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Prevalence of nosocomial infection and antibiotic use at a university medical center in Malaysia

Hughes AJ, Ariffin N, Huat TL, Abdul Molok H, Hashim S, Sarijo J, et al.

Infect Control Hosp Epidemiol, 2005 Jan;26(1):100-4.
PMID: 15693416

Most reports of nosocomial infection (NI) prevalence have come from developed countries with established infection control programs. In developing countries, infection control is often not as well established due to lack of staff and resources. We examined the rate of NI in our institution.

Matched MeSH terms: Drug Utilization Review/statistics & numerical data*
Fulltext Antibiotic use in residential aged care facilities

Lim CJ, Stuart RL, Kong DC

Aust Fam Physician, 2015 Apr;44(4):192-6.
PMID: 25901402

BACKGROUND: High infection burden among the residential aged care facility (RACF) population has long been recognised; however, existing infection prevention effort is often limited to infection surveillance activity. There is a scarcity of evidence to guide antimicrobial stewardship in the Australian RACF setting.
OBJECTIVE: This review summarises the current trends in antibiotic use and multi-drug resistant (MDR) organisms, challenges related to antibiotic prescribing and areas of suboptimal antibiotic prescribing for further improvement, particularly in the Australian RACF setting.
DISCUSSION: There is widespread antibiotic prescribing in RACF, which may lead to the emergence of antibiotic resistance. Accordingly, there is an immediate need for judicious antibiotic use in this high-risk population to curb the rapid emergence of MDR organisms and other adverse consequences associated with inappropriate antibiotic use, as well as to reduce healthcare costs.

Matched MeSH terms: Drug Utilization Review*
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.

Matched MeSH terms: Drug Utilization Review/economics*
Fulltext A systematic review and meta-analysis of pharmacist-led fee-for-services medication review

Hatah E, Braund R, Tordoff J, Duffull SB

Br J Clin Pharmacol, 2014 Jan;77(1):102-15.
PMID: 23594037 DOI: 10.1111/bcp.12140

The aim was to examine the impact of fee-for-service pharmacist-led medication review on patient outcomes and quantify this according to the type of review undertaken, e.g. adherence support and clinical medication review.

Matched MeSH terms: Drug Utilization Review/statistics & numerical data*
Fulltext Drug-related problems in patients with benign prostatic hyperplasia: a cross sectional retrospective study

Zaman Huri H, Hui Xin C, Sulaiman CZ

PLoS One, 2014;9(1):e86215.
PMID: 24475089 DOI: 10.1371/journal.pone.0086215

Benign Prostatic Hyperplasia (BPH) patients are at risk of acquiring drug-related problems (DRPs), as it is present in the majority of aging men. To date, DRPs among BPH patients have not been well studied. We conducted this retrospective study in a tertiary hospital in Malaysia from January 2009 to June 2012 with the aim of identifying the factors associated with DRPs among BPH patients. The Pharmaceutical Care Network Europe Classification Version (PCNE) 5.01 was used as a tool to classify DRPs. We enrolled 203 patients from 259 hospital admissions. A total of 390 DRPs were found and there was an average of 1.5±1.3 problems per hospitalization. 76.1% of hospital admissions included at least one DRP. The most common DRP categories encountered were drug choice problems (45.9%), drug interactions (24.9%), and dosing problems (13.3%). Factors such as advanced age (p = 0.005), a hospital stay of more than 6 days (p = 0.001), polydrug treatments (p<0.001), multiple comorbidities (p<0.001), and comorbid cardiovascular disease (p = 0.011), diabetes mellitus(p = 0.001), hypertension (p<0.001) and renal impairment (p = 0.011) were significantly associated with the occurrence of DRPs. These data indicated that the prevalence of DRPs is high among BPH patients. The identification of different subtypes of DRPs and the factors associated with DRPs may facilitate risk reduction for BPH patients.

Matched MeSH terms: Drug Utilization Review/statistics & numerical data*
Appropriate antibiotic administration in elective surgical procedures: still missing the message

