Antimicrobial restrictions

Queensland Children’s Hospital Antimicrobial formulary

The Queensland Children’s Hospital (QCH) antimicrobial restriction procedure is a core component of the Antimicrobial stewardship program.

It is the responsibility of prescribing medical officer to obtain appropriate approval for antimicrobials.

The following list of antimicrobials should be followed in conjunction with current List of Approved Medicines (LAM).

All other antimicrobials not listed on this document or used for off label/ off license indications, require approval before use unless specific arrangements have been made with your department.

QCH Antimicrobial Traffic Light System

The antimicrobial formulary is divided into the following three categories:

Unrestricted (green)

Antimicrobials can be prescribed for clinically appropriate indication by all prescribers as per LAM criteria.

Restricted (amber)

Antimicrobials can be prescribed for listed indications for specific time frame. However, approval is required for use outside these indications (and time frames).

Where approval is required, the Prescriber will contact the Infectious Diseases consultant who will consider the antimicrobial’s use.

Please document:

The indication
Name of the authorising clinician and unique ID approval number must be annotated on the medication chart (or prescription).

For SAS medications, you must also complete the following forms to submit to pharmacy and infectious diseases consultant on service:

SAS category A form
CHQ Individual Patient approval form (QH staff only)

Restricted (red)

Antimicrobials may only be prescribed for following authorisation by Infectious Diseases or Clinical Microbiology and include:

Please document:

The indication
Name of the authorising clinician and unique ID approval number must be annotated on the medication chart (or prescription).

For SAS medications, you must also complete the following two forms and submit the to pharmacy and Infectious diseases consultant on service:

SAS category A form
CHQ Individual Patient approval form (QH staff only)

Search antimicrobial formulary (generic name)

