The Antimicrobial Stewardship Program (ASP) team at the National University Hospital (NUH) Singapore has compiled intravenous to oral (IV-to-PO) antibiotics conversion guidelines and conducted training sessions with pharmacists on IV-to-PO conversion. The primary aim of this study was to assess compliance with IV-to-PO guidelines, pre-and post-implementation of training, and to evaluate the acceptance rate and timeliness of pharmacist interventions for IV-to-PO antibiotic conversion. A chart-review study for two cohorts of patients newly prescribed IV clindamycin or metronidazole was conducted over two 6-week periods following training sessions detailing hospital recommendations for converting suitable patients to oral therapy. Cases were reviewed to compare IV-to-PO interventions by the end of 7 days and review the effectiveness of training and timeliness of any pharmacist intervention. There was no difference in proportion of patients suitable, but not converted to oral therapy by the end of 1 week (41/125 vs 30/115, p = 0.255) following the training session. There was also no significant difference in documented IV-to-PO antibiotic intervention rates (3/41 vs 5/30, p = 0.18) by pharmacists. Few pharmacists are actively intervening to convert patients from IV-to-PO antibiotics. Training was ineffective in improving intervention rates. These results show that the ASP team needs to come up with better strategies to ensure timely interventions for IV-to-PO antibiotic conversion.

Introduction: Institutional surgical antibiotic prophylaxis (SAP) guidelines are in place at all public hospitals in Singapore, but variations exist and adherence to guidelines is not tracked consistently. A national point prevalence survey carried out in 2020 showed that about 60% of surgical prophylactic antibiotics were administered for more than 24 hours. This guideline aims to align best practices nationally and provides a framework for audit and surveillance. Method: This guideline was developed by the National Antimicrobial Stewardship Expert Panel’s National Surgical Antibiotic Prophylaxis Guideline Development Workgroup Panel, which comprises infectious diseases physicians, pharmacists, surgeons and anaesthesiologists. The Workgroup adopted the ADAPTE methodology framework with modifications for the development of the guideline. The recommended duration of antibiotic prophylaxis was graded according to the strength of consolidated evidence based on the scoring system of the Singapore Ministry of Health Clinical Practice Guidelines. Results: This National SAP Guideline provides evidence-based recommendations for the rational use of antibiotic prophylaxis. These include recommended agents, dose, timing and duration for patients undergoing common surgeries based on surgical disciplines. The Workgroup also provides antibiotic recommendations for special patient population groups (such as patients with β-lactam allergy and patients colonised with methicillin-resistant Staphylococcus aureus), as well as for monitoring and surveillance of SAP. Conclusion: This evidence-based National SAP Guideline for hospitals in Singapore aims to align practices and optimise the use of antibiotics for surgical prophylaxis for the prevention of surgical site infections while reducing adverse events from prolonged durations of SAP. Keywords: Antibiotic prophylaxis duration, antimicrobial resistance, antimicrobial stewardship, hospital-acquired infection, surgical site infections

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