| ClassIII |
Antibiotics
requiring approval from the appropriate advisory source
regardless of dose.
Note: The Department of Pharmacy will dispense sufficient
medication to last up to and including 12 noon to give
the prescribing physician time to contact the appropriate
advisory source. |
| |
Amikacin |
Document gentamicin and tobramycin
resistance
Exceptions: Class I for use in the Pediatric
ICU and Burn Unit only |
| |
Cefepime |
Document ceftazidime resistance |
| |
Ciprofloxacin (IV) |
Document appropriateness over other
formulary antibiotics |
| |
Fluconazole (IV) |
Document need for IV fluconazole over
oral therapy |
| |
Foscarnet |
Document cytomegalovirus infection |
| |
Gancyclovir |
Document cytomegalovirus infection |
| |
Imipenem / Cilastatin |
Document need for imipenem/cilastin |
| |
Liposomal Amphotericin
B |
Document invasive fungal infection |
| |
Meropenem |
Document imipenem gram-negative resistance,
history of seizures or bacterial meningitis |
| |
Ribavirin |
Document Respiratory Syncytial Virus
infection |
| |
Rifampin (IV) |
Justify the need for the intravenous
preparation over the use of oral therapy |
| |
Tobramycin |
Document gentamicin resistance
Exceptions: Class I antibiotic for use in the
Medical ICU |
| |
Trovofloxacin (IV) |
Justify the need for trovofloxacin
over ciprofloxacin |
| |
Vancomycin (PO) |
Document resistance or contraindication
to use of metronidazole for the treatment of Clostridium
difficile |
| |
Vancomycin (IV) |
Provided a dose of 1 gram and the dosing
interval of Q12H is not exceeded. The Subcommittee recommends
standard dosing of 1 gm Q12H for adult patients with
normal renal function and modification of the regimen
by extending the dosing interval for patients with impaired
renal function.
AUTOMATIC STOP ORDER EVERY 96 HOURS FOR VANCOMYCIN |
Revised: October 3, 2000