Skip links and keyboard navigation

Antimicrobial restrictions

Formulary of commonly used antimicrobials - General use

Unrestricted

Unrestricted

 
  • Aciclovir (PO/cold sore cream)
    • Valaciclovir is the preferred oral option
  • Amoxicillin (IV/PO)
  • Amoxicillin/Clavulanate
  • Amphotericin B Lozenges
  • Ampicillin (IV)
  • Benzathine Penicillin (IM)
  • Benzylpenicillin (Penicillin G)
  • Cefalexin (Cephalexin)
  • Cefazolin (Cephazolin)
  • Chloramphenicol (Ear/Eye Drops)
  • Clotrimazole (PV)
    • Miconazole Cream is the Preferred Topical Agent
  • Dicloxacillin (PO)
    • Flucloxacillin is the Preferred IV Agent
  • Doxycycline (PO)
  • Flucloxacillin (IV)
    • Dicloxacillin is the Preferred Oral Agent
  • Metronidazole
  • Miconazole Cream
  • Neomycin (PO)
  • Nitrofurantoin
  • Nystatin (Topical)
  • Phenoxymethylpenicillin (Penicillin V)
  • Procaine Penicillin (IM)
  • Roxithromycin
  • Trimethoprim
  • Trimethoprim/Sulfamethoxazole (PO)
  • Valaciclovir

Restricted

Restricted

 
  • Aciclovir (IV)
    • Herpes simplex encephalitis (approval required after 24 hours)
    • Complicated varicella or zoster
  • Azithromycin (PO)
    • Pelvic Inflammatory Disease
    • Chlamydia trachomatis infections
    • Treatment or prophylaxis of pertussis in children and infants
    • Treatment of laboratory proven pertussis in adults
    • Prophylaxis of pertussis in susceptible contacts on the advice of a Public Health Physician [NOT available for follow-on therapy in severe CAP (if required use roxithromycin or doxycycline)]
  • Azithromycin (IV)
    • Severe CAP (3 days)
    • Severe Pelvic Inflammatory Disease
  • Ceftriaxone
    • Empiric therapy for suspected or proven Bacterial Meningitis
    • Acute Epiglottitis
    • Moderate to severe CAP/HAP in patients with non-immediate type penicillin hypersensitivity
    • Spontaneous Bacterial Peritonitis in patients with ascites
    • Acute pyelonephritis where there are contra-indications to the use of gentamicin (as listed in the eTG)
    • Neisseria gonorrhoeae infections and Severe Pelvic Inflammatory Disease
    • Intra-abdominal infections in patients with non-immediate type penicillin allergy (in combination with metronidazole)
  • Cefuroxime
    • Treatment of LRTI in patients with non-immediate type penicillin hypersensitivity
  • Clarithromycin
    • As a component of combination therapy for eradication of Helicobacter pylori
  • Clindamycin (PO)
    • In accordance with the Metro South Health Cellulitis Pathway
    • Diabetic Foot Infections in patients with immediate type penicillin hypersensitivity (in combination with other agents)
    • Severe furunculosis as per the prescribing guideline
    • Community-acquired aspiration pneumonia in patients with penicillin hypersensitivity
    • Periodontal abscess in patients with penicillin hypersensitivity
    • Open fractures (in combination with other agents) as per the prescribing guideline.
      Note: Lincomycin is the only IV Lincosamide available
  • Erythromycin
    • PROM in accordance with O&G guideline
    • Prokinetic agent in ileus/pseudo-obstruction
  • Gentamicin
    • Maximum of 48 hours Empirical Therapy
  • Lincomycin (IV)
    • In accordance with the Metro South Health Cellulitis Pathway (PDF, 188.48 KB)
    • Diabetic Foot Infections in patients with immediate type penicillin hypersensitivity (in combination with other agents)
    • Community-acquired aspiration pneumonia in patients with immediate type penicillin hypersensitivity
    • In combination with appropriate agents for necrotising Skin & Soft Tissue Infections or Toxic Shock Syndrome
    • Intrapartum prophylaxis for group B streptococcus in patients with immediate type penicillin hypersensitivity
    • Open fractures (in combination with other agents) as per the prescribing guideline
  • Moxifloxacin (PO & IV)
    • PO for Treatment of mild to moderate CAP in patients with immediate type penicillin hypersensitivity
    • IV for Treatment of severe CAP in patients with immediate type penicillin hypersensitivity or as above in patients who cannot swallow
  • Mupirocin (nasal/topical)
    • Decolonisation of S. aureus (including MRSA) in dialysis patients in accordance with renal unit guidelines
    • For impetigo as directed in the eTG
  • Oseltamivir
    • For initiation by ED, ICU or Respiratory staff for suspected or proven influenza pneumonia
  • Piperacillin/Tazobactam (IV)
    • Moderate to severe HAP
    • In accordance with the PAH Febrile Neutropenia Protocol
    • Severe Diabetic Foot Infections
    • Infected Human or Animal Bite Wounds
    • Intra-abdominal Infections when switching from a Gentamicin based regimen after 48 Hours (if IV antibiotics still required)
    • Hospital-acquired sepsis – unknown source
    • Open fractures as per recommendations in the prescribing guideline
    • Spontaneous bacterial peritonitis in patients with ascites as per the recommendations in the prescribing guideline
    • For use as Surgical Prophylaxis in Accordance with Unit Protocols
  • Teicoplanin (IV)
    • For Use as Surgical Prophylaxis in Accordance with Unit Protocols
  • Vancomycin (IV)
    • Empiric therapy for severe community-acquired sepsis
    • Empiric therapy for severe nosocomial sepsis in patients with IV lines and/or known to be colonised with MRSA
    • Empiric therapy for surgical site infections in patients known to be colonised with MRSA
    • Treatment of suspected or proven pneumococcal meningitis
    • Empiric therapy in combination with Meropenem for post-neurosurgical CNS infections
    • Haemodialysis patients with presumed sepsis as per prescribing guideline
    • Peritonitis in a CAPD patient as per prescribing guideline
    • In accordance with the Metro South Health Cellulitis Pathway (PDF, 188.48 KB)

