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REMEDY : BNSSG referral pathways & Joint Formulary

BNSSG Adult Joint Formulary
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5. Infections

First line drugs Second line drugs Specialist drugs Secondary care drugs
Recommended in both primary and secondary care Alternatives (often in specific conditions) in both primary and secondary care Where a specialist input is needed (see introduction for definition) Prescribing principally within secondary care only

This chapter is approved for use within NBT NHS Trust, UHB NHS Foundation Trust and BNSSG Primary Care 


  • BNSSG Primary Care Antimicrobial Guidelines click here 

  • NBT antibiotic guidelines click here (N.B. Only available via Trust intranet)

  • UHBW antibiotic guidelines click here (N.B. Only available via Trust intranet)

  • WAHT see local guidance

  • Community IV charts click here


Antimicrobial prescribing is strictly regulated for four major reasons:

1.    To ensure the use of appropriate and effective antimicrobials

2.    To prevent the development and spread of bacterial resistance

3.    To contain cost

4.    To prevent adverse events such as Clostridium difficile diarrhoea


The antimicrobials stocked are split into three categories:

  • Unrestricted - may be prescribed by any medical staff without the involvement of the Department of Medical Microbiology
  • Restricted - only available after discussion with, or if recommended by, a Medical Microbiologist, Infectious Diseases Consultant or Consultant HIV Immunologist unless used in accordance with North Bristol NHS Trust Wide antimicrobial guidelines
  • Restricted (Speciality) - when a speciality (directorate/area) is listed then the restriction does not apply to medical staff from that speciality


It is an important safety and cost consideration that antimicrobial agents are not continued for longer than necessary. When a parenteral antimicrobial is prescribed, the use of that agent should always be reviewed after 48 hours.

When prescribing an oral antimicrobial, a five-day course length should be prescribed unless there are extenuating circumstances. The Ward Pharmacist in conjunction with the Department of Medical Microbiology will monitor the duration of antimicrobial therapy in accordance with the Trust's Policy on Duration of Treatment.

There are significant drug interactions with antibiotics. Please refer to the BNF or your Pharmacist for further information.


For topical antibiotics please refer to Chapter 13: Skin