Antibiotic formulary

Establish a protocol (eg, a preprinted order sheet) that standardizes antibiotic choice according to current published evidence, formulary availability, institutional resistance patterns, and cost,... 

Hypersensitivity is the most important side-effect of penicillins and is manifest usually by rashes and rarely anaphylactic reactions. Allergic reactions to penicillins occur in 1-10% of exposed individuals anaphylactic reactions occur in fewer than 0.05% treated patients (Joint Formulary Committee, 2008). General side-effects of antibiotics include nausea, vomiting, abdominal pain, diarrhoea, headache and vaginitis. 

Formulary decisions Restricting broad spectrum antibiotics to infectious disease service Designating more expensive, equal-efficacy drug to nonformulary status Cost-effectiveness analyses... 

Formulary management Antibiotic restrictions Compliance with prescribing according to institution-specific guidelines... 

British National Formulary. British Medical Association Pharmaceutical Press, London. [The chapter on drugs used in the treatment of infections is a particularly useful section. New editions of the BNF appear at regular intervals] Brown, A.G. (1981) New naturally occurring [5-lactam antibiotics and related compounds. J Antimicrob Chemother, 7,15-48. 

As a result of these observations, a variety of methods have been utilized to modify antimicrobial use in an effort to combat resistance. These include the use of an antimicrobial formulary, re.striction of agents, requirement of prior approval to obtain specific agents, multidisciplinary antibiotic management teams, and the use of computerized support systems. The impact of these programs on resistance is reviewed elsewhere,and one or more of these methods is being employed in many institutions. 

Massoomi, F. Formulary management Antibiotics and therapeutic interchange. Pharm. Pract. Manage. Q 1996, 16 (3), 11 -18. 

In the course of U.S. Senate sub-committee hearings on drug pricing and equivalence of generics late 1967, it developed that different commercial preparations of chloramphenicol antibiotic, all of which conformed with specifications of the U.S. Pharmacopeia and the regulations of the FDA, were not therapeutically equivalent. One brand showed more rapid absorption and plasma-level build-up, a critical difference. As a sequel, competitive brands were temporarily withdrawn from sale while the FDA and a joint National Formulary-USP panel undertook a review of test procedures. 

Infrared spectra are now widely used in the examination of pharmaceuticals. The sixteenth revision of The Pharmacopoeia of the United States (U.S.P.) and the eleventh edition of the National Formulary (N.F.) have presented identification tests which used infrared spectroscopy, whereas no infrared tests were used in U.S.P. XV or N.F. X. Infrared spectra have attained acceptance in legal considerations and are now given in patent applications as characteristics of antibiotics of unknown structure. In the pharmaceutical industry there are many applications for quantitative infrared analyses in research and development work, pharmacy research, and in various phases of pharmaceutical production. For example, infrared data are used to characterize reaction conditions and yields, to assay the purity of intermediate products, to examine such problems as the stability of a drug in the material in which it is suspended, and to maintain quality control in the chemical production of bulk drugs. A recent review (Papendick et al, 1969) has given many references to fractionation and isolation methods for pharmaceutical analysis, such as the various types of chromatography, electrophoresis, countercurrent distribution, and extraction. The authors presented many references to infrared analyses for a wide variety of compounds (Table 16.1). 

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