| Formulary Chapter 5: Infections - Full Chapter
|
|
| Chapter Links... |
 NICE NG199: Clostridioides difficile infection: antimicrobial prescribing |
| NICE NG15: Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use |
| NICE NG79: Sinusitis (acute): antimicrobial prescribing |
| NICE NG79: Sinusitis (acute): antimicrobial prescribing (visual summary) |
 Summary of antimicrobial prescribing guidance - managing common infections |
| Details... |
| 05.01 |
Antibacterial drugs |
|
|
Aminosalicylic Acid
|
Formulary
|
Hospital use only under microbiological advice
|
|
|
Tedizolid (Oral and IV )
|
Formulary
|
|
|
|
Telavancin
(Injectable)
|
Formulary
|
|
|
|
Aminosalicylic Acid (Granupas 4 g gastro-resistant granules)
|
Formulary
|
Hospital use only under microbiological advice
|
|
|
| 05.01.01 |
Penicillins |
|
|
| 05.01.01.01 |
Benzylpenicillin and phenoxymethylpenicillin |
|
|
Benzylpenicillin Benzathine
|
Formulary
|
For use by GUM & STD services only
|
|
|
Benzylpenicillin Sodium
|
Formulary
|
 Injectable for suspected Meningitis in Primary Care
 In secondary care for related indications
|
UKMI Q&A: How do you treat syphilis with parenteral benylpenicillin?
|
Phenoxymethylpenicillin
(Oral presentations)
|
Formulary
|
|
Summary of antimicrobial prescribing guidance - managing common infections
|
Procaine Penicillin G
(Injection)
|
Formulary
|
for hospital use only as advised by GUM
|
|
|
| 05.01.01.02 |
Penicillinase-resistant penicillins |
|
|
Flucloxacillin
(Oral presentations)
|
Formulary
|
|
Summary of antimicrobial prescribing guidance – managing common infections
|
Flucloxacillin
(Injection)
|
Formulary
|
|
|
|
Temocillin
(injection)
|
Formulary
|
|
|
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Temocillin (Negaban®)
|
Formulary
|
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|
|
| 05.01.01.03 |
Broad-spectrum penicillins |
|
|
Amoxicillin
(Injection)
|
Formulary
|
|
|
|
Amoxicillin
(Oral presentations)
|
Formulary
|
|
|
|
Co-amoxiclav
(Oral presentations)
|
Formulary
|
|
Summary of antimicrobial prescribing guidance - managing common infections
|
Co-amoxiclav
(Injection)
|
Formulary
|
|
|
|
| 05.01.01.04 |
Antipseudomonal penicillins |
|
|
Piperacillin and Tazobactam
(injection)
|
Formulary
|
For hospital use only
|
|
|
| 05.01.01.05 |
Mecillinams |
|
|
Pivmecillinam Hydrochloride
(Oral presentations)
|
Formulary
|
|
Summary of antimicrobial prescribing guidance – managing common infections
Urinary tract infection information leaflet
|
| 05.01.02 |
Cephalosporins, carbapenems and other beta-lactums |
|
|
| 05.01.02 |
Other beta-lactam antibiotics |
|
|
| 05.01.02.01 |
Cephalosporins |
|
|
Cefalexin
(Oral presentations)
|
Formulary
|
|
Summary of antimicrobial prescribing guidance - managing common infections
|
Cefotaxime
(Injection)
|
Formulary
|
Hospital use only under microbiological advice
|
|
|
Cefazolin
|
Formulary
|
Hospital use only under microbiological advice
|
|
|
Cefepime
|
Formulary
|
Hospital use only under microbiological advice
|
|
|
Cefiderocol (Fetcroja®)
|
Formulary
|
Hospital use only under microbiological advice. Blueteq applications required
|
|
|
Cefixime (Suprax®)
|
Formulary
|
Hospital use only under microbiological advice
|
|
|
Ceftazidime
|
Formulary
|
Hospital use only under microbiological advice
Under OPAT sheme
|
|
|
Ceftazidime with avibactam
|
Formulary
|
