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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