Antimicrobial	Colour code
Amoxycillin (IV and PO)	Green
Amoxycillin / Clavulanic acid (PO)	Green
Amphotericin B lozenges (PO)	Green
Ampicillin (IV)	Green
Benzathine penicillin (IM)	Green
Benzylpenicillin (IV)	Green
Cefaclor (PO)	Green
Cephalexin (PO)	Green
Cephazolin IV (Inpatient)	Green
Chloramphenicol (eye drops)	Green
Clotrimazole (topical)	Green
Dicloxacillin (PO)	Green
Flucloxacillin (IV and PO)	Green
Metronidazole (PO and IV)	Green
Miconazole (topical cream)	Green
Nitrofurantoin (PO)	Green
Nystatin (PO and topical)	Green
Permethrin (topical)	Green
Phenoxymethylpenicillin (PO)	Green
Pyrantel (PO)	Green
Roxithromycin (PO)	Green
Tinidazole (PO)	Green
Trimethoprim (PO)	Green
Trimethoprim / Sulfamethoxazole (PO)	Green
Aciclovir (PO and IV) Oral Department of ophthalmology for treatment of severe herpes zoster ophthalmicus For up to 48 hours on the advice of Consultant Specialist Staff for (IMPS review and approval required after 48 hours): a) Treatment of herpes simplex virus infections in immunocompromised paediatric patients (up to 18 years of age) or b) Treatment of herpes zoster in immunocompromised patients; Microbiological confirmation of diagnosis (viral culture, antigen detection or nucleic acid amplification by PCR) is required but need not delay commencing treatment of the initial episode. Once microbiological diagnosis confirmed, subsequent recurrences may be treated on clinical grounds. All other indications including prophylaxis require IMPS approval	Amber
Aciclovir cold sore ointment Haematology/Oncology all other indications require IMPS approval	Amber
Aciclovir Eye Ointment Department of Ophthalmology All other indications require IMPS approval	Amber
Albendazole (PO) Treatment of adults and children with Ancylostoma caninum (Eosinophilic enterocolitis), Ancylostoma duodenale/Necator americanus (Hookworm), Ascaris lumbricoides (Roundworm), Trichuris trichiuria (Whipworm) or Enterobius vermicularis (Pinworm). IMPS approval is required for all other indications including for treatment of Echinococcus granulosus (Hydatids), alternative treatment for children with Strongyloides stercoralis or Snail ingestion.	Amber
Amoxicillin/ Clavulanic acid (IV) For empiric treatment of animal bites/wounds and retropharyngeal abscess for up to 24 hours according to CHQ Antibiocard. ID review and approval required after 24 hours. For empiric treatment of complicated appendicitis for up to 4 days according to CHQ Antibiocard. ID review and approval required after 24 hours. ID review and approval required after 4 days. All other indications for treatment or prophylaxis require IMPS Approval	Amber
Amoxycillin, Clarithromycin and Esomeprazole (Triple therapy) Triple therapy pre-approved for 7 days for proven H.pylori eradication under care of a Gastroenterologist according to the Australian Therapeutic guidelines (Antibiotics).	Amber
Amphotericin B Liposomal (IV) Haematology/ Oncology (according to CHQ Febrile neutropenia protocol – febrile neutropenic >96hours – ID consultation required within 24hours from commencing) or in accordance with CHQ Post liver transplant protocol (Use in high risk patients -with cholestasis OR a 2nd transplant OR if active fungal infection) All other indications including prophylaxis require IMPS approval	Amber
Azithromycin (IV) For severe community acquired pneumonia >5yoa (According to PICU Empirical antibiotic guidelines), For treatment of severe acute Bordetella pertussis infection where PO medications contraindicated or not tolerated (according to PICU Empirical antibiotic guidelines and CHQ Antibiocard) All other indications require IMPS Approval	Amber
Azithromycin (tablets and suspension) (PO) For use in Cystic fibrosis patients according criteria specified in CHQ-GDL-01073 Empirical antimicrobial therapy for children with Cystic Fibrosis For use in Non CF bronchiectasis patients according to criteria specified in CHQ-GDL-01072 Non-Cystic Fibrosis Bronchiectasis (CSLD) - Antimicrobial Therapy for Children For life threatening pneumonia in children less than 5 years old according to CHQ Antibiocard For severe community acquired pneumonia in children more than 5years old (According to PICU Empirical antibiotic guidelines and CHQ Antibiocard), For treatment of severe acute B. pertussis infection (according to PICU Empirical antibiotic guidelines and CHQ Antibiocard). For STD prophylaxis per Child Advocacy service protocol (guideline under review – contact ID team for advice) All other indications for treatment or prophylaxis require IMPS Approval	Amber