Hospital use only under microbiological advice
|
|
|
Ceftobiprole (Zevtera®)
|
Formulary
|
Hospital use only under microbiological advice
|
|
|
Ceftolozane with tazobactam
|
Formulary
|
Hospital use only under microbiological advice
|
|
|
Ceftriaxone
|
 Restricted
|
Injectable - Green under OPAT scheme in Primary Care
Secondary care - for specific indications
|
|
|
Cefuroxime (Oral and IV )
|
Formulary
|
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|
|
| 05.01.02.02 |
Carbapenems |
|
|
|
Ertapenem
(injection)
|
Formulary
|
Amber Rec under OPAT Scheme in Primary care
Hospital use under microbiological advice
|
|
|
Imipenem with Cilastatin
(Infusion)
|
Formulary
|
For hospital use only
|
|
|
Imipenem with Cilastatin (Primaxin®)
(Infusion)
|
Formulary
|
For hospital use only
|
|
|
Imipenem with cilastatin and relebactam (Recarbrio®)
|
Formulary
|
|
|
|
Meropenem
(injection)
|
Formulary
|
Primary care-Amber Rec under agreed OPAT Pathway
Secondary care-Microbiological advice
|
|
|
Meropenem with vaborbactam (Vaborem® )
(IV)
|
Formulary
|
|
|
|
| 05.01.02.03 |
Other beta-lactums antibiotics |
|
|
Aztreonam
|
Formulary
|
Hospital use only under microbiological advice
|
|
|
| 05.01.03 |
Tetracyclines |
|
|
Demeclocycline
(Capsules)
|
Formulary
|
For Antimicrobial use by Microbiologist and Hyponatraemia indications
|
|
|
Doxycycline
(Oral presentation)
|
Formulary
|
|
Summary of antimicrobial prescribing guidance – managing common infections
|
Lymecycline (oral presentations)
|
Formulary
|
|
Summary of antimicrobial prescribing guidance - managing common infections
|
Oxytetracycline (oral)
|
Formulary
|
Recommended by Dermatologist
|
|
|
Tetracycline
|
Formulary
|
Specialist Advice for H. pylori relapse only
|
Summary of antimicrobial prescribing guidance – managing common infections
|
| 05.01.03 |
Tigecycline |
|
|
Tigecycline
(Injection)
|
Formulary
|
|
|
|
| 05.01.04 |
Aminoglycosides |
|
|
Amikacin
(injection)
|
Formulary
|
Hospital use only under microbiological advice
|
|
|
Amikacin (Amikin®)
|
Formulary
|
Hospital use only under microbiological advice
|
|
|
Gentamicin
(injectable and IV)
|
Formulary
|
For hospital use only
|
|
|
|
Tobramycin (Munuza ®
|
Formulary
|
|
|
|
Tobramycin (Tymbrineb ® )
(Nebuliser)
|
Formulary
|
|
|
|
Tobramycin (Vantobra ® )
(Nebuliser)
|
Formulary
|
|
|
|
Tobramycin
(injection)
|
Formulary
|
|
|
|
Tobramycin (TOBI Podhaler®)
(Nebuliser solution)
|
Formulary
|
For specialist prescribing only
|
NICE TA276: Cystic fibrosis (pseudomonas lung infection) - colistimethate sodium and tobramycin (TA276)
|
Tobramycin (Bramitob®)
(Nebuliser)
|
Formulary
|
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|
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Septopal
(30 bead chain)
|
Formulary
|
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|
|
| 05.01.05 |
Macrolides |
|
|
Azithromycin (Azyter®)
(15mg/g )
|
Formulary
|
|
|
|
Azithromycin
|
Formulary
|
Tablets/ suspension -For Sexual Health (GUM Clinics) in Primary care only
 IV-For Respiratory Indications
|
Summary of antimicrobial Prescribing guidance-managing common infections
|
Clarithromycin
(injection)
|
Formulary
|
|
|
|
Clarithromycin
(Oral presentations)
|
Formulary
|
|
Summary of antimicrobial prescribing guidance - managing common infections
|
Erythromycin
(tablets)
|
Formulary
|
|
Meds Q&A: Is there an interaction between erythromycin and statins?
