Welcome to #AntibioticWeekly! I'll be discussing the Restricted Antibiotics under the DOH Antimicrobial Stewardship Program:

Cefepime - a 4th generation Cephalosporin used for several infections; has coverage for gram+ and gram-, pseudomonas, but no coverage for Enterococci

Colistimethate/Colistin:
Polymyxin E; widely used for multidrug-resistant gram-negative organisms. More appropriate choice for urinary tract infections since the active form is excreted in the urine (Colistin is a prodrug)

Ertapenem - a Carbapenem with NO activity against pseudomonas aeruginosa; may be used instead of meropenem for non-pseudomonal infections.

Linezolid- covers MSSA, MRSA, Vancomycin-resistant Enterococci and Strep. pneumoniae; has excellent oral bioavailability- IV and oral doses are the same.
Linezolid IV solutions should NOT be exposed to light.

Meropenem- a Carbapenem with broad spectrum activity against gram+ and gram- organisms; with Ertapenem, widely used against extended-spectrum beta-lactamase- producing organisms, can be also used for CNS(brain) infections.

Polymyxin B- same with Colistin, widely used for multidrug-resistant gram-negative organisms; used in situations where Colistin may not be used, such as renal impairment.
Polymyxin B is NOT used for urinary tract infections.

Vancomycin - a glycopeptide drug used for gram-positive infections, including Methicillin-Resistant Staphylococcus aureus (MRSA). Used also in Clostridioides difficile ('deadly diarrhea') infections as an oral form.

Aztreonam - a monobactam widely used for gram-negative organisms, but no activity against gram-positive organisms.

Amphotericin B: used in a wide variety of Candida and other fungal infections.
Has three forms: Standard(as deoxycholate), lipid, and liposomal.
In terms of nephrotoxicity:

Standard>Lipid>Liposomal

But costs for the drugs are higher

Voriconazole - used where Amphotericin B does not cover the organisms- Aspergillus terreus, Amphotericin B-resistant strains of fungi.
Note: Use Ideal Body Weight to compute for doses.

What's common in what I mentioned, that these drugs are used for resistant/multidrug-resistsnt organisms! They are reserve drugs used for certain organisms and situations, and should be monitored by your pharmacy or stewardship team. Restriction of these drugs help...

..in mitigating haphazard ordering. Approval by an ID physician or stewardship physician or clinical pharmacist can be done to assess appropriateness of orders of such drugs.

And that's it for #AntibioticWeekly! See you again next week!

**resistant sorry for the typo

I'm sorry, I forgot to black out the brand name of the Cefepime stock we have. HUHUHU

P.S. The ones I featured here are NOT absolute(they may be different in your hospital) and these are the only ones available in our institution. You can have others, such as Tigecycline, Mica/Anidula/Caspofungin, etc, or depending on your antibiogram data :-) #AntibioticWeekly