Cefepime (IV) According to CHQ Paediatric Peritoneal Dialysis Peritonitis Clinical Pathway (for empiric therapy up to 72hrs- ID review and approval required after 72hours) All other indications including prophylaxis require IMPS Approval	Amber
Cefotaxime (IV) According to CHQ Guideline: Empirical antimicrobial therapy for children with Non-Cystic Fibrosis Bronchiectasis for up to 14 days. ID Approval required after 72 hours therapy for: Empiric therapy for suspected or proven meningitis or community acquired sepsis (PICU and Non PICU) or skeletal/soft tissue infections (if <5yo and not Hib immune) or cholangitis (according to CHQ Antibiocard and CHQ PICU Empirical antibiotic guidelines) or PICU: Severe empyema and community acquired pneumonia (according to CHQ PICU Empirical antibiotic guidelines ) for up to 72 hours (ID approval required after 72 hours) For Nosocomial/ ventilator associated pneumonia for patients who have been in PICU for less than 5 days, for up to 72 hours (ID approval required after 72hours) according to CHQ PICU Empirical antibiotic guidelines or ID Approval required after 24 hours therapy for: Empirical therapy for suspected Tracheitis, epiglottitis and retropharyngeal abscess (according to CHQ Antibiocard) All other indications require IMPS approval	Amber
Cefoxitin (IV) For Use in accordance with CHQ Paediatric Surgical Antibiotic Prophylaxis protocol (QH staff only) – abdominal surgery (1 dose), biliary surgery (until biliary drain is removed) All other indications require IMPS Approval	Amber
Ceftazidime (IV) For use in Cystic fibrosis patients for inpatient and HITH management (intermittent dosing) according to CHQ-GDL-01073 Empirical antimicrobial therapy for children with Cystic Fibrosis for up to 14 days For use in Non CF bronchiectasis patients for inpatient management (intermittent dosing) according to CHQ-GDL-01072 Non-Cystic Fibrosis Bronchiectasis - Antimicrobial Therapy for Children for up to 14 days For use in accordance with the CHQ Febrile Neutropenia protocol (PDF) for up to 72hours (ID approval required after 72 hours), in patients with delayed type hypersensitivity to piperacillin/tazobactam. For Nosocomial sepsis (PICU) for up to 72 hours (ID approval required after 72hours) according to CHQ PICU Empirical antibiotic guidelines For Nosocomial/ ventilator associated pneumonia for patients who have been in PICU for more than 5 days, for up to 72 hours (ID approval required after 72hours) according to CHQ PICU Empirical antibiotic guidelines All other indications require IMPS approval	Amber
Ceftazidime intravitreal injection Department of Ophthalmology all other indications require IMPS approval.	Amber
Ceftriaxone (IV) According to CHQ Guideline: Empirical antimicrobial therapy for children with Non-Cystic Fibrosis Bronchiectasis for up to 14days. ID Approval required after 72 hours therapy for: Empiric therapy for suspected or proven meningitis or community acquired sepsis (PICU and Non PICU) or skeletal/soft tissue infections (if <5yo and not Hib immune) or cholangitis (according to CHQ Antibiocard and CHQ PICU Empirical antibiotic guidelines) or PICU: Severe empyema and community acquired pneumonia (according to CHQ PICU Empirical antibiotic guidelines) for up to 72 hours (ID approval required after 72 hours) For Nosocomial/ ventilator associated pneumonia for patients who have been in PICU for less than 5 days, for up to 72 hours (ID approval required after 72hours) according to CHQ PICU Empirical antibiotic guidelines OR ID Approval required after 24 hours therapy for: Empirical therapy for suspected Tracheitis, epiglottitis and retropharyngeal abscess (according to CHQ Antibiocard) All other indications require IMPS approval	Amber
Ceftriaxone IV (HITH) 72 hours approval for HITH for the following indications according to the target="_blank">CHQ-GDL-63012 CHQ Hospital in the Home antibiotic guidelines in infants (>3 months of age) and children deemed to be unsuitable for oral antimicrobial therapy: Community acquired pneumonia (not tolerating oral therapy) Cellulitis Lymphadenitis Pre-septal/peri-orbital cellulitis	Amber
