5.1.7 Some other antibacterials

Chloramphenicol

Chloramphenicol
  • Capsules 250mg
  • Injection 1g

Fusidic acid

Sodium fusidate
  • Tablets 250mg (£6.02 = 10 tablets)
  • Fusidic acid oral suspension 250mg/5ml (5ml is approximately equivalent to 175mg sodium fusidate) (£6.73 = 50ml)

Indications

  • Infections caused by staphylococci, especially in osteomyelitis

Notes

  1. MHRA Drug Safety Update (September 2011): Systemic fusidic acid (Fucidin) should not be given with statins because of a risk of serious and potentially fatal rhabdomyolysis.

Vancomycin and teicoplanin

Vancomycin
  • Capsules 125mg, 250mg (£140.08 = 28 x 250mg capsules)
  • Injection 500mg, 1g
  • Intrathecal injection 10mg/2ml (unlicensed preparation)

Indications

Notes

  1. Blood level monitoring is mandatory for IV use.
Teicoplanin
  • Injection 200mg, 400mg

Daptomycin

Daptomycin
  • Intravenous infusion 350mg, 500mg vials

Linezolid

Linezolid
  • Tablets 600mg
  • Suspension 100mg/5ml
  • Intravenous infusion 600mg/300ml

Notes

  • Monitor full blood count (including platelet count) weekly.
  • Linezolid should only be initiated in a hospital environment and after consultation with a relevant specialist such as a microbiologist. In exceptional circumstances it may be considered appropriate for a GP to commence treatment in a primary care setting (off-license use), only under the recommendation and supervision of a microbiologist. This should be discussed on an individual patient basis.
  • Linezolid should only be used for life-threatening or deep seated infections due to MRSA where alternate therapy, e.g. vancomycin, is unsuitable. Linezolid is not active against infections caused by Gram negative pathogens. Specific therapy against Gram negative organisms must be initiated concomitantly if a Gram negative pathogen is documented or suspected.
  • The maximum treatment duration is 28 days. The safety and effectiveness of linezolid when administered for periods longer than 28 days have not been established.
  • BNF CHM advice
    Optic neuropathy:
    Severe optic neuropathy may occur rarely, particularly if linezolid is used for longer than 28 days. The CHM recommends that:
    1. patients should be warned to report symptoms of visual impairment (including blurred vision, visual field defect, changes in visual acuity and colour vision) immediately;
    2. patients experiencing new visual symptoms (regardless of treatment duration) should be evaluated promptly, and referred to an ophthalmologist if necessary;
    3. visual function should be monitored regularly if treatment is required for longer than 28 days.
    Blood disorders:
    Haematopoietic disorders (including thrombocytopenia, anaemia, leucopenia, and pancytopenia) have been reported in patients receiving linezolid. It is recommended that full blood counts are monitored weekly. Close monitoring is recommended in patients who:
    1. receive treatment for more than 10–14 days;
    2. have pre-existing myelosuppression;
    3. are receiving drugs that may have adverse effects on haemoglobin, blood counts, or platelet function;
    4. have severe renal impairment.
    If significant myelosuppression occurs, treatment should be stopped unless it is considered essential, in which case intensive monitoring of blood counts and appropriate management should be implemented.
  • Spontaneous reports of serotonin syndrome associated with the co-administration of linezolid and serotonergic agents, including antidepressants such as selective serotonin reuptake inhibitors (SSRIs) have been reported. Co-administration of linezolid and serotonergic agents is therefore contraindicated except where administration of linezolid and concomitant serotonergic agents is essential. In those cases patients should be closely observed for signs and symptoms of serotonin syndrome.

For additional interaction and monitoring requirements associated with treatment, please refer to the manufacturer's

summary of product characteristics for up-to-date information.

Polymixins

Colistimethate sodium
  • Injection 500,000 units, 1million-units, 2million-units
  • Promixin 1million-units
  • Dry powder for inhalation

Notes

  1. For patients with Cystic Fibrosis (CF) treatment should only be prescribed by secondary care
  2. Colistimethate sodium injection is included for nebulised use in non-CF patients with bronchiectasis.
  3. Colistimethate sodium dry powder for inhalation is recommended as an option for use in line with NICE TA276: Colistimethate sodium and tobramycin dry powders for inhalation for treating pseudomonas lung infection in cystic fibrosis (March 2013)

Rifaximin

Rifaximin
  • Tablets 550mg (£259.23 = 56 tablets)

Indications

  • Hepatic encephalopathy

Dose

  • 550mg twice a day
  • The clinical benefit of rifaximin was established from a controlled study in which subjects were treated for 6 months. Treatment beyond 6 months should take into consideration the individual balance between benefits and risks, including those associated with the progression of hepatic dysfunction.
  • Rifaximin should be co-prescribed alongside lactulose (or alternative laxative) sufficient to open bowels twice per day.

Notes

  1. Treatment with rifaximin should be initiated by a Gastroenterology Consultant. Once the patient is stabilised on treatment repeat prescriptions may be issued by primary care, however the ongoing management of the patient's liver disease will continue to be the responsibility of secondary care.
  2. Rifaximin is a non-absorbed antibacterial agent and there are no specific monitoring requirements associated with treatment.
  3. Secondary care will monitor the ongoing need for continuation of rifaximin in individual patients
  4. NICE TA337 Rifaximin is recommended, within its marketing authorisation, as an option for reducing the recurrence of episodes of overt hepatic encephalopathy in people aged 18 years or older (March 2015).

Fidaxomicin


Fidaxomicin

Not routinely commissioned for use in NEW Devon CCG and South Devon and Torbay CCG, following consideration by the clinical policy committee. Click here for more information.

Tedizolid

Tedizolid
  • Tablets 200mg
  • Powder for concentrate for solution for infusion 200 mg

 

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