ZSFGH Restricted Antimicrobials

Modified Date: 
January 1, 2017

Restricted Antimicrobials at San Francisco General Hospital

Antimicrobial

Restricted Route/ Form

Unrestricted Indication

Amikacin

All

None – all initial use requires approval by ID pharmacist or ID fellow

Amphotericin B liposomal

All

None – all initial use requires approval by ID pharmacist or ID fellow

Azithromycin 

600 mg tab 

Prophylaxis or treatment of MAC

1 gm packet

Treatment of Chlamydia

Aztreonam

All

None – all initial use requires approval by ID pharmacist or ID fellow

Capreomycin

All

None – all initial use requires approval by ID pharmacist or ID fellow

Ceftaroline

All

None – all initial use requires approval by ID pharmacist or ID fellow

Ceftazidime

IV

Ophthalmic injection and/ or drops

Ceftriaxone 

2gm IV, IM

Osteomyelitis, endocarditis, meningitis

Clarithromycin

PO

Treatment of H. pylori or MAC

Co-artem

PO

None – all initial use requires approval by ID pharmacist or ID fellow

Daptomycin

All

None – all initial use requires approval by ID pharmacist or ID fellow

Foscarnet

IV

Ophthalmic injection

Ganciclovir

IV

Ophthalmic injection

Imipenem

All

None – all initial use requires approval by ID pharmacist or ID fellow

Itraconazole

All

None – all initial use requires approval by ID pharmacist or ID fellow

Linezolid

All

None – all initial use requires approval by ID pharmacist or ID fellow

Meropenem

All

None – all initial use requires approval by ID pharmacist or ID fellow

Micafungin

All

None – all initial use requires approval by ID pharmacist or ID fellow

Moxifloxacin

All

None – all initial use requires approval by ID pharmacist or ID fellow

Pentamidine

All

None – all initial use requires approval by ID pharmacist or ID fellow

Piperacillintazobactam

All

None – all initial use requires approval by ID pharmacist or ID fellow

Posaconazole

All

None – all initial use requires approval by ID pharmacist or ID fellow

Rifampin

IV

None – all initial use requires approval by ID pharmacist or ID fellow

PO

Tuberculosis

Voriconazole

All

None – all initial use requires approval by ID pharmacist or ID fellow

Non-Formulary*

All

None – all initial use requires approval by ID pharmacist or ID fellow

 

*Non-formulary antimicrobials include but are not limited to the following: Colistin, Caspofungin, Fidaxomicin, Posaconazole, Quinpristin/dalfopristin, Tigecycline