Cefuroxime (PO) For use in Non CF bronchiectasis patients according to criteria specified in CHQ-GDL-01072 Non-Cystic Fibrosis Bronchiectasis - Antimicrobial Therapy for Children All other indications require IMPS approval	Amber
Cephalothin eyedrops Department of Ophthalmology all other indications require IMPS approval.	Amber
Chloramphenicol eye ointment For ophthalmic use only All other indications require IMPS approval	Amber
Cephazolin Intravitreal and intracameral injection	Amber
Cephazolin IV (HITH) 72 hours approval for HITH for the following indications according to the CHQ-GDL-63012 CHQ Hospital in the Home antibiotic guidelines in infants (>3 months of age) and children deemed to be unsuitable for oral antimicrobial therapy: Community acquired pneumonia (not tolerating oral therapy) Cellulitis Lymphadenitis Pre-septal/peri-orbital cellulitis	Amber
Ciprofloxacin (PO) for Cystic fibrosis patients according to CHQ Respiratory Antibiocard or for Chemoprophylaxis of meningococcal contacts on advice from Infectious diseases consultant/ Public health medical officer (according to CHQ Antibiocard) all other indications require IMPS approval	Amber
Ciprofloxacin ear/eye drops Eye drops: Department of Ophthalmology – for treatment of bacterial keratitis or Ear drops: On advice from ENT consultant for the treatment of: Chronic suppurative otitis media in an Aboriginal or a Torres Strait Islander person aged 1 month or older Chronic suppurative otitis media in a patient less than 18 years of age with perforation of the tympanic membrane Chronic suppurative otitis media in a patient less than 18 years of age with a grommet in situ) Otitis externa associated with perforation all other indications require IMPS approval	Amber
Clindamycin (PO) Approval required after 48 hours therapy for: Empiric therapy for suspected or proven impetigo or cellulitis or cervical lymphadenitis (outpatient management) in patients at risk of nMRSA in accordance with CHQ Antibiocard. All other indications require IMPS Approval	Amber
Colistin (nebulised) For Cystic fibrosis patients as second-line treatment to nebulised tobramycin for treatment of pulmonary infection with Pseudomonas aeruginosa OR in cases with demonstrated resistance by pseudomonas to tobramycin adverse reactions due to tobramycin as per CHQ Respiratory Antibiocard (for 12 weeks duration) all other indications require IMPS approval	Amber
Dapsone (PO) For use by haematology/oncology as alternative to trimethoprim/sulfamethoxazole as PCP prophylaxis	Amber
Doxycycline (IV - SAS) For use by Physicians trained in interventional radiology and with proper skills in sclerotherapy – for use in schlerotherapy for treatment of lymphatic malformations in paediatric patients. all other indications require IMPS approval	Amber
Doxycycline (PO) For empiric therapy according to CHQ guideline: Management of Water-related Wound Infections in Children, in an established wound infection where wound was sustained during exposure to water (treatment – no organism identified) in children > 8 years of age. IMPS review and approval required within 24hours. CHQ IMPS Approval and discussion required for children <8 years of age and a diagnosis of Ricksettsial disease including Q Fever. For treatment of severe acne in children aged 8 years or older, under care of Dermatologist. Pre-approved duration: 3 months. IMPS approval required after 3 months. All other indications require IMPS Approval	Amber
Erythromycin (PO) IMPS approval required for all off label/off license indications	Amber
Famciclovir (PO) Haematology/Oncology team for use in the paediatric population (up to 18 years of age) for: Prophylaxis of viral infection for 12 months following allogeneic bone marrow transplant; Prophylaxis of viral infection for 3 months following autologous bone marrow transplant. Treatment of immunocompetent patients with herpes zoster in whom the duration of rash is less than 72 hours. Herpes zoster in immunocompromised patients. Ophthalmic herpes zoster. All other indications require IMPS Approval	Amber
Fluconazole (PO and IV) For use in accordance with Oncology/ Haematology antifungal prophylaxis and treatment guideline (QH staff only) all other indications require IMPS approval	Amber
