Other antibacterials (Formulary)

Important: Therapy notes

Important: Therapy notes

• Metronidazole is indicated for anaerobic infections.
• For use in trichomoniasis see NHS Highland and Western Isles Antimicrobial website.
• Warn patients of the risk of a disulfiram-like reaction if alcohol is taken while on metronidazole.

Important: Therapy notes

MHRA advice: Nitrofurantoin: reminder of the risks of pulmonary and hepatic adverse drug reactions (April 2023) (www.gov.uk).

• Nitrofurantoin may be used for urinary-tract infections in the first and second trimesters in pregnancy. 
• The modified release preparation has improved patient tolerability and may reduce the need for second-line antibiotics.

Important: Therapy notes

SPS article: What is a suitable combined oral contraceptive pill in a patient who is taking hepatic enzyme-inducing drugs, such as carbamazepine, phenytoin, rifampicin or rifabutin? (May 2019).

• Warn patients that rifampicin therapy might colour body secretions orange/red (including soft contact lenses). 
• Be aware of important drug interactions with rifampicin, eg failure of the oral contraceptive due to enzyme inducement (refer to BNF). 
• Avoid monotherapy due to rapid emergence of resistant strains.

Important: Therapy notes

• Sodium fusidate has a very limited spectrum of activity.  
• Avoid monotherapy as it will lead to emergence of resistant strains.

Important: Therapy notes

Important: Therapy notes

• For systemic infections where vancomycin is indicated, the intravenous route must be used. 
• For intravenous use follow hospital guidelines. 
• Drug levels require monitoring. 
• Vancomycin is very poorly absorbed and should only be used orally in the treatment of Clostridioides difficile diarrhoea see antimicrobial guidance.
• See: information pack for GPs Clostridioides difficile
• Vancomycin and teicoplanin are mainly reserved for treatment of known or suspected MRSA infection.