Summary of antimicrobial prescribing guidance – managing common infections
|
Erythromycin ethyl succinate
(Oral suspension)
|
Formulary
|
|
Summary of antimicrobial prescribing guidance – managing common infections
|
Erythromycin lactobionate
(injection)
|
Formulary
|
|
|
|
| 05.01.06 |
Clindamycin |
|
|
Clindamycin
(Capsules)
|
Formulary
|
Use 150mg capsules
 300mg capsules are Non-formulary
|
|
|
Clindamycin (300mg/2ml)
(Injection)
|
Formulary
|
|
|
|
| 05.01.07 |
Some other antibacterials |
|
|
Nitazoxanide (Alinia®)
(Oral powder for reconstitution to suspension, Tablet)
|
Restricted
|
For Hospital Use Only
|
|
|
Bedaquiline
|
Formulary
|
Hospital use only under microbiological and Tuberculosis specialist advice
|
|
|
Dalbavancin
|
Restricted
|
Hospital use only under microbiological advice
|
|
|
| 05.01.07 |
Chloramphenicol |
|
|
Chloramphenicol
(Oral and injection)
|
Formulary
|
For specialist use only
|
|
|
| 05.01.07 |
Fosfomycin |
|
|
| 05.01.07 |
Fusidic acid |
|
|
Fusidic acid
(Tablet, oral suspension)
|
Formulary
|
|
|
|
Sodium fusidate
(IV Infusion)
|
Formulary
|
|
|
|
Sodium fusidate
(Tablets)
|
Formulary
|
|
|
|
| 05.01.07 |
Vancomycin and teicoplanin |
|
|
Teicoplanin
(Oral ,IV and injection)
|
Formulary
|
For hospital use only
|
|
|
Vancomycin
(Capsules)
|
Formulary
|
|
|
|
Vancomycin
(Injection)
|
Formulary
|
|
|
|
| 05.01.07 |
Daptomycin |
|
|
Daptomycin
(injection)
|
Formulary
|
Hospital use only under microbiological advice
|
|
|
| 05.01.07 |
Linezolid |
|
|
Linezolid
(Oral formulations)
|
Formulary
|
For hospital use only
|
|
|
Linezolid
(infusion)
|
Formulary
|
For hospital use only
|
|
|
| 05.01.07 |
Quinupristin and dalfopristin |
|
|
| 05.01.07 |
Polymyxins |
|
|
Colistimethate
(Injection)
|
Formulary
|
Hospital use only under microbiological advice
|
|
|
Colistimethate (Promixin®)
|
Formulary
|
|
|
|
Colistimethate for nebulisation
|
Formulary
|
|
|
|
Colistimethate for nebulisation (Colomycin®)
|
Formulary
|
|
|
|
Colistimethate inhaler (Colobreathe®)
|
Formulary
|
|
|
|
| 05.01.07 |
Rifaximin |
|
|
Rifaximin (oral presentations)
|
Formulary
|
|
NICE TA 337 :Rifaximin for preventing episodes of overt hepatic encephalopathy
|
| 05.01.07 |
Fidaxomicin |
|
|
Fidaxomicin
(Tablets)
|
Formulary
|
On Microbiological advice only
|
|
|
| 05.01.08 |
Sulphonamides and trimethoprim |
|
|
Co-trimoxazole
(Oral presentations)
|
Formulary
|
|
Summary of antimicrobial prescribing guidance - managing common infections
|
Co-trimoxazole
(IV Infusion)
|
Formulary
|
|
|
|
Trimethoprim
(IV)
|
Formulary
|
|
|
|
Trimethoprim
(Oral presentations)
|
Formulary
|
|