Gentamicin (IV) Approval required after 72 hours therapy for: Empiric therapy for suspected sepsis (neonates), peritonitis, necrotising enterocolitis, NEC or uncomplicated and complicated appendicitis, pyelonephritis (or UTI in < 3 month old) and endocarditis according to CHQ Antibiocard For severe abdominal infection (including peritonitis and necrotising enterocolitis), nosocomial sepsis (including central venous line sepsis), surgical wound infection, urinary tract infection for critically ill patients according to CHQ PICU Empirical antibiotic guidelines For Use in accordance with CHQ Paediatric Surgical Antibiotic Prophylaxis guideline all other indications require IMPS approval	Amber
Gentamicin eye drops On advice from Ophthalmology team	Amber
Gentamicin IV (HITH) 72 hours approval for HITH for the following indications according to the CHQ-GDL-63012 CHQ Hospital in the Home antibiotic guidelines in infants (>3 months of age) and children deemed to be unsuitable for oral antimicrobial therapy: Urinary tract infections	Amber
Griseofulvin (PO) For use in recalcitrant laboratory proven tinea infections. All other indications require CHQ IMPS or Dermatology approval.	Amber
Hydroxychloroquine (PO) For use in rheumatological /interstitial lung disease/ immunological conditions. All other indications require IMPS approval	Amber
Itraconazole (PO) For treatment of ABPA according to CHQ Respiratory Antibiocard on advice of Respiratory Consultant or For use in accordance with Oncology/ Haematology antifungal prophylaxis and treatment guideline (QH staff only). all other indications require IMPS approval	Amber
Lincomycin (IV) Approval required after 48 hours therapy for: For use in patients with risk factors for nMRSA, as empiric antibiotic therapy (in combination with appropriate agents) for severe cellulitis, community acquired sepsis, empyema, toxic shock syndrome and bone/joint infection for critically ill patients according to CHQ Antibiocard and PICU Empirical antibiotic guidelines For use in accordance with CHQ Surgical Antibiotic Prophylaxis guidelines, in patients who have an immediate type hypersensitivity to penicillins/ cephalosporins all other indications require IMPS approval	Amber
Mebendazole (PO) Alternative treatment of Eosinophilic enterocolitis, Hookworm, Roundworm, Whipworm or Pinworm. all other indications require IMPS approval	Amber
Minocycline (PO) For use by Dermatologist in the treatment of severe acne all other indications require IMPS approval	Amber
Mupirocin (intranasal ointment) For use in according to CHQ Management of boils (furunculosis) (MSSA and MRSA decolonisation) OR for Eradication of Staph Aureus nasal colonisation in Cardiac surgery patients (QH staff only). All other indications require IMPS approval	Amber
Mupirocin (topical ointment) For use in according to CHQ MRSA eradication procedure (QH staff only). all other indications require IMPS approval	Amber
Neomycin (PO) For emergency management of hepatic encephalopathy. all other indications require IMPS approval	Amber
Ofloxacin eye drops On advice from Ophthalmology team All other indications require IMPS approval	Amber
Oseltamivir (PO) Treatment of clinically suspected or laboratory proven influenza in high risk inpatients (eg immunocompromised, oncology, cardiac or chronic respiratory) or PICU/HDU inpatients when started within 72 hours of symptom onset. All other patients require CHQ ID approval, including those with > 3 days of symptoms. OR In accord with a QH pandemic influenza protocol.	Amber
Piperacillin/ Tazobactam (IV) For use in Cystic fibrosis patients for inpatient and HITH management according to CHQ-GDL-01073 Empirical antimicrobial therapy for children with Cystic Fibrosis for up to 14 days For use in Non CF bronchiectasis patients for inpatient management (intermittent dosing) according to CHQ-GDL-01072 Non-Cystic Fibrosis Bronchiectasis - Antimicrobial Therapy for Children for up to 14 days or For empiric treatment of complicated appendicitis for up to 4 days according to CHQ Antibiocard. ID review and approval required after 24 hours. ID review and approval required after 4 days. For open compound fractures with severe tissue damage or clinical evidence of skin/soft tissue infection (up to 24hours) according to CHQ Antibiocard (ID approval required after 24 hours) For use in accordance with the CHQ Febrile Neutropenia protocol (PDF) for up to 72 hours (ID approval required after 72 hours) or Empiric therapy for Suspected Central Venous Access Device (CVAD) Infection (for up to 72hrs) according to CHQ guideline: Fever in a Child with Central Venous Access Device (ID approval required after 72 hours) or For use as per CHQ Liver transplant protocol (PDF)(QH staff only) (up to 24 hours) (ID approval required after 24 hours) or as a single dose per CHQ Renal transplant protocol (PDF)(QH staff only) or for Percutaneous transhepatic cholangiogram (with or without stent placement) per CHQ Surgical antibiotic prophylaxis guideline	Amber
