Pre-prescription authorisation

One effective way of reducing costs and AMU on the WHO Watch or Reserve lists is pre-prescription authorisation for the use of these drugs.

A clinician should complete an authorisation form for any agent on Watch or Reserve lists, with all the necessary information for the signature of a designated expert in AMR (such as an infection pharmacist, clinical microbiologist or infectious diseases physician). The drug cannot be dispensed unless authorised by one of these experts, although some facilities will allow a first dose to be given without authorisation for patients presenting with sepsis who require immediate treatment.

Pharmacy departments are custodians of these forms, which, once collected, can be analysed for audits or for giving institutional feedback at facility level. The designated expert may suggest alternative antimicrobials, if appropriate.