Gul YA, Hong LC, Prasannan S

Asian J Surg, 2005 Apr;28(2):104-8.
PMID: 15851363

OBJECTIVE: The aim of this study was to determine the appropriateness of antibiotic prophylaxis in selected elective surgical procedures in a tertiary referral centre.
METHODS: A cross-sectional study using retrospective data from January 2000 to May 2002 was performed pertaining to elective colorectal surgery, cholecystectomy and inguinal hernia repairs. Appropriateness of antibiotic administration was determined based on compliance with national and internationally accepted guidelines on prophylactic antibiotic prescribing policy. A single dose or omission of antibiotic administration was judged appropriate for cholecystectomy and inguinal hernia repair, while up to 24 hours' dosing was considered appropriate practice for colorectal surgery.
RESULTS: Of 419 cases, there were 55 (13.1%) colorectal procedures, 97 (23.2%) cholecystectomies and 267 (63.7%) inguinal hernia repairs. Antibiotics were administered in a total of 306 (73%) cases, with single-dose prophylaxis in only 125 (41%) of these. Prophylaxis was inappropriately prolonged in 80%, 52% and 31% of colorectal, cholecystectomy and inguinal hernia cases, respectively. The corresponding mean duration of anti-biotic administration was 2.4+/-2.2, 1.6+/-1.8 and 1.1+/-1.3 days, respectively.
CONCLUSION: Antibiotic prophylaxis in elective surgery continues to be administered haphazardly. This study supports close surveillance of antibiotic utilization by a dedicated team, perhaps consisting of microbiologists or pharmacists, to minimize inappropriate administration.

Matched MeSH terms: Drug Utilization Review*
Providing guidelines and education is not enough: an audit of gentamicin use at The Royal Melbourne Hospital

Leong CL, Buising K, Richards M, Robertson M, Street A

Intern Med J, 2006 Jan;36(1):37-42.
PMID: 16409311

BACKGROUND: Aminoglycoside antibiotics are commonly prescribed for the treatment of Gram-negative infections. Appropriate dosing and therapeutic monitoring of aminoglycosides are important because these agents have a narrow therapeutic index.
AIM: To audit gentamicin use at our hospital, focusing on selection of the initial dose and therapeutic monitoring practices, and to compare the results against recommendations in the existing hospital aminoglycoside guidelines, which had recently been promoted to doctors.
METHODS: This audit included all inpatients receiving gentamicin at The Royal Melbourne Hospital from 1 February to 12 March 2004. The principal researcher checked the drug charts of all inpatients to identify those receiving gentamicin and collected data from the medical records and the pathology database. Doses were considered 'concordant' if the dose given was within the recommended dosing range +/-20 mg.
RESULTS: A total of 132 courses of gentamicin was included in the study. Gentamicin was prescribed for prophylaxis in 31.1% of courses. Thirty-six per cent of patients prescribed gentamicin were more than 65 years of age. Eighty-two per cent of the gentamicin used therapeutically was given as a single daily dose. Sixty-six per cent of gentamicin initial dosing was not in accordance with existing hospital guidelines. Seventy-seven per cent of gentamicin courses requiring therapeutic drug monitoring received such monitoring; however, in only 8.8% of these was the monitoring conducted according to guidelines.
CONCLUSION: Aminoglycoside prescribing practices at our hospital are suboptimal, despite ready access to prescribing guidelines. Provision of a guideline and education sessions with doctors do not necessarily lead to widespread adoption of recommended practices. We suggest that changes to hospital systems related to prescribing and monitoring of aminoglycosides are required.

Matched MeSH terms: Drug Utilization Review*
Fulltext Evaluation of medication use in Malaysian predialysis patients

Salman M, Khan AH, Adnan AS, Syed Sulaiman SA, Shehzadi N, Asif N, et al.

Saudi J Kidney Dis Transpl, 2017 5 26;28(3):517-523.
PMID: 28540887 DOI: 10.4103/1319-2442.206451

Chronic kidney disease (CKD) patients suffer from multiple comorbidities and complications as a cause or consequence of kidney disease. Information regarding medication- prescribing patterns in predialysis patients is sparse. We conducted a retrospective study to evaluate the medication prescription patterns among predialysis patients. Medical records (both paper based and computerized) of patients at CKD Resource Centre, Hospital Universiti Sains Malaysia, were reviewed. A total of 615 eligible cases were included in the study. The mean number of medications prescribed per patient was 8.22 ± 2.81, and medication use was correlated to the renal function (stage 3a < stage 3b < stage 4 < stage 5; P <0.001). The top three prescribed medication groups were found to be lipid-lowering agents, calcium channel blockers, and antiplatelet agents. Some medication classes such as nonaluminum/noncalcium phosphate binders, erythropoietin-stimulating agents, and renin-angiotensin-aldosterone system blockers, particularly in advanced stage, were found to be underutilized. In conclusion, predialysis patients are prescribed a large number of medications. Our findings highlight the need for assessing the impact of current medication-prescribing patterns on morbidity and mortality rates in Malaysian predialysis population.

Matched MeSH terms: Drug Utilization Review/trends
Use of ATC to describe duplicate medications in primary care prescriptions

Lim CM, Aryani Md Yusof F, Selvarajah S, Lim TO

Eur J Clin Pharmacol, 2011 Oct;67(10):1035-44.
PMID: 21499761 DOI: 10.1007/s00228-011-1025-4

PURPOSE: We aimed to demonstrate the suitability of the Anatomical Therapeutic Chemical Classification (ATC) to describe duplicate drugs and duplicate drug classes in prescription data and describe the pattern of duplicates from public and private primary care clinics of Kuala Lumpur, Malaysia.