Posaconazole (PO) For use in accordance with Oncology/ Haematology antifungal prophylaxis and treatment guideline (QH staff only). All other indications require IMPS approval	Amber
Rifampicin (PO) For Chemoprophylaxis of meningococcal contacts on advice from Infectious diseases consultant. All other indications (including off label use) require IMPS approval	Amber
Teicoplanin (IV) For use in accordance with the CHQ Repair of fractured tunnelled cuffed central venous catheter guideline ( 1 dose) All other indications require IMPS Approval	Amber
Terbinafine (PO) For use on advice from Dermatologist All other indications require IMPS approval	Amber
Tobramycin (inhaled – TOBI podhaler) For use in Cystic fibrosis patients according to CHQ guideline: Empirical antimicrobial therapy for children with Cystic Fibrosis for up to 14 days. All other indications require IMPS approval	Amber
Tobramycin (IV and nebulised) Intravenous: For use in Cystic fibrosis patients for inpatient and HITH management according to CHQ-GDL-01073 Empirical antimicrobial therapy for children with Cystic Fibrosis for up to 14 days For use in Non CF bronchiectasis patients for inpatient management according to CHQ-GDL-01072 Non-Cystic Fibrosis Bronchiectasis - Antimicrobial Therapy for Children for up to 14 days All other indications require IMPS Approval Nebulised: For use in Cystic fibrosis patients according criteria specified in CHQ-GDL-01073 Empirical antimicrobial therapy for children with Cystic Fibrosis Queensland Children's Hospital: For use in Non CF bronchiectasis patients according to criteria specified in CHQ-GDL-01072 Non-Cystic Fibrosis Bronchiectasis - Antimicrobial Therapy for Children (For all other sites - ID approval as per local practices)	Amber
Tobramycin Eye drops and eye ointment For use on advice from Ophthalmology team All other indications require IMPS approval	Amber
Trimethoprim/ Sulfamethoxazole (IV) Approval required after 48hours for: use as initial treatment of suspected or proven PCP OR for PCP prophylaxis if unable to tolerate oral therapy. IMPS review and approval required within 48hours. All other indications require IMPS approval	Amber
Valaciclovir (PO) Oral Department of Ophthalmology for treatment of severe herpes zoster ophthalmicus On the advice of Consultant Specialist Staff for: a) Treatment of herpes simplex virus infections in immunocompromised paediatric patients (up to 18 years of age); or b) Treatment of herpes zoster in immunocompromised patients; or c) Use in the paediatric population (up to 18 years of age) for: Prophylaxis of viral infection for 12 months following allogeneic bone marrow transplant; Prophylaxis of viral infection for 3 months following autologous bone marrow transplant. All other indications require IMPS approval Microbiological confirmation of diagnosis (viral culture, antigen detection or nucleic acid amplification by PCR) is required but need Not delay commencing treatment of the initial episode. Once microbiological diagnosis confirmed, subsequent recurrences may be treated on clinical grounds.	Amber
ValGANciclovir (PO) For use as CMV prophylaxis in accordance with the CHQ Liver transplant protocol (QH staff only) and CHQ Renal transplant protocol (QH staff only) All other indications require IMPS approval	Amber
Vancomycin (IV) For use in accordance with the: CHQ Febrile Neutropenia protocol CHQ Repair of fractured tunnelled cuffed central venous catheter guideline ( 1 dose), CHQ Surgical Antibiotic Prophylaxis protocol and CHQ Cardiac surgical antibiotic prophylaxis protocol Approval required after 72 hours therapy for: Empiric therapy for suspected or proven meningitis (gram positive cocci in CSF), endocarditis, community acquired/nosocomial sepsis (PICU) in accordance with CHQ Antibiocard or CHQ PICU Empirical antibiotic guideline All other indications required IMPS team approval.	Amber
