5. Infections

This section of the Formulary is a general guide to treatment of infection in adults. Separate antimicrobial policies are available for paediatrics, SCBU, genitourinary medicine and the emergency department.

The antibacterial, antifungal and antiviral drugs included in this section are divided into two groups.

  1. Formulary list

These drugs may be prescribed by all doctors within the hospital.

Marked F.

  1. Restricted list

These drugs may only be prescribed on the advice of a microbiologist (Dr Isalska ext 2892, Dr Stanbridge ext 2884).

Marked R.

General principles of antibiotic therapy

  1. All antibacterial, antifungal and antiviral treatment should be given a review date.

  2. Intravenous therapy should be reviewed at 48 hours and if the patient's condition warrants it, consideration should be given to switching to oral therapy.

  3. The duration of antibiotic courses prescribed on discharge should be calculated in the light of previous antibiotic therapy administered on the ward.

  4. Always take appropriate cultures before starting therapy, but do not delay appropriate meningitis therapy.

  5. Always enquire about previous drug reactions and allergies, and consider the patient's renal and hepatic function before prescribing.

Hospital costs of Antimicrobial Agents (as at June 2003)

These are confidential and should not be shown to non-Trust Personnel

Antibiotic

Frequency

Dose

Cost per unit (IV)

Cost per unit (oral)

Amoxicillin

TDS

250mg
500mg

29p
45p

2.1p
3.7p

Aztreonam

QDS

1g

£7.62

  

Benzylpenicillin

QDS

600mg

43p

  

Cefotaxime

TDS

1g

£2.41

  

Ceftazidime

TDS

1g
2

£4.37
£8.74

  
         
         

 

Ceftazidime	TDS	1g

2g	£4.37

£8.74	-

-

Ceftriaxone	OD	1g	£9.40

£18.80	-

-

Cefuroxime	TDS	750mg	0.14p	-

Cefalexin	BD 	500mg	-	11p

Ciprofloxacin	BD	200mg

400mg

250mg	£19.49

£29.48

-	-

-

65p

Clarithromycin	BD	250mg

500mg	-

£10.29	82p

-

Co-Amoxiclav	TDS	1.2g

250/125	£2.52

-	-

32p

Doxycycline	OD	100mg	-	5.3p

Erymax	BD	250mg	-	27p

Erythromycin	QDS	250mg	-	7p

Flucloxacillin	QDS	250mg

500mg	-

 44p	3.7p

6.3p

Gentamicin	OD	5mg/kg	£1.80	-

Imipenem	TDS/QDS	500mg	£7.28	-

Linezolid	BD	600mg	£39.36	£39.36

Meropenem	TDS	1g	£20.20	-

Metronidazole	TDS	500mg

 200mg	70p

-	-

0.8p

Nitrofurantoin	QDS	50mg	-	4.7p

Piperacillin/Tazobactam	QDS	4.5g	£11.60	-

Rifampicin	BD/QDS	600mg	£8.22	19p

Sodium Fusidate	TDS	250mg	-	66.5p

Teicoplanin	OD	200mg

400mg	£18.21

£36.42	-

-

Tobramycin	TDS	80mg	£2.50	-

Trimethoprim	BD	200mg	-	3.6p

Vancomycin	QDS

BD/QDS	125mg

500mg	-

£3.64	£1.98

-

 

Antifungal	Frequency	Dose	Cost per unit

Fluconazole oral	OD	50-100mg	19p - 38p

Fluconazole IV	OD	200-400mg	£21.09 - £42.18

Itraconazole oral	OD/BD	200mg	£21.56

Amphotericin B IV	

  Fungizone	OD	0.25-1mg/kg/day	£3.80 - £7.60

  Abelcet	OD	5mg/kg/day	£96.50

  Ambisome	OD	1-3mg/kg/day	£233.04 - £582.60

Voriconazole oral	BD	200-300mg	£33.46 - £50.20

Voriconazole IV	BD	6mg/kg (2 doses)

4mg/kg (maintenance)	£237.93

£158.62

Caspofungin IV	OD	50mg	£352.04

5-Flucytosine IV	QDS	50mg/kg	£37.46