Restricted Antimicrobials at San Francisco VA (VASF)
Antimicrobials restricted to the infectious diseases service are available to order by house staff BUT require prior approval by ID provider/ ASP pharmacist before processing pharmacist will release the medication order.
ID/ASP Antimicrobial Approval Coverage:
- Monday – Sunday 8 am to 6:30 pm → Contact ASP Pharmacist (pager: 223-8046 or EXT 25269 or 23763)
- Monday – Sunday 6:30 pm to 10 pm & Holidays → Contact ID Fellow (pager: 443-5151)
If an order for an ID restricted agent is received without prior approval, pharmacist will make a reasonable attempt to contact prescribing provider/ ordering service.
Restricted agents ordered during off hours will be processed as one-time doses by pharmacy and reviewed for continuation by ID/ASP during business hours. Restricted antimicrobials may be continued when patients transfer units including antimicrobials initiated in the ICU prior to transfer.
| Drug | Restrictions |
| Amikacin | All indications restricted. Contact ID/ASP for approval. |
| Amphotericin B | All formulations and indications restricted. Contact ID/ASP for approval. |
| Atovaquone | All indications restricted. Contact ID/ASP for approval. |
| Aztreonam | Unrestricted for patients with a history of severe beta-lactam allergy. For all other indications, contact ID/ASP for approval. |
| Cefepime | All indications restricted. Approval by ID/ASP, Hematology-Oncology, or ICU primary team required before dispensing. |
| Cefidericol | All indications restricted. Contact ID/ASP for approval. |
| Ceftaroline | All indications restricted. Contact ID/ASP for approval. |
| Ceftazidime | All indications restricted. Contact ID/ASP for approval. |
| Ceftazidime-avibactam (Avycaz) | All indications restricted. Contact ID/ASP for approval. |
| Ceftolozane/tazobactam (Zerbaxa) | All indications restricted. Contact ID/ASP for approval. |
| Cidofovir | All indications restricted. Contact ID/ASP for approval. |
| Ciprofloxacin | Inpatient use only: approval by ID/ASP or GI section required before dispensing. |
| Clindamycin | Inpatient use only: approval by ID/ASO, Oral Surgery or ENT required before dispensing |
| Dalbavancin |
All indications restricted. Contact ID/ASP for approval. Non-formualry medication: Place Pharmacy Non-formulary Consult |
| Daptomycin | All indications restricted. Contact ID/ASP for approval. |
| Eravacycline | All indications restricted. Contact ID/ASP for approval. |
| Fidaxomicin | All indications restricted. Contact ID/ASP for approval. |
| Foscarnet | All indications restricted. Contact ID/ASP for approval. |
| Ganciclovir | All indications restricted. Contact ID/ASP for approval. |
| Imipenem-cilistatin | All indications restricted. Contact ID/ASP for approval. |
| Isavuconazole |
All indications restricted. Contact ID/ASP for approval. Non-fomulary medication: Place Pharmacy Non-formulary Consult |
| Itraconazole | All indications restricted. Contact ID/ASP for approval. |
| Levofloxacin |
Unrestricted for patients with CAP and beta-lactam allergy, or on hematology-oncology service. For all other indications (inpatient and outpatient), approval by ID/ASP or Heme/onc required before dispensing. |
| Linezolid | All indications restricted. Contact ID/ASP for approval. |
| Meropenem | All indications restricted. Contact ID/ASP for approval. |
| Minocycline |
All indications restricted. Approval by ID/ASP or Derm required before dispensing. IV formulation is NF: Place Pharmacy Non-Formulary Consult |
| Moxifloxacin | All indications restricted. Contact ID/ASP for approval. |
| Penicillin G Sodium (IV) |
Unrestricted for all indications: Non-formulary medication: Place Pharmacy Non-Formulary Consult |
| Piperacillin-tazobactam (Zosyn) | All indications restricted. Approval by ID/ASP or ICU required before dispensing. |
| Posaconazole | All indications restricted. Approval by ID/ASP or Heme/onc required before dispensing |
| Pyrimethamine | All indications restricted. Contact ID/ASP for approval. |
| Rifabutin | All indications restricted. Contact ID/ASP for approval. |
| Rifampin | Approval by ID/ASP required before dispensing except for O.R. graft soaking (one-time dose). |
| Sulfadiazine | All indications restricted. Contact ID/ASP for approval. |
| Voriconazole | All indications restricted. Contact ID/ASP for approval. |