These are the antimicrobials used within MTW NHS Trust and West Kent CCG, please refer to the appropriate Antimicrobial guidelines for guidance on the choice of antimicrobial for different indications.
Drug Safety Update
May 2014: Voriconazole: reminder of risk of liver toxicity, phototoxicity and squamous cell carcinoma.
July 2018: Parenteral amphotericin B: reminder of risk of potentially fatal adverse reaction if formulations confused
July 2020: Liposomal and lipid-complex formulations: name change to reduce medication errors
Never interchange liposomal, pegylated-liposomal, lipid-complex, and conventional formulations that contain the same drug substance
October 2020: Flucytosine (Ancotil): new contraindication in patients with DPD deficiency
Important Safety Information
Heart failure - itraconazole
Following reports of heart failure, caution is advised when prescribing itraconazole to patients at high risk of heart failure. Those at risk include:
- patients receiving high doses and longer treatment courses;
- older adults and those with cardiac disease;
- patients with chronic lung disease (including chronic obstructive pulmonary disease) associated with pulmonary hypertension;
- patients receiving treatment with negative inotropic drugs, e.g. calcium channel blockers.
Itraconazole should be avoided in patients with ventricular dysfunction or a history of heart failure unless the infection is serious.
Hepatotoxicity
Fluconazole: Monitor liver function with high doses or extended courses—discontinue if signs or symptoms of hepatic disease (risk of hepatic necrosis).
Itraconazole: Potentially life-threatening hepatotoxicity reported very rarely—discontinue if signs of hepatitis develop. Caution if history of hepatotoxicity/active liver disease or receiving other hepatotoxic drugs
Voriconazole: Hepatitis, cholestasis, and acute hepatic failure have been reported; risk of hepatotoxicity increased in patients with haematological malignancy. Consider treatment discontinuation if severe abnormalities in liver function tests.
Triazole antifungals (e.g. fluconazole, itraconazole, voriconazole) have the potential to interact with a wide variety of drugs please check BNF for details
