VASF Restricted Antimicrobials

Modified Date: 
September 22, 2023

 

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.