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)

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

Restricted (amber)

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:

Restricted (red)

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:

Search antimicrobial formulary (generic name)

AntimicrobialColour code

Amoxycillin (Amoxicillin) (IV and PO)


Pre-approved for first dose challenge, IDT or SPT and desensitisation by Paediatric Immunologist/Allergist or low risk oral challenge as per CHQ-GDL-01076 Paediatric antibiotic allergy assessment, testing and de-labelling.

Green

Amoxycillin / Clavulanic acid (Amoxicillin / Clavulanic acid) (PO)


Pre-approved for first dose challenge, IDT or SPT and desensitisation by Paediatric Immunologist/Allergist or low risk oral challenge as per CHQ-GDL-01076 Paediatric antibiotic allergy assessment, testing and de-labelling.

Green

Amphotericin B lozenges (PO)

Green

Ampicillin (IV)


Pre-approved for first dose challenge, IDT or SPT and desensitisation by Paediatric Immunologist/Allergist.

Green

Benzathine penicillin (IM)

Green

Benzylpenicillin (IV)


Pre-approved for first dose challenge, IDT or SPT and desensitisation by Paediatric Immunologist/Allergist.

Green

Cefaclor (PO)


Pre-approved for first dose challenge, IDT or SPT and desensitisation by Paediatric Immunologist/Allergist.

Green

Cephalexin (PO)


Pre-approved for first dose challenge, IDT or SPT and desensitisation by Paediatric Immunologist/Allergist or low risk oral challenge as per CHQ-GDL-01076 Paediatric antibiotic allergy assessment, testing and de-labelling.

Green

Cephazolin (Cefazolin) IV (Inpatient)


Pre-approved for first dose challenge, IDT or SPT by Paediatric Immunologist/Allergist. Desensitisation – ID approval required.

Green

Chloramphenicol (eye drops)

Green

Clotrimazole (topical)

Green

Dicloxacillin (PO)


Pre-approved for first dose challenge, IDT or SPT by Paediatric Immunologist/Allergist. Desensitisation – ID approval required.
Green

Flucloxacillin (IV and PO)


Pre-approved for first dose challenge, IDT or SPT and desensitisation by Paediatric Immunologist/Allergist or low risk oral challenge as per CHQ-GDL-01076 Paediatric antibiotic allergy assessment, testing and de-labelling.
Green

Framycetin - Gramicidin - Dexamethasone (Sofradex) 8mL Ear drops

Green

Metronidazole (PO and IV)


Pre-approved for first dose challenge, IDT or SPT and desensitisation by Paediatric Immunologist/Allergist.
Green

Miconazole (topical cream)

Green

Nitrofurantoin (PO)


Pre-approved for first dose challenge, IDT or SPT and desensitisation by Paediatric Immunologist/Allergist.
Green

Nystatin (PO and topical)

Green

Permethrin (topical)

Green

Phenoxymethylpenicillin (PO)


Pre-approved for first dose challenge, IDT or SPT and desensitisation by Paediatric Immunologist/Allergist or low risk oral challenge as per CHQ-GDL-01076 Paediatric antibiotic allergy assessment, testing and de-labelling.
Green

Pyrantel (PO)


Pre-approved for first dose challenge, IDT or SPT and desensitisation by Paediatric Immunologist/Allergist.
Green

Roxithromycin (PO)


Pre-approved for first dose challenge, IDT or SPT and desensitisation by Paediatric Immunologist/Allergist.
Green

Tinidazole (PO)


Pre-approved for first dose challenge, IDT or SPT and desensitisation by Paediatric Immunologist/Allergist.
Green

Trimethoprim (PO)


Pre-approved for first dose challenge, IDT or SPT and desensitisation by Paediatric Immunologist/Allergist.
Green

Trimethoprim / Sulfamethoxazole (PO)


Pre-approved for first dose challenge, IDT or SPT and desensitisation by Paediatric Immunologist/Allergist.
Green

Aciclovir (PO and IV)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required. IV Aciclovir not suitable for IDT or SPT due to alkaline pH.


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)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



  • 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).

  • For prophylaxis against Snail and Slug Ingestion (Angiostrongylus cantonensis infection/ rat lung worm)

  • IMPS approval is required for all other indications including for treatment of Echinococcus granulosus (Hydatids) and alternative treatment for children with Strongyloides stercoralis.


Amber

Amoxicillin/ Clavulanic acid (IV)


Pre-approved for first dose challenge, SPT or IDT by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



  • 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.

  • For empiric treatment of facial Cellulitis (of Dental Origin) according to CHQ-GDL-00758 Emergency Management of Paediatric Dental Emergencies

  • 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)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



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)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



Amber

Azithromycin (tablets and suspension) (PO)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



Amber

Cefazolin 5 % eye drops



  • Department of Ophthalmology

  • All other indications require IMPS approval.
Amber

Cefepime (IV)


Pre-approved for first dose challenge, SPT or IDT by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



Amber

Cefotaxime (IV)


Pre-approved for first dose challenge, SPT or IDT by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



or



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)


Pre-approved for first dose challenge, SPT or IDT by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



Amber

Ceftazidime (IV)


Pre-approved for first dose challenge, SPT or IDT by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.




