Protected Antibacterial and Antiviral agents

Any prescriber is authorised to use the following antibacterials for the listed indications.

Use outwith the listed indications, or where no specific indications are listed, should only be on recommendation of a Microbiology/Infectious Disease specialist.

All use is subject to licensing and SMC restrictions where these are in place.

Drug	Indications
Amikacin	1. Nebulised - on advice of a respiratory or infection specialist for treatment of non-tuberculous mycobacterial lung infections caused by M.avium complex in adults with limited treatment options who do not have cystic fibrosis.
Aztreonam	N.A.
Cefazolin	N.A.
Cefiderocol	N.A
Ceftazidime	1. Empirical treatment of CAPD peritonitis 2. Exacerbation of COPD/bronchiectasis in patients colonised with susceptible P. aeruginosa or resistant gram negative organisms.
Ceftazidime/avibactam (Zavicefta)	N.A.
Ceftolozane/tazobactam (Zerbaxa)	N.A.
Ceftriaxone	1. Suspected or proven bacterial CNS infection 2. Pelvic inflammatory Disease/tubo-ovarian abscess 3. Uncomplicated gonorrhoea. 4. Bacterial skin and soft tissue infections on Cellulitis OPAT pathway
Cefuroxime	1. Surgical prophylaxis as per NHS Ayrshire and Arran guidelines.
Chloramphenicol (IV or oral)	1. Suspected meningitis in penicillin anaphylaxis.
Ciprofloxacin (IV only)	1. Neutropenic Sepsis in patients with anaphylaxis to penicillins 2. Indication in line with Empirical Antimicrobial Policy, but oral route compromised.
Clindamycin	1. Diabetic foot infection on advice of Consultant Diabetologist 2. Pelvic-inflammatory disease and tubo-ovarian abscess in patients with anaphylaxis to penicillins. 3. Suspected chorioamnionitis with Group B strep (GBS) prophylaxis in patients with anaphylaxis to penicillins. 4. Treatment of necrotising fasciitis
Colistin	N.A.
Dalbavancin	1. For restricted indication in adult lower limb cellulitis OPAT pathway (See AthenA protocol)
Daptomycin	N.A.
Ertapenem	N.A.
Fidaxomicin	1. Second line treatment of C.difficile infection or 1st recurrence of C.difficile infection in line with Scottish Antimicrobial Prescribing Group treatment guidance.
Foscarnet	N.A.
Fosfomycin (IV only)	N.A.
Imipenem (+ cilastatin)	N.A.
Linezolid	1. Initial treatment of streptococcal bacteraemia in patients with known Vancomycin-resistant enterococci (VRE)
Meropenem	1. Initial treatment of sepsis in patients known to be colonised with ESBL-producing organisms. 2. Treatment of infections caused by gram negative organisms with no other reported susceptibility. 3. Initial treatment of necrotising fasciitis in patients known to be colonised with ESBL-producing organisms
Meropenem/vaborbactam	N/A.
Oritavancin	N.A
Piperacillin/tazobactam	1. First line treatment of febrile neutropenia in line with policy 2. Empirical substitution of Gentamicin as per 'IV Gentamicin Review after 72 Hours of treatment' algorithm
Pentamidine	N.A.
Tedizolid	N.A.
Teicoplanin	1. For surgical prophylaxis as per NHS Ayrshire & Arran guideline
Temocillin	1. Empirical treatment of Spontaneous bacterial peritonitis (SBP) 2. Meropenem-sparing option for treatment of infections caused by ESBL-producing organisms with no other reported susceptibilities. 3. Empirical substitution of Gentamicin in eGFR<20mL/hr or as per 'IV Gentamicin Review after 72 Hours of treatment' algorithm 4. Empirical substitution of gentamicin in patients with decompensated liver disease 5. Treatment of HAP in patients with contra-indications to co-trimoxazole or gentamicin
Ticarcillin/clavulanate	N.A.
Tigecycline	N.A.
Tobramycin	N.A