tablets
Tablets containing abacavir 300mg, lamivudine 150mg & zidovudine 300mg
Infectious diseases or microbiology advice only
Manufacturing supply problem with Vistide®unlicensed product can be obtained if required
Probenecid should also be prescribed when giving cidofovir infusions to reduce nephrotoxicity. See BNF for dosing. Probenecid is also an unlicensed product
24 mg/ml Solution for Infusion
Infectious diseases, microbiology, renal or Haematology advice onl
500 mg powder for concentrate for solution for infusion
Infectious diseases, microbiology, renal or Haematology advice only
450mg tablets
250mg in 5ml oral solution
Commissioner: NHS England
240 mg film-coated tablets
Approved for use in accordance with the following NICE TAs:
500 microgram & 1mg tablets
For use in treating Hepatitis B in accordance with NICE guidelines
Commissioner: NHS England - NICE TA153
100mg tablets
25mg in 5ml oral solution
For use in treating Hepatitis B in accordance with NICE guidelines
Commissioner: NHS England - NICE TA153
245mg tablets
For use in the treatment of chronic hepatitis B. Preferred treatment for many patients and may be used in combination with lamivudine NICE TA173
MHRA Drug Safety Update (Jan 2017): Direct-acting antivirals to treat chronic hepatitis C: risk of interaction with vitamin K antagonists and changes in INR
MHRA Drug Safety Update (Jan 2017): Direct-acting antiviral interferon-free regimens to treat chronic hepatitis C: risk of hepatitis B reactivation
MHRA Drug Safety Update (Dec 2018): Direct-acting antivirals for chronic hepatitis C: risk of hypoglycaemia in patients with diabetes
200mg capsules
Commissioner: NHS England - NICE TA253
MHRA Drug Safety Update (Nov’ 2014): baseline predictive factors for sepsis, worsening liver function, and mortality
Each film-coated tablet contains 50 mg elbasvir and 100 mg grazoprevir.
Commissioner: NHS England - NICE TA413
100mg/40mg tablets
Commissioner: NHS England - NICE TA499
400mg / 90mg film coated tablets
Commissioner: NHS England - NICE TA363
Commissioner: NHS England - NICE TA200
Used with pegylated interferon in the treatment of Hepatitis C NICE TA300
200mg tablets and capsules
Commissioner: NHS England - NICE TA75, NICE TA106, NICE TA200
Used with pegylated interferon in the treatment of Hepatitis C NICE TA300
NICE TA361 - Simeprevir in combination with sofosbuvir for treating genotype 1 or 4 chronic hepatitis C (terminated appraisal)
Epclusa(R) 400 mg/100 mg film-coated tablets
Commissioner: NHS England - NICE TA430
400mg/100mg/100mg film coated tablets
Commissioner: NHS England - NICE TA507
400mg film coated tablets
Commissioner: NHS England - NICE TA330
See MHRA Drug Safety Update (May 2015) - Sofosbuvir with daclatasvir; sofosbuvir and ledipasvir: risks of severe bradycardia and heart block when taken with amiodarone
See MHRA Drug Safety Update (Aug 2015) - Simeprevir with sofosbuvir: risk of severe bradycardia and heart block when taken with amiodarone
30mg, 45mg & 75mg capsules
6mg in 1ml (30mg in 5ml) oral suspension
Outside of flu season infectious diseases or microbiology advice only
Oral solution in under 1's only
Capsules can be opened and mixed with sugary liquid (to mask bitter taste)
PHE guidance on use of antiviral agents for the treatment and prophylaxis of influenza
5mg/blister dry powder for inhalation via Diskhaler®
For use if there is resistance to oseltamivir
Outside of flu season infectious diseases or microbiology advice only
PHE guidance on use of antiviral agents for the treatment and prophylaxis of influenza
Injection - Infectious Diseases and microbiology advice only - unlicensed product, supplied by GSK on a named patient basis. Individual cases to be discussed with GSK's medical team
6g in 300ml inhalation - for use on specialist microbiological advice
200mg tablets and capsules - approved for chronic hepatitis in line with NICE, see peginterferon alfa 2a/2b AND approved treatment for children and young people with chronic hepatitis C,
Remdesivir 100 mg concentrate for solution for infusion (each vial contains 100 mg of remdesivir, each mL of concentrate contains 5 mg of remdesivir).
Remdesivir 100 mg powder for concentrate for solution for infusion (each vial contains 100 mg of remdesivir, after reconstitution, each vial contains 5 mg/mL of remdesivir solution).
Unlicensed medicine - named patient use only
From 6 November an updated, an interim clinical commissioning policy has been put in place to define routine access to remdesivir in the treatment of COVID-19 across the UK.
Further information can be found in the attached alert; the interim clinical commissioning policy is also attached: https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103109
NICE ES27: COVID 19 rapid evidence summary: Remdesivir for treating hospitalised patients with suspected or confirmed COVID-19
Drugs for malaria prophylaxis are not prescribable on the NHS. Prescription only medicines for malaria prophylaxis should be prescribed privately. The GP may also make a charge for the consultation and supplying the prescription if they wish.
Some medicines for malaria prophylaxis are available for purchase over the counter at community pharmacies. Community pharmacies also have access to up to date advice regarding prophylactic regimes and can advise travellers accordingly.
The County Durham and Tees Valley APC Do Not Prescribe List and Grey List can be accessed online at: https://medicines.necsu.nhs.uk/download/tees-prescribing-grey-list/
200mg tablets (= 150mg chloroquine base)
68mg in 5ml syrup (= 50mg in 5ml chloroquine)
Tablets (100mg proguanil & 250mg atovaquone)
Paediatric tablets (proguanil 25mg & atovaquone 62.5mg)
Quinine sulphate 200mg tablets
MHRA Drug Safety Alert (Nov 2017): Quinine: reminder of dose-dependent QT-prolonging effects; updated medicine interactions
750mg in 5ml sugar-free suspension
Approved for use in patients intolerant of co-trimoxazole.
IV use should be on Infectious diseases, Microbiology, ITU or Haematology advice only
Sachets - containing piperazine phosphate 4g & sennosides 15.3mg/sachet
The County Durham and Tees Valley APC Do Not Prescribe List and Grey List can be accessed online at: https://medicines.necsu.nhs.uk/download/tees-prescribing-grey-list/
Unlicensed
Wuchereria bancrofti infections; brugia malayi infections; loa loa infections
Unlicensed Oral formulations - 3mg tablets
Chronic strongyloides infection; cutaneous larva migrans; scabies