Limited Use Note(s)

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Reason For Use CodeClinical Criteria
For the treatment of patients with:
362Methicillin-resistant Staphylococcus species (MRSA, MRSE) infections* in patients who are intolerant or have failed vancomycin therapy, or have contraindications to venous access.
LU Authorization Period: 1 year
363Vancomycin resistant Enterococcus species (VRE) infections* in patients switching from IV linezolid.
LU Authorization Period: 1 year
364Step-down therapy for the treatment of methicillin-resistant Staphylococcus species or vancomycin resistant Enterococcus species (VRE) infections* after parenteral therapy or hospital/ emergency department discharge.
* Infections must be documented and culture proven. Not approved for colonization (e.g. nares, urine, etc). Maximum 28 days supply.
LU Authorization Period: 1 year