ZSFG Restricted Antimicrobials & Workflow

Modified Date: 
February 17, 2022
April 6, 2023
August 30, 2024

Restricted Antimicrobials at Zuckerberg San Francisco General

All of the antimicrobials listed require approval by ID pharmacist or ID fellow, except for the routes and indications noted in the table below. 

Contact information:

  • ID Pharmacist: "ZSFG ID Pharmacist" on Epic secure chat (preferred) or pager 443-4379
  • ID Fellow: 443-2847

Approval workflow for adult patients:

  • Weekdays
    • 0800 - 1630: contact ID pharmacist
    • 1630 - 2000: contact ID fellow
    • 2001 - 0759: Pharmacy will release overnight doses pending approval the next day
  • Weekends & Holidays
    • 0800 - 2000: contact ID fellow
    • 2001 - 0759: Pharmacy will release overnight doses pending approval the next day

Approval workflow for neonates and pediatric patients:

  • Weekdays
    • 0800 - 1630: contact ID pharmacist
    • 1631 - 0759: Pharmacy will release sufficient doses pending ID pharmacist review
  • Weekends & Holidays
    • All hours: Pharmacy will release sufficient doses pending ID pharmacist review

Restricted

Antimicrobial

Comments

Amikacin

 

Amphotericin B (liposomal, conventional)

Approval not required for: opthalmic injection and drops

Artemether Lumefantrine (Coartem)  
Artesunate  

Aztreonam

 

Ceftaroline

 

Ceftazidime

Approval not required for: opthalmic injection and drops 

Ceftazidime-Avibactam (Avycaz)  
Ceftolozane-Tazobactam (Zerbaxa)  

Clarithromycin

Approval not required for: H pylori, MAC treatment or prophylaxis

Daptomycin

 

Ertapenem Approval not required for: ESBL within past year, new ICU admission for sepsis
Fidaxomicin (Dificid) Approval not required for high-risk first episode CDI and all 1st recurrence. See ZSFG C. Difficile Guideline for details

Foscarnet

Approval not required for opthalmic injection

Fosfomycin  

Ganciclovir

Approval not required for opthalmic injection

Imipenem

 

Isavuconazole Approval not required for continuation of prior to admission therapy

Itraconazole

Approval not required for: Aspergillus, Histoplasma, eosinophilic folliculitis, bullous tinea and continuation of prior to admission therapy 

Linezolid

Approval not required for: empiric necrotizing soft tissue infection (NSTI), IV formulation only

Meropenem

N/A

Micafungin

N/A

Moxifloxacin

Approval not required for opthalmic injection and/or drops

Penicillin G Benzathine (Bicillin L-A) ID approval required during shortage/recall (7/2025)

Pentamidine

 

Posaconazole

Approval not required for continuation of prior to admission therapy

Pyrimethamine  

Rifampin

Approval not required for: active or latent tuberculosis

Tigecycline  

Voriconazole

Approval not required for: opthalmic injection and/or drops and continuation of prior to admission therapy

Non-Formulary*

 

*Non-formulary antimicrobials at ZSFG include, but are not limited to: Apretude (cabotegravir injection), Cabenuva (cabotegravir/rilpivirine injection), caspofungin, cefiderocol, colistin, lenacapavir, omadacycline, tedizolid