V.      Guidelines for Use of Restricted Antimicrobials

a.      Obtaining approval for restricted antimicrobials

--Certain antimicrobial agents require approval from the section of Infectious Diseases before they will be dispensed by the pharmacy.  These agents are subject to restriction because:   1) these may be last-line agents for resistant infections; widespread use will result in resistance to these drugs and complete absence of therapeutic options;  2) there is typically less clinical information on efficacy than comparable agents; 3) these drugs may be more toxic than standard, equally effective therapy; 4) these agents typically have a higher acquisition cost than standard, equally effective therapy.

Thus, before dispensing initial doses of any of the restricted agents, approval must be obtained from ID pharmacy by paging 443-9421.  If full approval, or approval limited to a specific time period (e.g. 24 hours pending culture results), is granted, ID pharmacy will call the pharmacy directly and approve release of the drug.  A valid AOS must be submitted.  Between the hours of 2400 and 0700,  a single dose of the restricted antimicrobial may be dispensed.  Dispensing of subsequent doses requires contacting ID pharmacy.

Guidelines are general and cannot take into account all of the particular circumstances of a patient.  Some patients may not strictly qualify by these guidelines, but these patients will be evaluated on a case-by-case basis.

Click below to go to criteria for use for restricted antimicrobials:

b.     Amphotericin B lipid complex (ABLC)

c.     Caspofungin

d.     Voriconazole

e.     Linezolid

f.      Quinupristin/dalfopristin (Synercid)

g.     Daptomycin

h.    Tigecycline