Unrestricted antibiotics (do not require ID approval)

Acyclovir (IV and PO)

Amikacin

Amoxicillin

Amoxicillin-clavulanate

Ampicillin

Ampicillin-sulbactam

Bacitracin

Cefazolin

Ceftriaxone

Cephalexin

Clindamycin

Clotrimazole troches

Dapsone

Dicloxacillin

Doxycycline

Erythromycin

Gentamicin

Isoniazid

Metronidazole

Nitrofurantoin

Nystatin

Oxacillin

Penicillin

Terbinafine

Tetracycline

Trimethoprim/sulfamethoxazole (PO)

 

Do not require ID approval if meet criteria below (per GLA guidelines):

Atovaquone-proguanil

 • Travel to areas where transmission of chloroquine-resistant malaria is endemic (up to 30d) as per www.cdc.gov/travel. To start 1-2d prior to exposure and continue for 7d after return.

Azithromycin
 • IV use is unrestricted up to 5 days, but oral conversion is strongly recommended for non-ICU patients who are otherwise tolerating PO.
 • Chlamydia infection (single dose) or M. avium prophylaxis (once weekly)
 • PO (tablets): Discharge treatment for community-acquired pneumonia in patients who cannot tolerate oral doxycycline up to 5 days total therapy.

Cefotetan
 • Surgical prophylaxis (24 hours perioperatively)

Ciprofloxacin
 • Urinary tract infection, pyelonephritis, prostatitis (note that >30% of outpatient urine isolates at GLA are resistant to fluoroquinolones)(if resistance to cephalexin or TMP-SMX is suspected)
 • Diverticulitis (with metronidazole)
 • SBP prophylaxis (weekly)

Clarithromycin
 • Treatment of documented M. avium infection or H. pylori 

Ertapenem
 • Treatment of hospital-associated pneumonia in ward patients (up to 7d)
 • Severe diabetic foot infection (infection involving skin/subcutaneous tissue and/or deeper structures meeting at least one SIRS criterion (T > 38° C or < 36°C, pulse > 90/min, RR > 20/min, or PaCO2 < 32 mm Hg with WBC > 12,000 or < 4000 cells/uL or >/= 10% immature (band) forms)) (up to 7d)

• Urinary tract infection suspected or confirmed to be due to ceftriaxone-resistant Enterobacteriaceae (up to 7d)

Fluconazole
 • Single dose treatment for vaginal candidiasis
 • Oral thrush
 • Esophageal candidiasis
 • Suspected/confirmed pulmonary coccidioidomycosis (up to 30 days, please send ID consult for followup)

 • Weekly dosing for onychomycosis (typical dose: 200mg/week)

Levofloxacin
 • IV: Severe community-acquired pneumonia (requiring ICU care) and severe PCN allergy
 • PO: Step-down therapy from piperacillin/tazobactam or ertapenem for treatment of hospital-acquired pneumonia
 • Urinary tract infection, pyelonephritis, prostatitis (if resistance to cephalexin or TMP-SMX is suspected, ciprofloxacin is preferred). Note that >30% of outpatient urine isolates at GLA are resistant to fluoroquinolones.
 • Diverticulitis (with metronidazole; ciprofloxacin is preferred)

Meropenem
 • Empiric treatment of hospital-acquired or ventilator-associated pneumonia in ICU patients (3 day limit). 
 • Targeted therapy (7 day limit) of susceptible gram-negative pathogen resistant to all available fluoroquinolones, penicillins, cephalosporins and aminoglycosides
 • Susceptible P. aeruginosa resistant to all other ß-lactam antibiotics

Micafungin
 • Treatment of suspected disseminated candidemia in ICU patients (3 days)

Mupirocin

• Treatment of MRSA colonization prior to surgery

Oseltamivir

• Treatment of suspected influenza (acute respiratory symptoms, documented temperature >37.8°C/100°F plus two of the following: cough, headache, myalgia, sore throat) during flu season (October through March)

Valacyclovir
 •Treatment of herpes zoster

• Treatment/prophylaxis of oral or genital HSV infection in patients with prior clinical failure of acyclovir or inability to adhere to more frequent dosing of acyclovir

Vancomycin PO
 • Suspected (3 days) or proven (up to 14 days) treatment of  C. difficile colitis that is severe per GLA guidelines (http://www.vaglaid.org/gla-guidelines) or recurrent.

 

Requires Antibiotic Timeout for continuation past day 3 of therapy:

Empiric therapy is unrestricted until hospital day 3, at which time an antibiotic timeout note template must be completed to continue for an additional 48-96h; ID approval is required for further continuation.

Piperacillin/Tazobactam
Vancomycin (IV)

 

Requires ID approval (can send ID e-consult for non-urgent issues for outpatients)

Albendazole

Amphotericin

Antiretroviral agents

Atovaquone

Aztreonam

Cefepime (CURRENTLY IN SEVERE NATIONWIDE SHORTAGE, USE ALTERNATIVE AGENTS IF POSSIBLE)

Cefpodoxime

Ceftaroline

Ceftazidime

Ceftazidime/avibactam

Ceftolozone/tazobactam

Chloramphenicol

Chloroquine

Cidofovir

Colistin

Dalbavancin

Daptomycin

Ethambutol

Famciclovir

Flucytosine

Foscarnet

Fosfomycin

Ganciclovir

Imipenem-cilastatin

Itraconazole

Ivermectin

Ketoconazole

Linezolid

Mebendazole

Mefloquine

Minocycline

Nitazoxanide

Oritavancin

Paromomycin

Pentamidine

Polymyxin B (IV)

Primaquine
Pyrimethamine

Pyrazinamide

Quinupristin/dalfopristin

Ribavirin (non-viral hepatitis indications)

Rifabutin

Rifampin (use by pulmonary service unrestricted for treatment of latent tuberculosis)

Rifapentine

Rifaximin (needs GI approval when given for hepatic encephalopathy)

Streptomicin

Telavancin

Tigecycline

Tobramycin

Trimethoprim-sulfamethoxazole (IV)

Valganciclovir

Voriconazole

 

Medications that can be approved/prescribed by ID or GI when used for viral hepatitis

Adefovir

Daclatasavir

Elbasvir/grazoprevir

Entecavir

Interferon/peg-interferon

Lamivudine

Ledipasvir/sofosbuvir

Ombitasvir/paritaprevir/ritonavir +/- dasabuvir

Ribavirin

Simeprevir

Sofosbuvir

Sofosbuvir/velpatasvir

Telbivudine

Tenofovir

 

Requires PBM approval

Fidaxomicin

Isavuconium (isavuconazole)

Posaconazole

Tedizolid

Moxifloxacin

 

Drugs that are not available due to equivalent or better alternatives:

Anidulafungin

Caspofungin

Cefotaxime

Doripenem

Griseofulvin