Quick Guide to Antibiotics

2004 Aetna Formulary

If viral infection is suspected, consider Nonprescription Cough/Cold Medications^
^Nonprescription medications are not covered under Aetna pharmacy benefits plans.

Intranasal Decongestants

Oral Antihistamines

Antitussives

oxymetazoline HCl (e.g. Afrin, Dristan, others)

phenylephrine (e.g. Neo-Synephrine, Vicks, others)

diphenhydramine (e.g. Benadryl, others)

clemastine fumarate (e.g. Tavist Allergy, others)
chlorpheniramine maleate (e.g. Chlor-Trimeton
Allergy, others)
loratadine (e.g. Alavert, others)

dextromethorphan (Robitussin Cough,

Rondec DM, Benylin DM)

Oral Decongestants
phenylephrine (AH-chew D)
pseudoephedrine (Sudafed, Actifed, others)

Expectorants

guaifenesin (e.g. Robitussin, Scot-Tussin, generics)

Multiple combination products are available

within the Sudafed, Benadryl, Robitussin, and
Triaminic product families.

Formulary
Cephalosporins

Fluoroquinolones

Penicillins

Sulfonamides

cefaclor
cefaclor SR
cefadroxil
cefuroxime
cephalexin
cephradine
Cedax (ceftibuten)
Lorabid (loracarbef)
Omnicef (cefdinir)
Spectracef (cefditoren pivoxil)

Avelox (moxifloxacin) PR < 10 yr old

Cipro (ciprofloxacin) PR < 10 yr old
Cipro XR (ciprofloxacin) PR < 10 yr old

amoxicillin
amoxicillin/K clavulanate
ampicillin
cloxacillin
dicloxacillin
penicillin VK
Augmentin ES
(amoxicillin/K clavulanate)
Augmentin XR
(amoxicillin/K clavulanate)

sulfamethoxazole/trimethoprim
sulfisoxazole
sulfisoxazole/erythromycin

Macrolides
erythromycin base
erythromycin EC pellets
erythromycin ethylsuccinate
erythromycin stearate
Biaxin (clarithromycin)
Biaxin XL (clarithromycin)
Zithromax (azithromycin)

Tetracyclines
doxycycline hyclate PR 8 yr old
doxycycline pellets PR 8 yr old
minocycline PR 8 yr old
tetracycline PR 8 yr old

FORMULARY EXCLUSIONS

FORMULARY ALTERNATIVES

Cephalosporins

Cephalosporins

Cefzil (cefprozil)

cefuroxime

Lorabid

Duricef (cefadroxil)

cefadroxil
cephalexin

cephradine

Vantin (cefpodoxime)

Cedax
Omnicef

Spectracef (cefditoren pivoxil)

Fluoroquinolones
Floxin (ofloxacin) PR < 10 yr old
Levaquin (levofloxacin) PR < 10 yr old
Maxaquin (lomefloxacin) PR < 10 yr old

Fluoroquinolones
Noroxin (norfloxacin) PR < 10 yr old
Tequin (gatifloxacin) PR < 10 yr old
Zagam (sparfloxacin) PR < 10 yr old

Avelox PR < 10 yr old

Cipro PR < 10 yr old

Macrolides

Macrolides

Dynabac (dirithromycin)
PCE (erythromycin base dispertabs)
Tao (troleandomycin)

erythromycin
Biaxin
Biaxin XL

Geocillin (carbenicillin)

Spectrobid (bacampicillin)