Vancomycin Intravitreal and intracameral Injection Department of Ophthalmology All other indications require IMPS approval	Amber
Voriconazole (PO) For use in accordance with Oncology/ Haematology antifungal prophylaxis and treatment guideline (for treatment- IMPS approval required) All other indications require IMPS approval	Amber
Abacavir	Red
Adefovir (PO)	Red
Amikacin (IV and nebulised)	Red
Amorolfine (nail lacquer 5%)	Red
Amphotericin B lipid complex (Abelcet ) (IV)	Red
Amphotericin (Fungizone ) (SAS) IV	Red
Anidulafungin (IV)	Red
Artemether+Lumefantrine (Riamet) (PO)	Red
Artesunate (SAS) IV	Red
Atazanavir	Red
Atovaquone (PO)	Red
Atovaquone/ Proguanil (Malarone ) (PO)	Red
Aztreonam (IV and nebulised)	Red
Brincidofovir (Compassionate use/SAS) (PO)	Red
Capreomycin (SAS) (IV)	Red
Caspofungin (IV)	Red
Ceftolazone/Tazobactam (IV)	Red
Ceftazidime/Avibactam (IV)	Red
Ceftaroline (IV)	Red
Chloramphenicol (SAS) (IV)	Red
Chloroquine (SAS)	Red
Cidofovir (IV)	Red
Ciprofloxacin (IV)	Red
Colistin (IV)	Red
Ciprofloxacin/hydrocortisone (ear drops)	Red
Clarithromycin (PO)	Red
Clindamycin (IV)	Red
Cycloserine (SAS) (PO)	Red
Daclatasvir	Red
Daptomycin (IV)	Red
Darunavir (PO)	Red
Dicloxacillin (IV)	Red
Dolutegravir	Red
Doripenem (IV)	Red
Efavirenz	Red
Emtricitabine	Red
Enfuviritide	Red
Entecavir (PO)	Red
Ethambutol (PO) and (SAS – IV)	Red
Ertapenem (IV)	Red
Erythromycin (IV)	Red
Fluconazole (IV)	Red
Flucytosine (SAS) (IV and PO)	Red
Fosfomycin (SAS) (IV and PO)	Red
Foscarnet (IV)	Red
Fusidic acid (sodium fusidate) (PO)	Red
Ganciclovir (IV)	Red
HITH (Hospital in the home IV antimicrobials) CF patients receiving Tobramycin and Piperacillin/Tazobactam or Ceftazidime for (HITH) according to the CHQ-GDL-01073 Empirical antimicrobial therapy for children with Cystic Fibrosis Non-CF bronchiectasis patients receiving Ceftriaxone according to the CHQ-GDL-01072 Empirical antimicrobial therapy for children with Non-Cystic Fibrosis Bronchiectasis For the following indications according to the CHQ-GDL-63012 CHQ Hospital in the Home antibiotic guidelines in infants (>3 months of age) and children deemed to be unsuitable for oral antimicrobial therapy: Community acquired pneumonia (not tolerating oral therapy) Cellulitis Lymphadenitis Pre-septal/peri-orbital cellulitis Urinary tract infections see QCH Antimicrobial Formulary. Written confirmation of Infectious Diseases approval needs to accompany (CHQatHome) referral form.	Red
Hydroxychloroquine (PO) IMPS approval required for all indications during COVID-19 pandemic. Special consideration will be given on an individual patient basis for use in rheumatological /interstitial lung disease/ immunological conditions.	Red
Imipenem/cilastatin (IV)	Red
Isoniazid (PO) (SAS – IV)	Red
Ivermectin (PO)	Red
Ketoconazole (PO)	Red
Lamivudine	Red
Ledipasvir with Sofosbuvir	Red
Letermovir	Red
Linezolid (PO and IV)	Red
Lopinavir/Ritonavir	Red
Maraviroc (PO)	Red
Mefloquine (PO)	Red
Miltefosine (SAS)	Red
Moxifloxacin (PO and IV)	Red
Meropenem (IV)	Red
Micafungin (IV)	Red
Nalidixic acid (PO) (SAS)	Red
Natamycin eye drops (SAS)	Red
Netilmicin (SAS)	Red
Nevirapine	Red
Niclosamide (PO) (SAS)	Red
Nitazoxanide (SAS) (PO)	Red
Norfloxacin (PO)	Red
Palivizumab (IM)	Red
Paromomycin (SAS) (PO and topical)	Red
Para-Aminosalicylic acid (SAS)	Red
Pentamidine (IV and nebulised)	Red
Peramivir IV	Red
Posaconazole (IV) (compassionate use)	Red
Praziquantel (PO)	Red
Primaquine (PO)	Red
Pyrazinamide (PO) (SAS)	Red
Pyrimethamine (PO)	Red
Quinine (IV and PO)	Red
Quinupristin/Dalfopristin (IV)	Red
Raltegravir (PO)	Red
Ribavirin (PO)	Red
Ribavirin (IV) (SAS)	Red
Rifabutin (PO)	Red
Rifampicin (IV)	Red
Rifaximin (SAS – suspension) (PO)	Red
Rilpirivine (with tenofovir and emtricitabine) (PO)	Red
Sofosbuvir	Red
Streptomycin (SAS) (IM)	Red
Sulfadiazine (PO)	Red
Taurolidine/citrate antiseptic lock (Taurolock)	Red
Tenofovir	Red
Ticarcillin/Clavulanate (IV)	Red
Triclosan	Red
Tigecycline (IV)	Red
Vancomycin (PO) For use in accordance with CHQ Clostridium difficile infection CHQ Clostridium difficile infection management guideline (QH staff only) with IMPS approval only	Red
Voriconazole Intravitreal injection	Red
Voriconazole (IV)	Red
Voriconazole (eye drops)	Red
Zanamavir (inhaled) (IV- compassionate use only)	Red
Zidovudine	Red