METHODS: We analyzed prescription data year 2005 from all 14 public clinics in Kuala Lumpur with 12,157 prescriptions, and a sample of 188 private clinics with 25,612 prescriptions. As ATC Level 5 code represents the molecule and Level 4 represents the pharmacological subgroup, we used repetitions of codes in the same prescription to describe duplicate drugs or duplicate drug classes and compared them between the public and private clinics.

RESULTS: At Level 4 ATC, prescriptions with duplicates drug classes were 1.46% of all prescriptions in private and 0.04% in public clinics. At Level 5 ATC, prescriptions with duplicate drugs were 1.81% for private and 0.95% for public clinics. In private clinics at Level 5, 73.3% of prescriptions with duplicates involved systemic combination drugs; at Level 4, 40.3% involved systemic combination drugs. In the public sector at Level 5, 95.7% of prescriptions with duplicates involved topical products.

CONCLUSIONS: Repetitions of the same ATC codes were mostly useful to describe duplicate medications; however, we recommend avoid using ATC codes for tropical products for this purpose due to ambiguity. Combination products were often involved in duplicate prescribing; redesign of these products might improve prescribing quality. Duplicates occurred more often in private clinics than public clinics in Malaysia.

Matched MeSH terms: Drug Utilization Review
Fulltext Pattern of drug utilization in rural Malaysia

Hasamnis AA, Patil SS, Narayan KA, Khan AR, Mohanty BK

Ann Afr Med, 2010 Apr-Jun;9(2):106-7.
PMID: 20587935 DOI: 10.4103/1596-3519.64746
Matched MeSH terms: Drug Utilization Review
Fulltext Defined Daily Dose and Appropriateness of Clinical Application: The Coxibs and Traditional Nonsteroidal Anti-Inflammatory Drugs for Postoperative Orthopaedics Pain Control in a Private Hospital in Malaysia

Bakrin FS, Makmor-Bakry M, Che Hon WH, Faizal SM, Manan MM, Ming LC

Pharmacy (Basel), 2020 Dec 08;8(4).
PMID: 33302438 DOI: 10.3390/pharmacy8040235

INTRODUCTION: Drug utilization of analgesics in a private healthcare setting is useful to examine their prescribing patterns, especially the newer injectable cyclooxygenase (COX)-2 inhibitors (coxibs).
OBJECTIVES: To evaluate the utilization of coxibs and traditional nonsteroidal anti-inflammatory drugs (tNSAIDs) indicated for postoperative orthopaedic pain control using defined daily dose (DDD) and ratio of use density to use rate (UD/UR).
METHOD: A retrospective drug utilization review (DUR) of nonsteroidal anti-inflammatory drugs (NSAIDs) at an inpatient department of a private teaching hospital in Seremban, Malaysia was conducted. Patients' demographic characteristics, medications prescribed, clinical lab results, visual analogue scale (VAS) pain scores and length of hospital stay were documented. Orthopaedic surgeries, namely arthroscopy, reconstructive, and fracture fixation, were included. Stratified random sampling was used to select patients. Data were collected through patients' medical records. The DDD per 100 admissions and the indicator UD/UR were calculated with the World Health Organization's DDD as a benchmark. The inclusion criteria were patients undergoing orthopaedic surgery prescribed with coxibs (celecoxib capsules, etoricoxib tablets, parecoxib injections) and tNSAIDs (dexketoprofen injections, diclofenac sodium tablets). Data were analysed descriptively. This research was approved by the academic institution and the hospital research ethics committee.
RESULT: A total of 195 records of patients who received NSAIDs were randomly selected among 1169 cases. In term of the types of orthopaedic surgery, the ratio of included records for arthroscopy:fracture fixation:reconstructive surgery was 55.4:35.9:8.7. Most of the inpatients had low rates of common comorbidities such as cardiovascular disease as supported by their baseline parameters. The majority were not prescribed with other concomitant prescriptions that could cause drug interaction (74.9%), or gastroprotective agents (77.4%). Overall, DDDs per 100 admissions for all NSAIDs were less than 100, except for parecoxib injections (389.23). The UD/UR for all NSAIDs were less than 100, except for etoricoxib tablets (105.75) and parecoxib injections (108.00).
DISCUSSION: As per guidelines, the majority (96.9%) received other analgesics to ensure a multimodal approach was carried out to control pain. From the UD/UR results, the arthroscopy surgery was probably the most appropriate in terms of NSAID utilization.
CONCLUSION: The prescribing pattern of NSAIDs except parecoxib was appropriate based on adverse effect and concurrent medication profile. The findings of this DUR provide insight for a low-risk patient population at a private specialized teaching hospital on the recommended use of NSAIDs for postoperative orthopaedic pain control.

Matched MeSH terms: Drug Utilization Review