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Appendix 4 : Antimicrobial Formulary Restriction HPP

1. Restricted: Requires prior authorization from Infectious Diseases Physician / Paediatrician /Certain Approved Unit/Department
before use.
2. Conditional: Can be prescribed initially but all prescriptions will be reviewed at 72 hours by the Antimicrobial Stewardship Team
with feedback except those with *.
3. Controlled/General: Can be prescribed but will be subject to audit and review from time to time and if usage is high.
4. *Review by AMS team when necessary.
5. Pharmacy will not be issuing the medication if Antimicrobial Order Form (HPP/FAR/BR-03) is not filled completely and signed
according to the formulary.
6. Verbal order by designated consultant (conditional category)/specialist (controlled category) is accepted for cases after office
hours, weekend and Public Holidays. The MO on call should sign on behalf in the antimicrobial order form first. The incomplete
antimicrobial order form has to be signed by the ordering consultant/ specialist on the next working day.

Conditional (HOD/HOU/ General use/Available List
Resticted/Pre-Authorization (HOD/HOU/ Consultant) Consultant) Controlled (Specialist) B (MO)

(ID) (ID, Hemato-adult) (ALL Departments) (ALL Departments) (ALL Departments)
• All Oral Antiretrovirals • Anidulafungin 100mg • Cefepime* 1g Inj • Acyclovir 250mg Inj, 200mg • Albendazole 200mg
• Ceftaroline 600mg Inj Inj • Cefoperazone/sulbactam Tab, 800mg Tab. Tab, 200mg/5mL Syrup
• Chloroquine phosphate • Caspofungin 70mg Inj, 1g Inj* • Amikacin 250mg Inj, 500mg • Amoxicillin 250mg Cap,
250mg (base 150mg) 50mg Inj • Ciprofloxacin 200 mg Inj* Inj 125mg/5mL Syrup
Tab • Itraconazole 10mg/mL • Ertapenem 1 g Inj • Amoxicillin/clavulanate 1.2g • Ampicillin 500mg Inj,
• Daptomycin 500mg Inj Syrup • Fucidic acid 250mg Tab* Inj, 625mg Tab, 228mg/5mL 125mg/5mL Syrup
• Diethylcarbamazine • Linezolid 600mg Inj , • Imipenem/cilastatin Syrup • Benzathine penicillin G
100mg 600mg Tab 500mg Inj • Ampicillin/sulbactam 1.5g Inj, 2.4 Mega Inj
• Flucytosine 500 mg • Micafungin 50 mg Inj • Meropenem 1g Inj 375mg Tab, 250mg/5mL • Benzylpenicillin 1 MU
Tab • Pentamidine 300mg • Piperacillin/tazobactam Syrup Inj, 5MU Inj
• Foscarnet 6g Inj Inj 4.5g Inj* • Amphotericin B • Cephalexin 125mg/5mL
• Fosfomycin 3g • Vancomycin 500mg Inj (conventional) 50mg Inj Syrup, 250mg Cap
Granules (Oral) • Cloxacillin 500mg Inj,
125mg/5mL Syrup,
250mg Cap

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HPP AMG Antimicrobial Formulary Restriction HPP