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. Authorization is typically granted by the ID Consult team concurrent with any recommendations to use a restricted antimicrobial. “Curbside” approvals without formal consultation are not allowed.

2) Prescribers may page the CAUSE delegate by calling (336) 716-6770 (pager ID 6494) or by using the Wake On Call system.

When contacting the CAUSE delegate, the prescriber should be prepared to discuss the patient over the phone and provide detailed information that justifies use of the restricted antimicrobial.

Restricted Antimicrobials

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 notrestricted
  • Amphotericin B Lipid Complex (ABLC, Abelcet)
  • Aztreonam (Azactam)
  • Ceftaroline (Teflaro)
  • Ceftazidime (Fortaz)
  • Ceftazidime/avibactam (Avycaz)
  • Ceftolozane/tazobactam (Zerbaxa)
  • Colistin, Colistimethate (Colymycin)
  • Dalbavancin (Dalvance)
  • Daptomycin (Cubicin)
  • Ertapenem (Invanz)
  • Fidaxomicin (Dificid)
  • Imipenem (Primaxin)
  • Isavuconazonium (Cresemba)
  • Linezolid (Zyvox)
  • Meropenem (Merrem)
  • Peramivir (Rapivab) - oseltamivir and zanamivir are not restricted
  • Posaconazole (Noxafil)
  • Ribavirin inhaled - oral ribavirin products are not restricted
  • Tigecycline (Tygacil)
  • Voriconazole (Vfend)

Notable Drugs Not on Formulary

  • Doripenem (Doribax)
  • Liposomal Amphotericin B (Ambisome)
  • Oritavancin (Orbactiv)
  • Quinupristin/Dalfopristin (Synercid)
  • Tedizolid (Sivextro)
  • Telavancin (Vibativ)