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Impact of pharmacist recommendations on the cost of drug therapy in ICU patients at a Malaysian hospital

Zaidi ST, Hassan Y, Postma MJ, Ng SH

Pharm World Sci, 2003 Dec;25(6):299-302.
PMID: 14689820

To analyse clinical pharmacists interventions in the ICU of the Penang General Hospital (Penang, Malaysia) and to assess the pharmaco-economic impact of these interventions.
Fulltext Risk Assessment of Ambient Air Pollutants and Health Impact around Fuel Stations in Urban Cities of KSA

Zafar M, H Zaidi ST, Husain SS, Bukhari NM

Int J Prev Med, 2021;12:91.
PMID: 34584657 DOI: 10.4103/ijpvm.IJPVM_331_19

Background: In Saudi Arabia, fuel dispensing facilities commonly present around the residential places, educational institutions, and various health care facilities. Fuel pollutants such as benzene, toluene, and xylenes (BTX) and its alkyl derivatives are harmful to human health because of their toxic, mutagenic, or carcinogenic properties. The aim of this study was to determine the BTX concentration levels of common pollutants in and around fuel stations and their harmful health effects in the urban cites of KSA.
Methods: Forty fuel dispensing facilities were randomly selected on the basis of three different areas: residential, traffic intersection, and petrol pump locations (refueling stations). Portable ambient analyzer was used for measuring BTX concentration. t-test was applied to determine the difference between these different areas.
Results: All mean concentration values of pollutants such as BTX around residential, traffic intersection, and fuel stations are exceeding the limits of air quality standards values (P < 0.01). The mean levels of benzene are 10.3 and 11.07 ppm in Dammam and Khobar, respectively, and they exceed the reference level of 0.5 ppm. Hazard quotient was more than >1, which shows that carcinogenic probability has increased those who were living and working near fuel stations.
Conclusions: The results found that the high concentration of pollutants (BTX) is in the environment around fuel stations. The environmental contamination associated with BTX in petrol fuel stations impulses the necessity of preventive programs to reduce the further air quality deterioration and reduce the harmful health effects.
Fulltext Perceptions and Practices of Community Pharmacists towards Antimicrobial Stewardship in the State of Selangor, Malaysia

Khan MU, Hassali MA, Ahmad A, Elkalmi RM, Zaidi ST, Dhingra S

PLoS One, 2016;11(2):e0149623.
PMID: 26901404 DOI: 10.1371/journal.pone.0149623

BACKGROUND: Increasing antimicrobial resistance is one of the pressing concerns globally. Injudicious use of antibiotics is one of the modifiable factors responsible for antimicrobial resistance. Given the widespread use of antimicrobials in community settings, pharmacists have an important role in ensuring appropriate use of antibiotics. The objective of this study was to assess the perception and self-reported practices of community pharmacists towards antimicrobial stewardship.
METHODS: A cross-sectional study was conducted among community pharmacists between March-April, 2015, using a self-administered, pre-tested questionnaire in the State of Selangor, Malaysia. A simple random sampling approach was used to select pharmacy sites. Descriptive and inferential statistical methods were used to analyse the data.
RESULTS: A total of 188 pharmacists responded to the survey, giving a response rate of 83.5%. The majority of participants (n = 182, 96.8%) believed that antimicrobial stewardship program helps healthcare professionals to improve the quality of patient care. However, more than half of pharmacists were neutral in their opinion about the incorporation of antimicrobial stewardship programs in community pharmacies (n = 102, 54.2%). Though collaboration was often done by pharmacists with other health professionals over the use of antibiotics (n = 104, 55.3%), a significant proportion of participants (n = 102, 54.2%) rarely/occasionally participate in antimicrobial awareness campaigns. Pharmacists having postgraduate qualification were more likely to held positive perceptions of, and were engaged in, antimicrobial stewardship than their non-postgraduate counterpart (p<0.05). Similarly, more experienced pharmacists (> 10 years) held positive perceptions towards antimicrobial stewardship (p<0.05).
CONCLUSION: The study highlighted some gaps in the perception and practices of community pharmacist towards antimicrobial stewardship. Development of customized interventions would be critical to bridging these gaps and improve their perception and practices towards antimicrobial stewardship.
Fulltext Antimicrobial drug use in primary healthcare clinics: a retrospective evaluation