Summary of antimicrobial prescribing guidance – managing common infections
Urinary tract infection information leaflet
|
| 05.01.09 |
Antituberculosis drugs |
|
|
Rifampicin (Rimactane®)
|
Formulary
|
Hospital use only under microbiological and Tuberculosis specialist advice
|
|
|
Capreomycin
|
Formulary
|
Hospital use only under Microbiological/Tuberculosis advice only
|
NICE NG33: Tuberculosis
|
Cycloserine
|
Formulary
|
Hospital use only under microbiological and Tuberculosis specialist advice
|
|
|
Delamanid (Deltyba ®)
|
Formulary
|
Hospital use only under microbiological and Tuberculosis specialist advice
|
|
|
Ethambutol
|
Formulary
|
Hospital use only under microbiological and Tuberculosis specialist advice
Ethambutol liquid 400mg in 5ml (unlicensed)
|
|
|
Isoniazid
(Oral ,IV and injection)
|
Formulary
|
Hospital use only under microbiological and Tuberculosis specialist advice
|
|
|
Prothionamide
|
Formulary
|
Hospital use only under microbiological and Tuberculosis specialist advice
|
|
|
Pyrazinamide
|
Formulary
|
Pyrazinamide liquid 500mg in 5ml (unlicensed)
Hospital use only under microbiological and Tuberculosis specialist advice
|
|
|
Rifabutin
|
Formulary
|
Hospital use only under microbiological and Tuberculosis specialist advice
|
|
|
Rifampicin
(Oral presentations)
|
Formulary
|
Hospital use only under microbiological and Tuberculosis specialist advice
|
|
|
Rifampicin
(infusion)
|
Formulary
|
|
|
|
Rifampicin and Isoniazid (Rifinah® 300)
(tablets)
|
Formulary
|
Hospital use only under microbiological and Tuberculosis specialist advice
|
|
|
Rifampicin and Isoniazid (Rifinah® 150)
(tablets)
|
Formulary
|
Hospital use only under microbiological and Tuberculosis specialist advice
|
|
|
Rifampicin and Isoniazid and Pyrazinamide (Rifater®)
(tablets)
|
Formulary
|
Hospital use only under microbiological and Tuberculosis specialist advice
|
|
|
Rifampicin, isoniazid, pyrazinamide and ethambutol (Voractiv®)
(Tablets)
|
Formulary
|
Hospital use only under microbiological and Tuberculosis specialist advice
|
|
|
Streptomycin Sulphate
|
Formulary
|
|
|
|
Isoniazid
(solution SF)
|
 Unlicensed
|
Unlicensed special.
|
|
|
|
|
| 05.01.10 |
Antileprotic drugs |
|
|
Clofazimine
|
Formulary
|
Hospital use only under microbiological and Tuberculosis specialist advice
|
|
|
Dapsone
|
Formulary
|
Hospital use only under microbiological advice
|
|
|
Thalidomide (oral presentations)
|
Formulary
|
|
|
|
| 05.01.11 |
Metronidazole and tinidazole |
|
|
Metronidazole
|
Formulary
|
Tablets
Suspension £££££
|
Summary of antimicrobial prescribing guidance – managing common infections
UKMI Q&A: Metronidazole - is it safe to use with breastfeeding?
