Protected Antimicrobials
Approval process for use of anti-infective with formulary use criteria:
- All orders for non-formulary and protected anti-infectives must be reviewed and approved by an infectious diseases service (or other service as outlined below) unless use criteria are met. The ordering physician is responsible for contacting an approving service.
- If an order is received by pharmacy and it is not clear that use criteria are met or approval has been gained, the pharmacist will enter the order to remain active for 24 hours (exception, CMV-IG – see table below) and contact the ordering team to request they obtain approval. Because the order will be stopped in 24 hours, the review and approval must be initiated within 24 hours of the original order.
- If use is approved, ID will relay this information to the ordering physician as well as to the pharmacy through a progress note. If the restricted anti-infective is thought to be inappropriate, ID will provide alternative recommendations and communicate these recommendations to the physician originating the order.
- ID may decide that a formal consultation is necessary for approval. In this instance, a formal ID consultation will be required for continued use of the restricted agent.
Anti-Infective Formulary Guidelines
Non-formulary anti-infectives will be reviewed by the Antimicrobial Stewardship Program. If a patient is admitted for a reason other than infection and is on a non-formulary anti-infective at home, refer to Non-Formulary Policy, MS77, for additional information.
|
Drug |
Approving services |
Indications not requiring approval |
Notes |
|
ID |
None |
|
|
|
Bezlotoxumab (Zinplava) |
No approval required |
Clostridium difficile infection |
Restricted to use in the outpatient infusion center only |
|
Ceftazidime/avibactam (Avycaz) |
ID |
None |
|
|
Ceftolozane/tazobactam (Zerbaxa) |
ID |
None |
|
|
Colistin (colistimethate) |
ID, pulmonary |
None |
Requires formal consultation by ID or pulmonary service |
|
Cytomegalovirus immune globulin (CMV-IG, Cytogam) |
Transplant ID |
If ordered via P&T-approved order set (visceral transplant) |
Will not be dispensed unless approved |
|
Dalbavancin (Dalvance) |
ID |
None |
Restricted to use in the outpatient infusion center only |
|
Daptomycin (Cubicin) |
ID |
FDA-approved indications (skin/skin structure infections, S. aureus bacteremia, including those with right-sided infective endocarditis) |
|
|
Fecal Microbiota Live-jslm (Rebyota) |
No approval required |
Clostridium difficile infection prophylaxis |
Restricted to use in the outpatient infusion center and outpatient clinics only |
|
Fosfomycin (Monurol) |
No approval required |
Single-dose fosfomycin for simple cystitis can be used without restriction |
Documented susceptibility required if requesting more than one dose |
|
Isavuconazole (Cresemba) |
ID |
Prophylaxis in patients with hematologic malignancy unable to take alternative agents |
|
|
Miltefosine (Impavido) |
ID |
None |
|
|
Omadacycline (Nuzyra) |
ID |
None |
|
|
Oral Ribavirin for respiratory viruses (e.g. RSV) |
ID, heme/onc |
Continuation of home therapy for Hepatitis C |
|
|
Peramivir (Rabivab) |
ID |
None |
|
|
ID, pulmonary |
Irrigation and topical applications |
|
|
|
Posaconazole (Noxafil) |
ID |
Prophylaxis in patients with hematologic malignancy |
|
|
Tigecycline (Tygacil) |
ID |
None |
|