tobramycin injection — CareFirst (Caremark)

Initial criteria

• The requested drug will NOT be used intranasally or in a footbath
• The requested drug is being prescribed for an FDA-approved indication or an indication supported in the compendia of current literature (examples: AHFS, Micromedex, current accepted guidelines)
• The infection is proven or strongly suspected to be caused by susceptible microorganisms
• The patient cannot be treated with oral therapy OR the request is for vancomycin to be taken orally for the treatment of C. difficile-associated diarrhea or for staphylococcal enterocolitis

Approval duration

serious, chronic, recurring infection: 12 months; other indications: 3 months