|
Metronidazole
(infusion)
|
Formulary
|
|
|
|
Metronidazole
(suppositories)
|
Formulary
|
|
|
|
| 05.01.12 |
Quinolones |
|
|
Ciprofloxacin
(Oral presentations, ear drops, eye drops and eye ointment)
|
Formulary
|
|
Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects
|
Ciprofloxacin
(Infusion)
|
Formulary
|
|
Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects
|
Levofloxacin
(Infusion)
|
Formulary
|
|
Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects
|
Levofloxacin
(Tablets)
|
Formulary
|
- For multi resistant organisms, based on Microbiological sensitivity
|
Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects
|
Moxifloxacin
(Oral,IV)
|
Formulary
|
Hospital use only under microbiological advice
|
Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects
|
Norfloxacin
(Tablets)
|
Formulary
|
Hospital use only under microbiological advice
|
Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects
|
Ofloxacin
(Oral,IV)
|
Formulary
|
Hospital use only under microbiological advice /GUM
|
Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects
|
| 05.01.13 |
Urinary-tract infections |
|
|
Fosfomycin
(Sachets, Capsules)
|
Formulary
|
Second line treatment for sensitivities
|
NICE CG97: Lower urinary tract symptoms in men: management
Summary of antimicrobial prescribing guidance – managing common infections
NICE CG54: Urinary tract infection in under 16s: diagnosis and management
|
Fosfomycin Injection
|
Formulary
|
Hospital use only under microbiological advice
|
|
|
Methenamine hippurate
(Tablets)
|
Formulary
|
- On Microbiology/Urology advice
- Prescribing to be retained by Secondary care
|
|
|
Nitrofurantoin
(Tablets, MR Capsules,suspension)
|
Formulary
|
Modified release capsules preferred formulation-First line
Oral Suspension £££££
|
Nitrofurantoin now contraindicated in most patients with an estimated glomerular filtration rate (eGFR) of less than 45 ml/min/1.73m2
Summary of antimicrobial prescribing guidance – managing common infections
Urinary tract infection information leaflet
|
Trimethoprim
(Tablets)
|
Formulary
|
Second choice in UTI
|
Summary of antimicrobial prescribing guidance – managing common infections (January 2022)
Urinary tract infection information leaflet
|
|
|
|
|
|
|
| .... |
| Non Formulary Items |
Amikacin (Arikayce liposomal 590mg nebuliser dispersion)
|
Non Formulary
|
|
|
|
Ampicillin
|
Non Formulary
|
|
|
|
Ampicillin
|
Non Formulary
|
|
|
|
Azithromycin (Zedbac)
|
Non Formulary
|
|
|
|
Azithromycin (Zithromax)
|
Non Formulary
|
|
|
|
Aztreonam nebuliser solution (Cayston®)
|
Non Formulary
|
|
|
|
Cefaclor
|
Non Formulary
|
|
|
|
Cefaclor (Distaclor®)
|
Non Formulary
|
|
|
|
Cefaclor (Distaclor® MR)
|
Non Formulary
|
|
|
|
Cefadroxil
|
Non Formulary
|
|
|
|
Cefoxitin
|
Non Formulary
|
|
|
|
Cefoxitin (Renoxitin®)
|
Non Formulary
|
|
|
|
Cefpodoxime
|
Non Formulary
|
|
|
|
Cefradine
|
Non Formulary
|
|
|
|
Ceftaroline (Zinforo®)
|
Non Formulary
|
|
|
|
Cefuroxime Axetil
|
Non Formulary
|
|
|
|
Ciprofloxacin (Ciproxin®)
|
Non Formulary
|
|
|
|
Clarithromycin (Klaricid®)
|
Non Formulary
|
|
|
|
Clarithromycin (Klaricid® XL)
|
Non Formulary
|
|
|
|
Clarithromycin (Xetinin XL®)
|
Non Formulary
|
|
|
|
Clindamycin (Dalacin C®)
|
Non Formulary
|
|
|
|
Clindamycin 300mg Capsules
|
Non Formulary
|
|
|
|
Co-Amoxiclav (Augmentin®)
|
Non Formulary
|
|
|
|
Co-Amoxiclav (Augmentin-Duo®)
|
Non Formulary
|
|
|
|
Co-Fluampicil
|
Non Formulary
|
|
|
|
Collatamp EG Sponge
|
Non Formulary
|
|
|
|
Daptomycin (Cubicin®)
|
Non Formulary
|
|
|
|
Delafloxacin (Quofenix®)
|
Non Formulary
|
|
|
|
Ertapenem (Invanz®)
(injection)
|
Non Formulary
|
|
|
|
Erythromycin (Erythrocin®)
|
Non Formulary
|
|
|
|
Erythromycin (Erythroped®)
|
Non Formulary
|
|
|
|
Fidaxomicin (Dificlir®)
|
Non Formulary
|
|
|
|
Fosfomycin (Fomicyt ®)
|
Non Formulary
|
|
|
|
Fosfomycin 3g granules sachets (Alexi ®)
|
Non Formulary
|
|
|
|
Fosfomycin 3g granules sachets (Monuril ®)
|
Non Formulary
|
|
|
|
Levofloxacin 240mg nebuliser solution ampoules (Quinsair®)
|
Non Formulary
|
|
|
|
Linezolid (Zyvox®)
|
Non Formulary
|
|
|
|
Lymecycline (Tetralysal 300 capsules®)
|
Non Formulary
|
|
|
|
Minocycline
|
Non Formulary
|
|
|
|
Minocycline (Acnamino® MR)
|
Non Formulary
|
|
|
|
Minocycline (Minocin® MR)
|
Non Formulary
|
|
|
|
Neomycin sulphate
(tablets)
|
Non Formulary
|
For hospital use only or advice from Specialist/Microbiologist |
|
|
Nitrofurantoin (Macrobid®)
|
Non Formulary
|
|
|
|
Oritavancin
|
Non Formulary