Tetracyclines

Zithromax

amoxicillin

ampicillin

Tetracyclines
PR 8 yr old

doxycycline

PR 8 yr old

All member care and related decisions are the sole responsibility of the physician, and this information does not dictate or control physicians clinical
decisions regarding the appropriate care of members. Pharmacy benefits are not limited to the drugs on the formulary. Drugs on the Formulary Exclusions
List may be excluded from coverage under some pharmacy benefit plans unless a medical exception is obtained. Many drugs on the formulary are subject to manufacturer rebate arrangements between Aetna and the manufacturer of those drugs. The formulary is subject to change.
In accordance with state law, California HMO members enrolled in a closed formulary benefits plan who are receiving coverage for medications that are
moved to the Formulary Exclusions List, and California HMO members who are receiving coverage for medications that are added to the Precertification
or Step-Therapy Lists will continue to have those medications covered, for as long as the treating physician continues to prescribe the medication.
Not all programs, for example step-therapy, precertification and quantity limits, are available in all service areas.
For members in Texas, additions to the 2004 formulary will be effective no later than January 1, 2004. In accordance with state law, full-risk members
in Texas who are receiving coverage for medications that are removed from the formulary during the plan year will continue to have those medications
covered at the same benefit level until their plans renewal date.
The term Precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical
device meets the companys clinical criteria for coverage. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. The Aetna companies
that offer, underwrite or administer benefit coverage include Aetna Health Inc., Aetna Health of California Inc., Aetna Health of the Carolinas Inc., Aetna
Health of Illinois Inc., Aetna Health Insurance Company of Connecticut, Aetna Health Insurance Company of New York, Corporate Health Insurance
Company and/or Aetna Life Insurance Company. Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC.
This card may not be used after 12/31/04.
To submit medical exception or precertification requests for prescription medications:
Fax the precertification unit, toll free at 1-800-408-2386
Call the precertification unit, toll free at 1-800-414-2386
To submit requests online, go to: www.aetna.com, put your cursor on "Doctors & Hospitals" and select "Physician Self-Service" to
register for the secure website for physicians, hospitals and health care professionals. Once registered, you will be able to submit your
requests online.
Current formulary information is available online at www.aetna.com/formulary

05.03.869.1-INT (07/04)

PR < 10 yr old

Penicillins

Penicillins

Adoxa (doxycycline)

Cipro XR

2004 Aetna Inc.

Uppercase = Brand-name medication

lowercase = Generic medication
PR = Precertification required under most plans

CAREFUL ANTIBIOTIC USE

Stemming the tide of antibiotic resistance: Recommendations by the
CDC /AAP to promote appropriate antibiotic use in children.1

APPROPRIATE TREATMENT SUMMARY

Diagnosis
Otitis
Media

CDC/AAP Principles of Appropriate Antibiotic Use

1.
2.

3.

Rhinitis and
Sinusitis

Classify episodes of OM as acute otitis media (AOM) or otitis media with effusion (OME).
Only treat proven AOM.
Antibiotics are indicated for treatment of AOM, however, diagnosis requires
documented middle ear infection.
and, signs or symptoms of acute local or systemic illness.
Dont prescribe antibiotics for initial treatment of OME
treatment may be indicated if bilateral effusions persist for 3 months or more.

Rhinitis:
1. Antibiotics should not be given for viral rhinosinusitis.
2. Mucopurulent rhinitis (thick, opaque, or discolored nasal discharge) frequently accompanies viral rhinosinusitis.
It is not an indication for antibiotic treatment unless it persists without improvement for more than 10-14 days.
Sinusitis:
1. Diagnose as sinusitis only in the presence of:
prolonged nonspecific upper respiratory signs and symptoms (e.g. rhinorrhea and cough without
improvement for >10-14 days), or
more severe upper respiratory tract signs and symptoms (e.g. fever >39 C, facial swelling, facial pain).
2. Initial antibiotic treatment of acute sinusitis should be with the most narrow-spectrum agent which is active
against the likely pathogens.

Pharyngitis

1.
2.
3.

Cough
Illness and
Bronchitis

1.
2.

Diagnose as group A streptococcal pharyngitis using a laboratory test in conjunction with clinical and
epidemiological findings.
Antibiotics should not be given to a child with pharyngitis in the absence of diagnosed group A streptococcal
infection.
A penicillin remains the drug of choice for treating group A streptococcal pharyngitis.

Cough illness/bronchitis in children rarely warrants antibiotic treatment.

Antibiotic treatment for prolonged cough (>10 days) may occasionally be warranted:
Pertussis should be treated according to established recommendations.
Mycoplasma pneumoniae infection may cause pneumonia and prolonged cough
(usually in children older than 5 years); a macrolide agent (or tetracycline in children 8 years or older)
may be used for treatment.
Children with underlying chronic pulmonary disease (not including asthma) may occasionally benefit
from antibiotic therapy for acute exacerbations.

When parents demand antibiotics...

Provide educational materials and share your treatment rules to explain when
the risks of antibiotics outweigh the benefits.
Build cooperation and trust:
- dont dismiss the illness as only a viral infection - explicitly plan treatment of
symptoms with parents.
- give parents a realistic time course for resolution - prescribe analgesics and
decongestants, if appropriate.

References
1. Dowell SF, Editor. Principals of judicious use of antimicrobial agents for childrens upper respiratory tract infections. Pediatrics. Vol 1. January 1998 Supplement.
This guideline is provided for informational purposes only and is not intended to direct individual treatment decisions. All patient care and related decisions are the sole responsibility of providers, and this guideline does not dictate or control a providers clinical judgment regarding the appropriate treatment of any individual patient.
Guidelines developed by the Centers for Disease Control and Prevention (CDC). Reprinted with permission of CDC.