AMS

Antimicrobial Stewardship (AMS) Framework

A Role-Based Guideline & Actionable Insight Engine (Phase 1)

Please select your role or tool:

Doctor / Prescriber

View point-of-care rules for prescribing.

Pharmacist

See guidelines for audit, review, and intervention.

Microbiologist

Access rules for reporting and antibiograms.

AMS Lead

Review leadership, tracking, and reporting actions.

Nurse

Guidelines for administration and monitoring.

Administrator

Core elements for leadership and resource commitment.

Tools

Antibiotic Calculator

Get rule-based recommendations. (Demo)

Surgical Prophylaxis (SCIP)

Get rule-based prophylaxis guidance.

IV-to-PO Switch Guide

View criteria and conversion data.

Demo Antibiogram

View sample hospital susceptibility data.

Guideline Library

Access source guidelines and literature.

Rule-Based Antibiotic Calculator

Select options to get a demo recommendation.

Clinical Condition Community-Acquired Pneumonia (CAP) - Mild Community-Acquired Pneumonia (CAP) - Severe Hospital-Acquired Pneumonia (HAP) UTI - Uncomplicated (Cystitis) UTI - Complicated (Pyelonephritis) SSTI - Mild (Cellulitis / Abscess) SSTI - Severe (Necrotizing)

Location / Region Default / N. America / Europe Southeast Asia China Middle East Other

Patient Parameters

Age (Years)

Gender Male Female

Weight (kg)

Height (cm)

Serum Cr (mg/dL)

Patient Factors

Penicillin Allergy (Severe/Anaphylaxis)

Severe Hepatic Impairment

Pregnant or Breastfeeding

Immunocompromised

Specific Pathogen / Comorbidity Risks

MRSA Risk Factors

Pseudomonas Risk Factors

Seizure Disorder (Epilepsy)

QTc Prolongation Risk

History of C. difficile

Calculated Parameters:

BMI: N/A

BSA (Mosteller): N/A m²

eGFR (C-G): N/A mL/min

Recommendation:

Legend:

Access - First-line choice, low resistance potential.

Watch - High-priority agent, monitor closely for resistance.

Reserve - Last-resort agent for MDR infections. Specialist approval needed.

Disclaimer: This is a demo calculator for illustrative purposes only. Do not use for clinical decision-making. Always consult local guidelines and senior clinical staff.

Phase 2: LLM-Powered AMS Platform

Upgrade path from a rule-based app to a dynamic, intelligent system.

This Phase 1 app provides a robust, rule-based foundation. The next evolution (Phase 2) is to transform this static tool into a dynamic, context-aware "co-pilot" powered by Large Language Models (LLMs) and real-time data integration.

1. From Static Rules to Dynamic Guidance

The hard-coded rules for each role (and the complex calculator) will be replaced by a dynamic recommendation engine. Instead of seeing a generic checklist, the app will provide specific, patient-centered advice.

• Phase 1 (Current): "If CAP-Mild and no allergy, recommend Amoxicillin."
• Phase 2 (Future): "Patient has CAP, eGFR 25, and QTc 470ms. Recommend Ceftriaxone (no renal adjustment needed) + Doxycycline (safer than macrolides with QTc risk). Here is the calculated renal dose for Doxycycline..."

2. Real-Time Data Integration (via FHIR)

The app will connect to the hospital's Electronic Health Record (EHR) using standards like FHIR. This allows the LLM to access (with appropriate permissions) the patient's real-time data:

• Patient Demographics (age, weight)
• Allergies
• Lab Results (creatinine, WBC)
• Microbiology (culture results)
• Current Medications & Vitals

3. Retrieval-Augmented Generation (RAG)

To ensure safety and accuracy, the LLM will not rely on its internal memory. It will use a RAG pipeline. When a doctor needs advice, the LLM will query a curated, trusted knowledge base containing:

• WHO, CDC, ICMR, and NICE guidelines
• The hospital's specific AMS policies
• The up-to-date local antibiogram

The LLM then synthesizes this evidence with the patient's data to provide a safe, verifiable, and cited recommendation.