|
|
|
|
Pivmecillinam (Selexid®)
|
Non Formulary
|
|
|
|
Quinupristin and dalfopristin (Synercid®)
(injection)
|
Non Formulary
|
|
|
|
Telithromycin (Ketek®)
|
Non Formulary
|
|
|
|
Tinidazole (Fasigyn®)
|
Non Formulary
|
|
|
|
| |
Key |
|
Restricted Drug |
|
Unlicensed |
|
|
Link to adult BNF
|
|
|
Link to children's BNF
|
|
|
Link to SPCs
|
|
Cytotoxic Drug |
|
Controlled Drug |
|
|
High Cost Medicine |
|
Cancer Drugs Fund |
|
NHS England |
|
Homecare |
|
ICB |
|
Low carbon footprint |
|
Medium carbon footprint |
|
High carbon footprint |
|
| Status |
Description |
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All Settings
Suitable for initiation, ongoing prescribing, and discontinuation in both primary and secondary care settings. They are generally familiar, frequently used therapies that can be started within their licensed indications without specialist oversight. |
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Specialist only
Designated for initiation, ongoing prescribing, monitoring, exclusively by a specialists either in a hospital or as part of a specialist service (to note this could be in a non-hospital setting). Primary care should neither start nor continue these treatments except as part of a specialist service. A specialist could be either a medical or non-medical prescriber. |
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Specialist advice
Prescribers in primary care should seek advice and a recommendation from a specialists prior to initiating a medicine. Once agreed with a specialist, medicines can be initiated, prescribed and monitored in primary care without a formal shared-care agreement. |
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Specialist initiation
Medicines in this category require a specialist to start therapy, titrate dosage, and assess initial efficacy or tolerability. Once stabilised, prescribing responsibility may transfer to primary care without the need for a formal shared-care agreement. |
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Shared care agreement
Prescribing responsibility can be shared across health settings and between specialists and GPs only when formal shared care arrangement has been made. For example, there may be extensive and complex monitoring requirements or significant safety concerns (note would need a national policy on this to define the criteria for requiring a formal SCA), this will be produced once nationally. |
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Do not prescribe
Not approved for routine prescribing in primary or secondary care. For example, because they are agents classified in the BNF as “not NHS” or “Drugs of Low Clinical Value”, or they are products on NICE’s “do not do” list or NHS England’s “should not routinely prescribe” list. |
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Self Care
Not for routine prescribed in primary or secondary care unless as part of care for a long term condition. Instead, patients should be encouraged to self care with support from community pharmacy. |
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Medicines which are suitable for initiation and maintenance prescribing by primary and secondary care clinicians. These medicines should be initiated and prescribed within their licensed indications |
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Amber Specialist Initiation: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate. This may be supported by a RICaD, annotated within the formulary entry. |
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Amber Shared Care: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing, in accordance with an ESCA, annotated within the formulary entry. |
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Amber Specialist Recommendation: Initiation and maintenance of prescribing in Primary Care following recommendation from a specialist. |
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Medicines for initiation and maintenance prescribing by Specialists (hospital or GPs with Special Interest) only |
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Positive NICE TA and /or awaiting local clarification on place in therapy; Please contact your Medicines Optimisation team for more information. |
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Non-formulary Medicines which APC/Trust DTC has actively reviewed and do not recommend for use. |
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