University of Pennsylvania Medical Center Guidelines for Antibiotic Use

 COMMONLY USED FORMULARY ANTI-INFECTIVES AND RESTRICTION CATEGORIES


Category I: No Restrictions

Category II: Some Restrictions, Infectious Disease Approval NOT REQUIRED if prescribed as described below

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

Abacavir (II) Use unrestricted if patient receiving regimen as an outpatient; initiation of therapy requires I.D. approval
Abacavir/Lamivudine (Epzicom) (II) Use unrestricted if patient receiving regimen as an outpatient; initiation of therapy requires I.D. approval
Abacavir/Lamivudine/Zidovudine (Trizivir) (II) Use unrestricted if patient receiving regimen as an outpatient; initiation of therapy requires I.D. approval

Acyclovir (I)

No Restrictions
Adefovir (II) Use restricted to the treatment of hepatitis B
Amikacin (III) All use requires I.D. approval
Amoxicillin (I) No Restrictions
Amoxicillin/clavulanic acid (III) All use requires I.D. approval
Amphotericin B (II)

< 1 mg/kg/day is unrestricted for oncology patients

All other use requires I.D. approval

Amphotericin B Lipid Formulation (III) All use requires I.D. approval
Ampicillin (I) No Restrictions
Ampicillin/sulbactam (II) 1.5gm q 6 h as monotherapy or in combination with gentamicin. Initial empiric use does not require approval, but to continue use for more than 72 hrs, I.D. approval is required.
Amprenavir (II) Use unrestricted if patient receiving regimen as an outpatient; initiation of therapy requires I.D. approval
Atazanavir (II) Use unrestricted if patient receiving regimen as an outpatient; initiation of therapy requires I.D. approval
Atovaquone (II) Use unrestricted for PCP prophylaxis in liver or kidney transplant patients who are sulfa allergic (dose: 1500 mg PO daily with a fatty meal)
Azithromycin (II)

Unrestricted if ordered by OB/Gyn as single 1 to 2 gm PO dose.

All other use requires I.D. approval

Aztreonam (III) All use requires I.D. approval
Caspofungin (III) All use requires I.D. approval
Cefadroxil (I) No restrictions
Cefazolin (II) A. 500mg q 8 h or less frequently

B. 1gm q 6-8 h for the treatment of pyelonephritis in pregnancy

Cefepime (II) 1gm q 8 h as monotherapy or in combination with gentamicin for treatment of neutropenic fever

All other use requires I.D. approval

Cefotaxime (II) For use ONLY in the Neonatal Intensive Care Unit
Ceftazidime (II) For use ONLY in the Neonatal Intensive Care Unit
Ceftriaxone (III) All use requires I.D. approval
Cefuroxime axetil (III) All use requires I.D. approval
Cephalexin (I) No Restrictions
Chloramphenicol (III) All use requires I.D. approval
Cidofovir (III) All use requires I.D. approval
Clarithromycin (II) In combination with amoxicillin and lansoprazole for the treatment of infections caused by Helicobacter pylori
Clindamycin-ORAL (I) No Restrictions
Clindamycin-IV (II) OB/GYN service for treatment of post-partum endometritis and pelvic inflammatory disease at a dose of 900mg IV q 8 h; Oral Maxillofacial Surgery (OMFS) and otorhinolaryngology (ORL/ENT) at a dose of 600mg IV q 8 h
Colistin methanesulphonate (polymyxin E) (III) All use requires I.D. approval
Dapsone (I) No Restrictions

Darunavir (II)

Use unrestricted if patient receiving regimen as an outpatient; initiation of therapy requires I.D. approval
Dicloxacillin (I) No Restrictions
Didanosine (ddI) (II) Use unrestricted if patient receiving regimen as an outpatient; initiation of therapy requires I.D. approval
Doxycycline (I) No Restrictions
Efavirenz (II) Use unrestricted if patient receiving regimen as an outpatient;  initiation of therapy requires I.D. approval
Emtricitabine (II) Use unrestricted if patient receiving regimen as an outpatient;  initiation of therapy requires I.D. approval
Emtricitabine/tenofovir (Truvada) (II) Use unrestricted if patient receiving regimen as an outpatient;  initiation of therapy requires I.D. approval
Emtricitabine/tenofovir/efavirenz (Atripla) (II) Use unrestricted if patient receiving regimen as an outpatient;  initiation of therapy requires I.D. approval
Enfuvirtide (II) Use unrestricted if patient receiving regimen as an outpatient;  initiation of therapy requires I.D. approval
Entecavir (II) Use restricted to the treatment of hepatitis B
Erythromycin (I) No Restrictions
Ethambutol (I) No Restrictions
Fluconazole ORAL (II)