Amber

Ceftazidime intravitreal injection



  • Department of Ophthalmology

  • all other indications require IMPS approval.


Amber

Ceftriaxone (IV)


Pre-approved for first dose challenge, SPT or IDT by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



or




  • 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)


Pre-approved for first dose challenge, SPT or IDT by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.


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)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



Amber

Chloramphenicol eye ointment



  • For ophthalmic use only

  • All other indications require IMPS approval


Amber

Cephazolin (Cefazolin) Intravitreal and intracameral injection


  • Department of Ophthalmology

  • All other indications require IMPS approval.


Amber

Cephazolin (Cefazolin) 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)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



or



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)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.


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)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.


For use by haematology/oncology as alternative to trimethoprim/sulfamethoxazole as PCP prophylaxis



Amber

Doxycycline (IV - SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.



  • 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)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



  • 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)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.


IMPS approval required for all off label/off license indications


Amber

Famciclovir (PO)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



  • 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)


Pre-approved for first dose challenge, SPT or IDT by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



Amber

Gentamicin (IV)


Pre-approved for first dose challenge, SPT or IDT by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.


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)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



  • For use in recalcitrant laboratory proven tinea infections.

  • All other indications require CHQ IMPS or Dermatology approval.


Amber

Hydroxychloroquine (PO)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.


Restricted to prescribing by the following authorised specialists:

  1. Rheumatologists

  2. Immunologists

  3. Dermatologists specifically treating patients with cutaneous lupus

  4. Nephrologists specifically treating patients with SLE

  5. Infectious diseases specialists for treatment of patients with Q fever

  6. Prescribers providing ongoing therapy for patients with SLE or severe RA



For further information refer to the List of Approved Medicines (LAM) homepage at: https://qheps.health.qld.gov.au/medicines/services/lam.


Recommendations from the Australian guidelines for the clinical care of people with COVID-19
https://app.magicapp.org/#/guideline/L4Q5An/section/j1bkzL


  • Do not use hydroxychloroquine for the treatment of COVID-19.

  • This recommendation applies to adults, children and adolescents, pregnant and breastfeeding women, older people living with frailty and those receiving palliative care.

  • Use of hydroxychloroquine may still be considered in the context of randomised trials with appropriate ethical approval, such as combination therapies that include hydroxychloroquine.




Amber

Itraconazole (PO)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



  • For treatment of ABPA according to CHQ GDL 01073 Empirical antimicrobial therapy for children with Cystic Fibrosis on advice of Respiratory Consultant


or



Amber

Lincomycin (IV)


Pre-approved for first dose challenge, SPT or IDT by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.


Approval required after 48 hours therapy for:




Amber

Mebendazole (PO)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



  • Alternative treatment of Eosinophilic enterocolitis, Hookworm, Roundworm, Whipworm or Pinworm.

  • all other indications require IMPS approval


Amber

Minocycline (PO)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



  • For use by Dermatologist in the treatment of severe acne

  • all other indications require IMPS approval


Amber

Mupirocin (intranasal ointment)

Amber

Mupirocin (topical ointment)



Amber

Neomycin (PO)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.



  • 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)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



Amber

Piperacillin/ Tazobactam (IV)


Pre-approved for first dose challenge, SPT or IDT by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



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



or



Amber

Posaconazole (PO)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



Amber

Rifampicin (PO)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



Amber

Teicoplanin (IV)


Pre-approved for first dose challenge, SPT or IDT by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



Amber

Terbinafine (PO)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



  • For use on advice from Dermatologist

  • All other indications require IMPS approval


Amber

Tobramycin (inhaled – TOBI podhaler)



Amber

Tobramycin (IV and nebulised)


Pre-approved for first dose challenge, SPT or IDT by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.


Intravenous:



Nebulised:



Amber

Tobramycin Eye drops and eye ointment



  • For use on advice from Ophthalmology team

  • All other indications require IMPS approval


Amber

Trimethoprim/ Sulfamethoxazole (IV)


Pre-approved for first dose challenge, SPT or IDT by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.


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)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.


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)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



Amber

Vancomycin (IV)


Pre-approved for first dose challenge, SPT or IDT by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.


For use in accordance with the:



Approval required after 72 hours therapy for:



Amber

Vancomycin Intravitreal and intracameral Injection



  • Department of Ophthalmology

  • All other indications require IMPS approval


Amber

Voriconazole (PO)


Pre-approved for first dose challenge by Paediatric Immunologist/Allergist. Ongoing use/ desensitisation – ID approval required.



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Abacavir


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation. High risk for hypersensitivity reactions.