Shamsuddin S, Akkawi ME, Zaidi ST, Ming LC, Manan MM

Int J Infect Dis, 2016 Nov;52:16-22.
PMID: 27639454 DOI: 10.1016/j.ijid.2016.09.013

OBJECTIVES: To examine the appropriateness of antibiotics prescribed for acute infection based on the Malaysian national antibiotic guidelines and the defined daily dose (DDD) system of the World Health Organization (WHO). This study also aimed to describe the factors influencing the drug use pattern and to investigate the procurement patterns of antibiotics in the primary healthcare setting.
METHODS: A retrospective cohort follow-up study of randomly selected patients from all patients who received any antibiotic between January and December 2013 was conducted at three primary healthcare clinics in Selangor State of Malaysia. For each patient, the following information was recorded: name of the antibiotic, frequency and dose, and Anatomical Therapeutic Chemical (ATC) group. The defined daily dose per 1000 inhabitants per day was calculated for each antibiotic. The national antibiotic guidelines were used to assess the appropriateness of each antibiotic prescription.
RESULTS: A total of 735 patients were included in the study. The five most used antibiotics were amoxicillin (1.36g, 35.2%), cloxacillin (0.68g, 26.3%), erythromycin (0.32g, 22.3%), bacampicillin (0.13g, 7.2%), and cephalexin (0.11g, 6.9%). Respiratory tract infections were the most commonly treated infections, and the doctors' preferred antibiotic for the treatment of these infections was amoxicillin. More than 18% of all amoxicillin prescriptions were deemed inappropriate according to the national antibiotic guidelines. In terms of procurement costs, USD 88885 was spent in 2011, USD 219402 in 2012, and USD 233034 in 2013 at the three primary healthcare clinics, an average of USD 180440 per year for the three clinics.
CONCLUSIONS: This study reports the antibiotic usage at three primary healthcare clinics in Klang Province. The most prescribed antibiotic was amoxicillin in capsules (250mg), which was mainly prescribed for respiratory infections. Although the national antibiotic guidelines state that amoxicillin is a preferred drug for acute bacterial rhinosinusitis, this drug is also being prescribed for other disease conditions, such as acute pharyngitis and acute tonsillitis. This result shows that current practice is not following the current antibiotic guidelines, which state that phenoxypenicillin should be the preferred drug.
KEYWORDS: Antibiotic guideline; Defined daily dose; Drug utilization study; Prescribing pattern; Upper respiratory tract infection
Study site: Klinik Kesihatan Anika, Klinik Kesihatan Pandamaran, Klinik Kesihatan Bukit Kuda, Kelang, Selangor, Malaysia
Fulltext Levofloxacin: Insights Into Antibiotic Resistance and Product Quality

Izadi E, Afshan G, Patel RP, Rao VM, Liew KB, Meor Mohd Affandi MMR, et al.

Front Pharmacol, 2019;10:881.
PMID: 31474853 DOI: 10.3389/fphar.2019.00881

Counterfeit and substandard medicines are recognized as one of serious threats to public health. The product quality of antibacterial medicine will compromise patients' recovery and increase the chance of antibacterial resistance. The review aims to provide a summary of low quality levofloxacin issues and the risk factors as well as suggesting the aspects of product quality that need to be regulated strictly. Quality of the active ingredient, levofloxacin, has an important role to contribute to successful therapy. The poor quality of raw material, directly and indirectly, causes treatment failure as the presence of insufficient dose, mislabeled content, and poor dissolution characteristics can lead to lower bioavailability. Identifying and reporting these factors can potentially help in improving the quality of drug marketed in various developing countries and may also reduce the incidences of treatment failure. Dissolution test is used for testing the dissolution profiles and the rate of drug release from solid formulation such as oral formulations, thus providing information regarding the in vivo performance of a formulation and its bioequivalence. On the other hand, quality-testing procedures are used for comparing the quality of products.