4. Interactive Chat & Analysis

A chat interface will be introduced, allowing users to ask complex, conversational questions:

• Doctor: "My patient has HAP, is allergic to penicillin, and has renal failure. What are the empiric options?"
• Pharmacist: "Flag all patients on IV vancomycin for more than 5 days who are eligible for an oral switch."
• AMS Lead: "Show me the prescribing trends for 'Watch' antibiotics in the ICU this month compared to last."

5. Dynamic, Role-Based Dashboards

The static rule lists will become live dashboards:

• AMS Lead: Sees real-time graphs of antibiotic consumption (DOTs), AWaRe ratios, and adherence to guidelines.
• Pharmacist: Gets a prioritized worklist of patients needing intervention (e.g., "bug-drug mismatch," "IV to PO switch").
• Doctor: Receives personalized, confidential feedback on their prescribing patterns compared to anonymized peers.

Surgical Prophylaxis (SCIP) Guide

Select procedure type to get recommendations.

Procedure Type Cardiac Surgery (e.g., CABG) Colorectal Surgery Hysterectomy (Abdominal/Vaginal) Orthopedic (Joint Replacement) General Clean (e.g., Hernia Repair)

Penicillin Allergy (Severe/Anaphylaxis)

IV-to-PO Switch Guide

Clinical criteria and common oral conversions.

Clinical Criteria for Switching

• Patient is clinically improving (e.g., fever resolved, WBC normalizing).
• Patient has a functioning gastrointestinal (GI) tract.
• Patient is able to tolerate oral intake (no NPO status, no severe nausea/vomiting).
• An appropriate oral agent with good bioavailability is available.

Common Oral Conversions

IV Antibiotic	Oral Equivalent	Bioavailability / Notes
Levofloxacin	Levofloxacin	~99% (1:1 conversion)
Moxifloxacin	Moxifloxacin	~90% (1:1 conversion)
Doxycycline	Doxycycline	~90-100% (1:1 conversion)
Fluconazole	Fluconazole	>90% (1:1 conversion)
TMP/SMX	TMP/SMX	~90-100% (1:1 dose conversion)
Clindamycin	Clindamycin	~90%. (e.g., 600-900mg IV q8h -> 300-450mg PO q6-8h)
Metronidazole	Metronidazole	>90% (1:1 conversion)
Ceftriaxone	Cefpodoxime, Cefdinir	No direct oral equivalent. Requires "step-down" to different agent.
Pip/Tazobactam	Amox/Clavulanate, Ciprofloxacin	No direct oral equivalent. Step-down based on culture results.

Demo Hospital Antibiogram

Example Data: ICU - Urine Isolates (n=100)

Disclaimer: This is demo data for illustrative purposes only. Always use your institution's most recent, unit-specific antibiogram.

Pathogen	Ampi/Sulbactam	Pip/Tazobactam	Cefepime	Meropenem	Ciprofloxacin	Nitrofurantoin	TMP/SMX
E. coli	45%	82%	85%	98%	61%	92%	70%
K. pneumoniae	30%	78%	80%	96%	72%	50%	71%
P. aeruginosa	10%	80%	85%	88%	75%	N/A	N/A

How to Read This

• This table shows the percentage of isolates (%S) that were susceptible to a given antibiotic.
• Example: For *E. coli* from ICU urine samples, only 61% were susceptible to Ciprofloxacin. This would be a poor choice for empiric therapy.
• In contrast, 98% were susceptible to Meropenem (a broad-spectrum carbapenem) and 92% to Nitrofurantoin (a narrow-spectrum option for cystitis).

Guideline & Literature Library

Official links to source AMS guidelines (open in new tab).

WHO AWaRe Classification (2023)

The 2023 WHO AWaRe classification of antibiotics for evaluation and monitoring of use.

CDC Core Elements of AMS

The US CDC's practical framework for implementing AMS programs in various settings.

ICMR AMS Guidelines (India)

Indian Council of Medical Research's hub for AMR and stewardship guidelines.

NICE (UK) Guideline [NG15]

The specific NICE guideline covering antimicrobial stewardship in health and social care.

IDSA/SHEA AMS Guideline

The joint IDSA and SHEA practice guideline on implementing AMS programs.

ESCMID AMS Topic Hub

European Society of Clinical Microbiology and Infectious Diseases topic page for AMS.

Synthesizing guidelines from WHO AWaRe, CDC Core Elements, ICMR, and NICE.