Prior Authorization of Restricted Antimicrobials

Prior authorization is required for certain restricted antimicrobials. Prescribers wishing to use a restricted antimicrobial may obtain authorization by one of two methods:

1) If Infectious Diseases consultation already is obtained, prescribers should request authorization from the attending physician or fellow on the ID Consult team. “Curbside” approvals without formal consultation are not allowed.

2) Prescribers may page the CAUSE delegate at 806-6494. When using this method, the prescriber should be prepared to discuss the patient over the phone and provide detailed information that justifies use of the restricted antimicrobial.

The following antimicrobials have been selected for restriction by the CAUSE Advisory Board, a group of physicians, pharmacists, and microbiologists representing many medical disciplines throughout the medical center. The reasons for restricting an antimicrobial include potential for negative impact on antibiotic resistance, complexity of use (e.g. complicated dosing or multiple drug interactions), high risk of toxicity, the drug’s limited or unique indications, and cost.

DRUGS REQUIRING PRIOR AUTHORIZATION:

Acyclovir Intravenous (Zovirax) - oral acyclovir products are not restricted

Amikacin (Amikin) **National shortage**

Amphotericin B Lipid Complex (ABLC, Abelcet)

Aztreonam (Azactam)

Ceftaroline (Teflaro)

Ceftazidime (Fortaz)

Colistin, Colistimethate (Colymycin)

Daptomycin (Cubicin)

Ertapenem (Invanz)

Fidaxomicin (Dificid)

Imipenem (Primaxin)

Linezolid (Zyvox)

Meropenem (Merrem)

Micafungin (Mycamine) **prior approval not required for oncology services**

Posaconazole (Noxafil)

Quinupristin/Dalfopristin (Synercid)

Tigecycline (Tygacil)

Voriconazole (Vfend)

 

NOTABLE DRUGS NOT ON FORMULARY:

Doripenem (Doribax)

Telavancin (Vibativ)

Liposomal Amphotericin B (Ambisome)

Amphotericin B Colloidal Dispersion (Amphotec)

 

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CAUSE
Christopher Ohl, MD
CAUSE Medical Director

cohl@wakehealth.edu

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Last Updated: 06-25-2014
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Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.