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

All other use requires I.D. approval

Fluconazole IV (III) All use requires I.D. approval
5-Flucytosine (I) No Restrictions
Fosamprenavir (II) Restricted agent -unrestricted if inpatient is using as outpatient. Initiation of therapy requires ID approval
Foscarnet (III) All use requires I.D. approval
Ganciclovir-IV (II) Liver and Heart Transplant Patients: post-operatively

All other use requires I.D. approval

Ganciclovir-ORAL (II) Heart Transplant Patients: post-operatively

All other use requires I.D. approval

Gentamicin (I) No Restrictions
Indinavir (II) Use unrestricted if patient receiving regimen as an outpatient; initiation of therapy requires I.D. approval
Isoniazid (I) No Restrictions
Itraconazole (III) ORAL and IV - All use requires I.D. approval

*IV formulation not kept in stock - requires 24-48hrs to order

Ketoconazole (I) No Restrictions
Lamivudine (II) Use unrestricted if patient receiving regimen as an outpatient; initiation of therapy requires I.D. approval
Lamivudine/zidovudine (Combivir)(II) Use unrestricted if patient receiving regimen as an outpatient; initiation of therapy requires I.D. approval
Levofloxacin (II) 750 mg q 24 h in combination with gentamicin 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
Lopinavir/Ritonavir (Kaletra)(II) Use unrestricted if patient receiving regimen as an outpatient; initiation of therapy requires I.D. approval
Mefloquine (III) All use requires I.D. approval
Meropenem (III) All use requires I.D. approval
Metronidazole-ORAL (I) No Restrictions
Metronidazole-IV (II) Use unrestricted if ordered q 12 h or less frequently
Nafcillin (I) No Restrictions
Nelfinavir (II) Use unrestricted if patient receiving regimen as outpatient; initiation requires I.D. approval.
Nevirapine (II) Use unrestricted if patient receiving regimen as an outpatient; initiation of therapy requires I.D. approval
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.
Nitrofurantoin (II) Urology and OB/Gyn Service
Norfloxacin (III) All use requires I.D. approval
Oseltamivir (III) All use requires I.D. approval
Oxacillin (II) ICN and Transitional Nurseries ONLY
Penicillin (I) No Restrictions
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
Piperacillin (III) All use requires I.D. approval
Piperacillin/tazobactam (III) All use requires I.D. approval
Posaconazole (III) All use requires I.D. approval
Pyrazinamide (I) No Restrictions
Rifabutin (III) All use requires I.D. approval
Rifampin-ORAL (I) No Restrictions
Rifampin-IV (III) All use requires I.D. approval
Ritonavir (II) Use unrestricted if patient receiving regimen as an outpatient; initiation of therapy requires I.D. approval
Saquinavir (II) Use unrestricted if patient receiving regimen as an outpatient; initiation of therapy requires I.D. approval
Stavudine (II) Use unrestricted if patient receiving regimen as an outpatient; initiation of therapy requires I.D. approval
Streptomycin (I) No Restrictions
Sulfadiazine (I) No Restrictions
Sulfamethoxazole (I) No Restrictions
Sulfisoxazole (I) No Restrictions
Telbivudine (II) Use restricted to the treatment of hepatitis B
Tenofovir (II) Use unrestricted if patient receiving regimen as an outpatient; initiation of therapy requires I.D. approval
Tetracycline (I) No Restrictions
Tigecycline (III) All use requires I.D. approval
Tobramycin (II) IV -Cystic fibrosis patients with organisms resistant to gentamicin and in ESRD patients on dialysis

AEROSOL (TOBI) - Cystic fibrosis patients

Trimethoprim (I) No Restrictions
Trimethoprim-Sulfamethoxazole (I) No Restrictions
Valacyclovir (II) Total daily dose 3 grams
Valgancyclovir (II)

CMV prophylaxis in heart, kidney, kidney-pancreas and lung transplant patients [Not for use liver transplants]: dose is 900 mg po qd.

All other use requires ID approval

Vancomycin-ORAL (III) All use requires I.D. approval

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

Vancomycin-IV (III) All use requires I.D. approval; if approved for empiric therapy, additional I.D. approval required to continue > 72 hours
Vidarabine (III) All use requires I.D. approval
Voriconazole (III) All use requires I.D. approval
Zidovudine (II) Use unrestricted if patient receiving regimen as an outpatient; initiation of therapy requires I.D. approval

***TO USE A RESTRICTED ANTI-INFECTIVE FOR AN INDICATION NOT LISTED, PLEASE PAGE 306-0336***

updated 7/24/07 by Ann Marie Marr

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