University of Pennsylvania Medical Center Guidelines
for Antibiotic Use


Category I: No Restrictions

Usage may be evaluated by a Pharmacy Clinical Specialist based on UPHS guidelines. If criteria for use are not met, the physician will be contacted with recommendations for alternative therapy

Category II: Antiretrovirals

Initiation of or change in antiretroviral therapy requires prior approval and should not occur without input from an Infectious Diseases Physician. Ambulatory regimens may be continued without prior approval

Category III: All use requires Infectious Disease Approval (Beeper 306-0336)

***Anti-infectives listed by the category of anti-infective (scroll down to see full list)***

Amikacin (I) No Restrictions
Amoxicillin (I) No Restrictions
Amoxicillin/clavulanic acid (I) No Restrictions
Ampicillin (I) No Restrictions
Ampicillin/sulbactam (I) No Restrictions
Azithromycin (I)

No Restrictions

Aztreonam (III) All use requires I.D. approval
Cefadroxil (I) No Restrictions
Cefazolin (I) No Restrictions
Cefepime (I) No Restrictions
Cefixime (I)

No Restrictions

Cefotaxime (I) For use ONLY in the Neonatal Intensive Care Unit
Ceftazidime (III) All use requires I.D. approval
Ceftriaxone (I) All use requires I.D. approval
Cefuroxime axetil (I) No Restrictions
Cephalexin (I) No Restrictions
Chloramphenicol (III) All use requires I.D. approval
Clarithromycin (I) No Restrictions
Clindamycin (I) No Restrictions
Colistin methanesulphonate (polymyxin E) (III) All use requires I.D. approval
Daptomycin (III) All use requires I.D. approval
Dicloxacillin (I) No Restrictions
Doxycycline (I) No Restrictions
Erythromycin (I) No Restrictions
Gentamicin (I) No Restrictions
Levofloxacin (III) 750 mg q 24 h in combination with aminoglycoside for febrile neutropenic patients who are allergic to beta-lactam agents

All other use requires I.D. approval

Linezolid (III) All use requires I.D. approval
Meropenem (III) All use requires I.D. approval
Metronidazole (I) No Restrictions
Nafcillin (I) No Restrictions
Nitrofurantoin (I) No Restrictions
Norfloxacin (I)

No Restrictions

Oxacillin (I)

ICN and Transitional Nurseries ONLY

Penicillin (I) No Restrictions
Piperacillin (I) No Restrictions
Piperacillin/tazobactam (I) No Restrictions
Rifabutin (III) No Restrictions
Rifampin-ORAL (I) No Restrictions
Rifampin-IV (III) All use requires I.D. approval
Streptomycin (I) No Restrictions
Sulfadiazine (I) No Restrictions
Tetracycline (I) No Restrictions
Tigecycline (III) All use requires I.D. approval
Tobramycin (I)  

No Restrictions

Inhaled Tobramycin (TOBI) (III)

Use unrestricted for Cystic fibrosis patients

All other use requires I.D. approval

Trimethoprim-Sulfamethoxazole (I) No Restrictions
Vancomycin-ORAL (I) No Restrictions

**NOTE: Metronidazole is the 1st line agent for mild to moderate antibiotic-associated colitis caused by C. difficile**

Vancomycin-IV (I) No Restrictions


Amphotericin B (I) No Restrictions
Amphotericin B Lipid Formulation (I) No Restrictions
Caspofungin (III) All use requires I.D. approval
Fluconazole (III)

Use unrestricted for Bone Marrow Transplant Patients - both Allogeneic and Autologous (for Leukemia and Lymphoma); Multiple Myeloma - 400 mg q 24 h

Use unrestricted for treatment of vaginal candidiasis - 200 mg one time dose only

All other use requires I.D. approval

5-Flucytosine (I) No Restrictions
Itraconazole-ORAL (I) No Restrictions

*IV formulation no longer available*

Ketoconazole (I) No Restrictions
Posaconazole (III) All use requires I.D. approval
Voriconazole-ORAL (III)

Use unrestricted for the treatment of neutropenic fever in patients with ≥ 4 days of fevers

All other use requires I.D. approval

Voriconazole-IV (III) All use requires I.D. approval



Acyclovir (I)

No Restrictions
Adefovir (I)

No Restrictions

Cidofovir (I) No Restrictions
Entecavir (I)

No Restrictions

Foscarnet (I) No Restrictions
Ganciclovir (I)

No Restrictions

Oseltamivir (III) All use requires I.D. approval
Telbivudine (I)

No Restrictions

Valacyclovir (I)

No Restrictions

Valgancyclovir (I)

No Restrictions


Abacavir Indinavir
Abacavir/lamivudine (Epzicom™) Lamivudine (also unrestricted for the treatment of hepatitis B)
Abacavir/lamivudine/zidovudine (Trizivir®) Lamivudine/zidovudine (Combivir®)
Amprenavir Lopinavir/ritonavir (Kaletra™)
Atazanavir Maraviroc


Didanosine (ddI) Nevirapine
Efavirenz Raltegravir
Efavirenz/emtricitabine/tenofovir (Atripla™) Ritonavir
Emtricitabine Saquinavir
Emtricitabine/tenofovir (Truvada™)  Stavudine 
Enfuvirtide Tenofovir
Etravirine Zidovudine


Atovaquone (I)

No Restrictions

Dapsone (I) No Restrictions
Ethambutol (I) No Restrictions
Isoniazid (I) No Restrictions
Mefloquine (I) No Restrictions
Nitazoxanide (III) All use requires I.D. approval. Recommended dose is 500 mg PO BID x 3 days in immunocompetent hosts. An ID consult must be obtained for treatment of immunocompromised patients.
Pentamidine AEROSOL & IV (III) All use requires I.D. approval. FOR AEROSOL - also required: respiratory therapy form & documentation of neg. PPD and CXR neg. for TB
Pyrazinamide (I) No Restrictions

updated 6/01/09 by Shawn Binkley, PharmD

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