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4. Formulary Restriction

Formulary restriction is one of the pillars of AMS Programme. MOH drug formulary implements
restrictions based on category of prescribers; however, these restrictions may not be adequate
to guide the local prescribers about judicious use of antibiotic. Therefore, each district is
required to formulate their own district’s formulary with consideration of specific MOH
program such as Integrated Management of Childhood Illnesses and Modified Syndromic
Approach.

All prescribers should comply with formulary restriction either from local or national formulary
which can be implemented through pre-approval (can only be started after getting a specific
approval) either written or verbally.

5. Antibiotic Selection and Dose Optimization

Antimicrobial selection and dose optimization should be tailored to patient characteristics/
allergic history, causative organism, site of infection, and pharmacokinetic and
pharmacodynamic characteristics of the antimicrobial agent. Concomitant drug use should
be reviewed to prevent interaction.

Strategies that may be considered include:

• Weight-based dosing of certain antimicrobials for paediatric.
• Dose adjustments for patients with renal dysfunction, liver dysfunction and elderly.
• Selection based on local sensitivity and resistance pattern.

6. Education

Antimicrobial Stewardship team should provide continuous education for prescribers,
pharmacists and paramedics to enhance knowledge and promote good prescribing behavior
especially to new staffs. Educational Key Points (Appendix 10) must be highlighted during
these sessions to instill appropriate use of antimicrobial.

Recommended Educational Programs

1. Continuous Medical Education (CME)

2. Newsletter including a sub-topic on antibiotics in any publications

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