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.
Commonly Prescribed Restricted Antimicrobials (see attached pdf for full list)
| Drug | Restrictions |
| Cefepime | Approval by ID/ASP, Hematology-Oncology, or ICU primary team required before dispensing. |
| 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 |
Contact ID/ASP for approval. Non-formualry medication: Place Pharmacy Non-formulary Consult |
| Daptomycin | Contact ID/ASP for approval. |
| Isavuconazole |
All indications restricted. Contact ID/ASP for approval. Non-fomulary medication: Place Pharmacy Non-formulary Consult |
| Levofloxacin |
Unrestricted for patients with CAP and severe 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 | Contact ID/ASP for approval. |
| Meropenem | Contact ID/ASP for approval. |
| Minocycline |
All indications restricted. Approval by ID/ASP or Derm required before dispensing. IV formulation is Non Formulary: Place Pharmacy Non-Formulary Consult |
| Moxifloxacin | Contact ID/ASP for approval. |
| Piperacillin-tazobactam (Zosyn) | Approval by ID/ASP or ICU required before dispensing. |
| Posaconazole | Approval by ID/ASP or Heme/onc required before dispensing |
| Voriconazole | All indications restricted. Contact ID/ASP for approval. |