Restricted Antimicrobials UCSF Medical Center

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The Pharmacy and Therapeutics Committee of UCSF Medical Center has authorized the restricted use of certain antimicrobials.  Release of a restricted antimicrobial by the pharmacy can be achieved by:

1) documentation of one of the unrestricted indications for the antimicrobial on order entry; or

2) consultation with the a member of the Antimicrobial Stewardship Program (ASP) or the ID fellow for active ID consults.  

More details on the antimicrobial ordering process are available here.

Restricted Antimicrobials

Antimicrobial Unrestricted Indications
Amikacin IV None; all use requires authorization from the Antimicrobial Stewardship Program or consulting ID fellow
Amphotericin B liposomal (AmBisome)

1) Documented or suspected fungal pneumonia in a patient intolerant of or with contraindications to voriconazole

2) Prophylaxis against fungal infections in patients on the hematology/BMT service or lung transplant service

All other indications require approval from the Antimicrobial Stewardship Program or consulting ID fellow

Caspofungin

1) Documented sterile site (not urine or respiratory) infection  with microbiologically confirmed Candida glabrata or Candida kruseii

2) Documented sterile site infection (not urine or respiratory) infection with yeast, pending species identification

3) Prophylaxis against fungal infections in patients on the hematology/BMT service with intolerance of or contraindications to voriconazole

All other indications require approval from the Antimicrobial Stewardship Program or consulting ID fellow

Ceftaroline

None; all use requires authorization from the Antimicrobial Stewardship Program or consulting ID fellow

Cidofovir

None; all use requires authorization from the Antimicrobial Stewardship Program or consulting ID fellow

Colistin IV

None; all use requires authorization from the Antimicrobial Stewardship Program or consulting ID fellow

Daptomycin

None; all use requires authorization from the Antimicrobial Stewardship Program or consulting ID fellow

Foscarnet IV

None; all use requires authorization from the Antimicrobial Stewardship Program or consulting ID fellow

Imipenem

None; all use requires authorization from the Antimicrobial Stewardship Program or consulting ID fellow

Linezolid

1) Documented infection of a sterile site (not urine or respiratory) with microbiologically confirmed vancomycin-resistant Enterococcus

2) Documented infection of a sterile site (not urine or respiratory) with Enterococcus or streptococci in an immuncompromised or severely ill patient pending susceptibility testing

3) Suspected or documented Gram-positive infection in patient with severe vancomycin allergy

All other indications require approval from the Antimicrobial Stewardship Program or consulting ID fellow

Posaconazole

1) Prophylaxis against fungal infections in patients on the hematology/BMT service with intolerance of or contraindications to voriconazole

All other indications require approval from the Antimicrobial Stewardship Program or consulting ID fellow

Quinupristin/dalfopristin (Synercid)

None; all use requires authorization from the Antimicrobial Stewardship Program or consulting ID fellow

Tigecycline

None; all use requires authorization from the Antimicrobial Stewardship Program or consulting ID fellow