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Appendix 6: Example of Formulary Restriction
Antimicrobials are divided into 3 categories – the first being antimicrobials that require
preauthorization before it can be prescribed. Authorization is issued by the relevant consultant
of the department and in accordance with preapproved indications. The second category
involves antimicrobials that can be prescribed for certain indications which will be subject to
a review by the stewardship team within 3 working days and justification for its continuation
is required. The last category is other antimicrobials that do not require pre-approvals.
Example:
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-./,)0,123/4, -78.9:;<,<1,$=>,<:?@,A:BC:D4,
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*"+$,-,'"#$) 4/#,&9-,"#)
!"
#$
./01&23#+"#) = )>)? ):.)
4/5",&#/%&'$) 6#8"10$3(&9&#/')@!A@!B)
6#"(3'/23#+"#) C'3,&#/%&'$)
7$#8/9"("#$) 69"#&+'-,&0"($)
:/#,-,'&;"5) C'3&5&D3"#&'&0)
.&'"08"#)
)
70 Protocol on Antimicrobial Stewardship (AMS) Programme in Healthcare Facilities | Second Edition 2022