Clinical scenarios involving antimicrobials that require ID approval

All patients requiring Hospital in the Home (HITH) Parenteral Antibiotics (excluding CF patients receiving Tobramycin and Piperacillin/Tazobactam for HITH OR non-CF bronchiectasis patients receiving Ceftriaxone- see QCH Antimicrobial formulary)
Antimicrobials which may require special aseptic compounding
Antimicrobial eye drops e.g. Ceftazidime, Cephazolin, Vancomycin, Voriconazole, Natamycin
Antimicrobials for Intravitreal injections e.g. Amphotericin, Voriconazole, Ceftazidime and Vancomycin;
Antimicrobials for Intrathecal or Intraventricular administration e.g. Vancomycin, Gentamicin.

Authorising infectious diseases physicians and clinical microbiologists at QCH

Use of a restricted antimicrobial at QCH can be authorised by the clinicians listed below:

Dr Julia Clark
Dr Clare Nourse
Dr Meryta May
Dr Vikram Vaska
Dr Sophie Wen
ID Fellow/Registrar
Clinical Microbiologist: Dr Claire Heney

CHQ medication approval process

Antimicrobial supply for inpatients

Pharmacy may provide 24 hours initial supply of antibiotics to avoid unnecessary delay in treatment. Exceptions may apply.

Antimicrobial supply for outpatients

ID consultation and approval is required before antimicrobial supply will be dispensed.

Further supply will be dependent on receipt of ID approval. If no approval is forthcoming, this will be escalated to the primary treating Consultant, IMPS Consultant on call and the AMS Team. It is the responsibility of the prescriber to notify the pharmacy if ID approval is granted.

CHQ Medication approval process flow chart (QH staff only)

Documenting the antimicrobial plan on the medication chart and prescription

If approval is required, the Prescriber will contact the Infectious Diseases consultant who will consider the antimicrobial’s use.

This consultation must be documented in the patient’s medical notes and any approvals also documented, before further stock will be supplied from the pharmacy.

A unique approval number will be given to the prescriber and be annotated as described below.

Document the antimicrobial plan on the medication chart as per this example:

The National Inpatient Medication Chart should be annotated with the following information:

The Indication for Antimicrobial Therapy
The Intended Duration or Review Date for Antimicrobial Therapy
The words “ID approved” and the unique ID Approval number provided by the Approving ID Physician or Microbiologist.

The chart should be Numbered with the Days of Therapy to assist with review.

Outpatient prescription

The Outpatient prescription should be annotated with the following information:

The Indication for Antimicrobial Therapy
The Intended Duration or Review Date for Antimicrobial Therapy
The PBS restriction/ authority number (If required)
The unique ID Approval number provided by the Approving ID Physician or Microbiologist.

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Antimicrobial restrictions

Antimicrobial restrictions

Queensland Children’s Hospital Antimicrobial formulary

QCH Antimicrobial Traffic Light System

Unrestricted (green)

Restricted (amber)

Restricted (red)

Search antimicrobial formulary (generic name)

Amoxycillin (IV and PO)

Amoxycillin / Clavulanic acid (PO)

Amphotericin B lozenges (PO)

Ampicillin (IV)

Benzathine penicillin (IM)

Benzylpenicillin (IV)

Cefaclor (PO)

Cephalexin (PO)

Cephazolin IV (Inpatient)

Chloramphenicol (eye drops)

Clotrimazole (topical)

Dicloxacillin (PO)

Flucloxacillin (IV and PO)

Metronidazole (PO and IV)

Miconazole (topical cream)

Nitrofurantoin (PO)

Nystatin (PO and topical)

Permethrin (topical)

Phenoxymethylpenicillin (PO)

Pyrantel (PO)

Roxithromycin (PO)

Tinidazole (PO)

Trimethoprim (PO)

Trimethoprim / Sulfamethoxazole (PO)

Aciclovir (PO and IV)

Aciclovir cold sore ointment

Aciclovir Eye Ointment

Albendazole (PO)

Amoxicillin/ Clavulanic acid (IV)

Amoxycillin, Clarithromycin and Esomeprazole (Triple therapy)

Amphotericin B Liposomal (IV)

Azithromycin (IV)

Azithromycin (tablets and suspension) (PO)

Cefepime (IV)

Cefotaxime (IV)

Cefoxitin (IV)

Ceftazidime (IV)

Ceftazidime intravitreal injection

Ceftriaxone (IV)

Ceftriaxone IV (HITH)

Cefuroxime (PO)

Cephalothin eyedrops

Chloramphenicol eye ointment

Cephazolin Intravitreal and intracameral injection

Cephazolin IV (HITH)

Ciprofloxacin (PO)

Ciprofloxacin ear/eye drops

Clindamycin (PO)

Colistin (nebulised)

Dapsone (PO)

Doxycycline (IV - SAS)

Doxycycline (PO)

Erythromycin (PO)

Famciclovir (PO)

Fluconazole (PO and IV)

Gentamicin (IV)

Gentamicin eye drops

Gentamicin IV (HITH)

Griseofulvin (PO)

Hydroxychloroquine (PO)

Itraconazole (PO)

Lincomycin (IV)

Mebendazole (PO)

Minocycline (PO)