Red

Adefovir (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Amikacin (IV and nebulised)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Amorolfine (nail lacquer 5%)

Red

Amphotericin B lipid complex (Abelcet ) (IV)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Amphotericin (Fungizone ) (SAS) IV


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Anidulafungin (IV)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Artemether+Lumefantrine (Riamet) (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Artesunate (SAS) IV


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Atazanavir


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Atovaquone (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Atovaquone/ Proguanil (Malarone ) (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Aztreonam (IV and nebulised)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Bacitracin (topical) (SAS)

Red

Bedaquiline (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Benznidazole (PO) (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Brincidofovir (Compassionate use/SAS) (PO)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Capreomycin (SAS) (IV)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Caspofungin (IV)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Cefpodoxime (PO) (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Ceftolazone/Tazobactam (IV)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Ceftazidime/Avibactam (IV)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Ceftaroline (IV)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Cephalothin (Cefalotin) eye drops (Cefalotin) – temporary shortage until 2021



  • Department of Ophthalmology

  • all other indications require IMPS approval.




Red

Chloramphenicol (SAS) (IV)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Chloroquine (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Cidofovir (IV)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Ciprofloxacin (IV)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Clofazimine (PO) (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Colistin (IV)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Ciprofloxacin/hydrocortisone (ear drops)

Red

Clarithromycin (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Clindamycin (IV)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Cycloserine (SAS) (PO)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Daclatasvir


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Daptomycin (IV)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Darunavir (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation. High risk of hypersensitivity in patients with a sulpha allergy.

Red

Delamanid (PO) (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Dicloxacillin (IV)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Dolutegravir


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Doripenem (IV)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Efavirenz


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Elvitegravir (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Emtricitabine


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Enfuviritide


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Entecavir (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.


Red

Ethambutol (PO) and (SAS – IV)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Ertapenem (IV)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Erythromycin (IV)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.


Red

Ethionamide (PO) (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Fidaxomicin (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Fluconazole (IV)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Flucytosine (SAS) (IV and PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Fosfomycin (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Fosfomycin IV (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Foscarnet (IV)

Red

Fusidic acid (sodium fusidate) (PO)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Ganciclovir (IV)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

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

Imipenem/cilastatin (IV)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Isavuconazole (IV/oral)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Isoniazid (PO) (SAS – IV)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Ivermectin (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Ketoconazole (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Lamivudine


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Ledipasvir with Sofosbuvir


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Letermovir


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Levofloxacin IV/PO (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Linezolid (PO and IV)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Lopinavir/Ritonavir


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Maraviroc (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Mefloquine (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Miltefosine (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Moxifloxacin (PO and IV)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Meropenem/Vaborbactam (IV)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Meropenem (IV)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Methenamine hippurate


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Micafungin (IV)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Nalidixic acid (PO) (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Natamycin eye drops (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Netilmicin (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Nevirapine


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Niclosamide (PO) (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Nitazoxanide (SAS) (PO)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Norfloxacin (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.


Red

Palivizumab (IM)

Red

Paromomycin (SAS) (PO and topical)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Para-Aminosalicylic acid (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.


Red

Pentamidine (IV and nebulised)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.


Red

Peramivir IV


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Pivmecillinam (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Polymyxin B (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Posaconazole (IV) (compassionate use)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Praziquantel (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Pretomanid (PO) (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Primaquine (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Pristinamycin (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Pylera ( Bismuth, Metronidazole, Tetracycline) (SAS)

Red

Pyrazinamide (PO) (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Pyrimethamine (PO)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Quinine (IV and PO)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Quinupristin/Dalfopristin (IV)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Raltegravir (PO)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Remdesivir IV


For use within CHQ under the guidance of Paediatric ID consultant as per the criteria for access to Remdesivir from the National Medical Stockpile.

ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Ribavirin (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Ribavirin (IV) (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Rifabutin (PO)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Rifampicin (IV)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Rifapentine (PO) (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Rifaximin (SAS – suspension) (PO)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Rilpirivine (with tenofovir and emtricitabine) (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Sofosbuvir


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Streptomycin (SAS) (IM)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.


Red

Sulfadiazine (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Tafenoquine (PO)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Taurolidine/citrate antiseptic lock (Taurolock)

Red

Tedizolid (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Telithromycin (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Tenofovir


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Tetracycline (SAS)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Ticarcillin/Clavulanate (IV)


Drug discontinued in 2018.

Red

Triclosan

Red

Tigecycline (IV)


ID approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Vancomycin (PO)



Red

Voriconazole Intravitreal injection

Red

Voriconazole (IV)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Voriconazole (eye drops)

Red

Zanamavir (inhaled) (IV- compassionate use only)


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

Red

Zidovudine


ID approval and SAS approval required for Paediatric Immunologist/Allergist-led first dose challenge, SPT or IDT and desensitisation.

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.

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.

National Inpatient Medication Chart

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.

Hospital outpatient prescription