ZSFG Restricted Antimicrobials & Workflow

Site:
Zuckerberg San Francisco General
Modified Date:
Category:
Policies, Procedures, & Protocols

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

 

CeftazidimeApproval not required for: opthalmic injection and drops 
Ceftazidime-Avibactam (Avycaz) 
Ceftolozane-Tazobactam (Zerbaxa) 
ClarithromycinApproval not required for: H pylori, MAC treatment or prophylaxis
Daptomycin

 

ErtapenemApproval 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
FoscarnetApproval not required for opthalmic injection
Fosfomycin 
GanciclovirApproval not required for opthalmic injection
Imipenem

 

IsavuconazoleApproval not required for continuation of prior to admission therapy
ItraconazoleApproval not required for: Aspergillus, Histoplasma, eosinophilic folliculitis, bullous tinea and continuation of prior to admission therapy 
LinezolidApproval not required for: empiric necrotizing soft tissue infection (NSTI), IV formulation only
Meropenem

N/A

Micafungin

N/A

MoxifloxacinApproval not required for opthalmic injection and/or drops
Penicillin G Benzathine (Bicillin L-A)ID approval required during shortage/recall (7/2025)
Pentamidine

 

PosaconazoleApproval not required for continuation of prior to admission therapy
Pyrimethamine 
RifampinApproval not required for: active or latent tuberculosis
Tigecycline 
VoriconazoleApproval 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