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iii. Infected implant or prostheses
iv. Necrotising soft tissue infection
v. Melioidosis (at least 10 to 14 days of IV therapy)
vi. Deep-seated infection e.g. abscesses/empyema
vii. Complicated orbital cellulitis (abscess or other complication)

Conditions not recommended for IV to PO conversion:
i. Endocarditis
ii. Central nervous system infections (e.g. meningitis, brain abscess, etc.)
iii. Staphylococcus aureus bacteremia

If patient deteriorates clinically after the conversion from IV to PO antibiotic
(which indicates failure of oral therapy), IV therapy should be reinitiated.

Example of Antimicrobials That Can Be Included in IV to PO Therapy Conversion
and Bioavailability of Selected Antimicrobials Available in Both IV and PO
Formulations (Appendix 8).

h) AMS Round
Audit and feedback can also be done in a real-time manner during AMS rounds or
normal everyday ward rounds. Appropriateness of a prescribed antimicrobial can
be assessed during the round and immediate oral or written feedback can be
delivered. Issues that can be assessed include compliance to guidelines, streamlining
after microbiology test results are released, dose optimization, IV to oral switch,
duration of the treatment and any further investigation required.

The frequency of the AMS round shall depend on the facility’s resources and the
urgency of interventions. For example:

• Patients on one or more restricted antimicrobials (Appendix 9)

• Patients on prolonged antimicrobials i.e. more than 2 weeks

• Patients on 2 antibiotics without overlapping spectrum (excluding patients on
HIV-opportunistic infections, anti-tuberculosis and H. pylori treatment)

• Other cases as deemed necessary by ward pharmacists (e.g. antibiotic indication
not clear or not in keeping with antimicrobial guideline)

36 Protocol on Antimicrobial Stewardship (AMS) Programme in Healthcare Facilities | Second Edition 2022