ID approval required

ID approval required

 
  • All intravenous antimicrobials where duration exceeds seven days
  • Amikacin
  • Amphotericin B (IV)
  • Caspofungin
  • Ceftazidime
  • Cefoxitin
  • Ciprofloxacin (PO & IV)
  • Ertapenem
  • Fluconazole (PO & IV)
  • Home IV Antimicrobial Therapy
    • ASIS - All patients must be approved by Infectious Diseases
    • HITH - Unless following the cellulitis pathway, patients must be approved by Infectious Diseases
  • Linezolid (PO & IV)
  • Meropenem
  • Norfloxacin
  • Rifampicin (PO & IV)
  • Ticarcillin-clavulanate
  • Tobramycin (IV & NEB)
  • Trimethoprim/Sulfamethoxazole (IV)
  • Vancomycin (PO)
  • Voriconazole (PO & IV and eye drops)

Document the antimicrobial plan

Document the antimicrobial plan on the medication chart as per this example:

Antimicrobial Restriction Chart Example

Annotate the medication chart should with the following information:

  • The Indication for Antimicrobial Therapy
  • The Intended Duration or Review Date for Antimicrobial Therapy
  • The Name of the Approving ID Physician or Microbiologist (If Authorisation is Required)
  • The chart should be Numbered with the Days of Therapy to assist with review.

Use of the Metro South antimicrobial restrictions

Note: For prescribing in children, please refer to the Lady Cilento Children's Hospital (LCCH) antimicrobial formulary.

For other antimicrobials, see the complete antimicrobial formulary (XLS, 71.5 KB) spreadsheet.

The Metro South Health antimicrobial formulary is divided into three levels of access:

  1. Unrestricted - Antimicrobials are “free” to use for clinically appropriate indications by all prescribers.
  2. Restricted - Antimicrobials may only be prescribed for certain indications (listed) under the direction of a consultant. For other indications – see below.
  3. Approval required - Antimicrobials may only be prescribed following authorisation by Infectious Diseases or Clinical Microbiology. The indication and name of the authorising clinician must be annotated on the medication chart.

Use of a restricted antimicrobial in Metro South can be authorised by the clinicians listed below. Your usual point of contact with the Infectious Diseases Unit should be consulted in the first instance (e.g. ID registrar consulting to your unit).

All other antimicrobials not listed require approval before use unless specific arrangements have been made with your department. Contact Infectious Diseases or check the complete antimicrobial formulary (XLS, 71.5 KB). Consult your ward or unit Clinical Pharmacist for further assistance with this policy or email Antibiotics_PAH@health.qld.gov.au.

Units are encouraged to develop protocols in consultation with Infectious Diseases when a restricted agent needs to be prescribed on a regular basis.

Authorisers

Authorising Infectious Diseases Physicians and Microbiologists:

  • Dr Evan Bursle
  • Dr Patrick Harris
  • Dr Andrew Henderson
  • Dr David Looke
  • Dr Wendy Munckhof
  • Dr Geoffrey Playford
  • Dr Naomi Runnegar
  • Dr Marjoree Sehu
  • Dr David Siebert
  • Infectious Diseases Advanced Trainees
  • Clinical Microbiologist

Further information

Last updated 8 March 2017
Last reviewed 16 November 2015

Page feedback

Contact (optional)

Please provide your phone number or email address if you are happy for us to contact you with any follow-up questions.