Search

Background: Fluoroquinolones are indicated for the treatment of a number of infections due to their broad-spectrum activity. Objectives: In the present study we aimed to describe the types and characteristics of fluoroquinolones prescribed, to examine the pattern of Fluoroquinolones used and to calculate and compare the Defined Daily Doses (DDD) for each Fluoroquinolones with the WHO guidelines. Methods: The full prescription record of patients prescribed with fluoroquinolones was reviewed and the data which met the inclusion and exclusion criteria were recorded. In this study, the data were recorded as the DDD per 1000 inhabitants per day. Data from the patient’s prescription record and demographic profile were assessed using descriptive statistics. Results and Discussion: Out of 200 screened patients’ prescription, 51% were males. Patient in the age group of >60 years old was 30.5%; followed by age group 40-49 years, 18.5%. Ciprofloxacin 250mg (Ciprobay 250mg) was the most widely prescribed fluoroquinolone, accounting for 31 % of the prescriptions. This was followed by levofloxacin 500mg (Cravit 500mg) 25% and moxifloxacin 400mg (Avelox 400mg) 18.5%. Ofloxacin (Tarivid 100mg) was only 4%. In term of calculation based on DDD, the four most utilized fluoroquinolones were levofloxacin 500mg (0.049 DID) followed by moxifloxacin (0.03 DID), Ciprofloxacin 500mg (0.028 DID), and ciprofloxacin 250mg (0.024 DID). The least utilized antibiotic was ofloxacin 100mg (0.0069 DID). The total fluoroquinolones antibiotics used for the outpatient department in the hospital were 0.1409 DID. Conclusion: The accessed data revealed that the DDD, for all the Fluoroquinolones utilized at this hospital complied with the recommended WHO DDD. Key words: Pharmacoepidemiology, Antimicrobial, Ciprofloxacin, Levofloxacin, Prescribing pattern, DDD.

Drug utilization of oral hypoglycemic agents (OHAs) in a private healthcare setting is useful to examine the prescribing pattern of OHAs, especially the newer fixed dose combination (FDC) products. This study was aimed to evaluate the prescribing pattern of OHAs indicated for Type 2 diabetes mellitus (T2DM), to determine the costs of OHAs prescribed and total cost per prescription in the treatment of T2DM in an outpatient department of a private hospital located in central Malaysia. Retrospective review of electronic medical record (EMR) study design was adopted. Patient’s demographic characteristics, medications prescribed, prescribers’ details and cost per prescription were documented. Defined daily dose (DDD) of OHAs and drug cost were calculated. Research ethics protocol was approved and no personal data was collected. Out of the 396 EMR screened, 135 fulfilled the inclusion criteria and subsequently were analysed. In term of demography, mean age of the sample was 51 years old with 59% were male and ethnicity composition of 71% Malay and 19% Chinese. Metformin and “metformin+dipeptidyl peptidase-4 inhibitor” (DPP-4i) were the most commonly prescribed single-drug and FDC OHA, respectively. Average cost of OHAs and total cost per prescription was less than USD 68 and USD 185, respectively. Meanwhile, FDC covered 28.91% of incidences of prescriptions, but 44.6% of cost and SGTL-2i covered 9% incidences of prescriptions and 16.29% of cost. Prescribing pattern of OHA was appropriate based on patient’s T2DM diagnosis, however, dosage given were not in accordance with WHO DDD.

INTRODUCTION: Awareness on antibiotics resistance among outpatients in hospital settings is reasonably explored and this study aimed to investigate the sociodemographic impact and the level of acquaintance towards antibiotics practice and resistance. MATERIALS AND METHODS: This cross-sectional study was conducted on 270 patients from the outpatient department of KPJ Seremban Specialist Hospital (KPJSSH), Malaysia. A pre-validated questionnaire was used to collect the data on the demographics of the patients, their knowledge, attitude, and usage of antibiotics. The study was approved by the KPJUC ethics committee (KPJUC/RMC/BPH/EC/2017/104). RESULTS: The mean age of the respondents was 36 ± 11.07 years and 50.37% of them have moderate knowledge on antibiotics. The knowledge and attitude on antibiotics usage exhibited a significant difference (p=0.001) amongst these patients in association with literacy. The results showed that the literate respondents have significant knowledge on the identification of antibiotics (p=0.021), their roles, and adverse effects (p=0.004). The attitude of the respondents towards following the prescription was significantly associated with their literacy (p=0.004). CONCLUSION: This study reveals that respondents have the least knowledge on antibiotic course compliance and termination of therapy, which could lead to antimicrobial resistance. In conclusion, inculcating the knowledge of antimicrobial resistance, adverse effects, and course compliance among the patients may help overcome the national and global issues on multi-drug-resistant diseases.

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&rsquo, 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&rsquo, medical records. The DDD per 100 admissions and the indicator UD/UR were calculated with the World Health Organization&rsquo, 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.

Neuropathology of Alzheimer’s disease comprises cholinergic neuronal loss with an accumulation of amyloid beta (Aβ) protein and oxidative stress. Prunus domestica (Rosaceae) has been implicated to treat inflammation, anxiety, obesity, and neurological diseases. This study was designed to determine the antioxidant potential and neurocognitive effects of P. domestica fruit extract on scopolamine-induced amnesia. Mice were treated with 200 and 400 mg/ kg of ethanolic extract of P. domestica (EEPD) for 15 days and induced with amnesia by scopolamine (1 mg/kg). The total phenolic content and free radical scavenging ability on 1,1-diphenyl-2-picrylhydrazyl and 2,2′-azino-bis 3-ethylbenzothiazoline-6-sulphonic acid radical scavenging assay indicated the potential ability of the antioxidant system by EEPD. Behavioral and habituation memory was assessed using the Y-maze test, open-field test, and traction test, which revealed the potential impact on neurobehavioral improvement in scopolamine-induced amnesia in mice. The brain neurotransmitter metabolic enzyme acetylcholinesterase (AChE) indicated significant reduction and escalated memory performance after the treatment of EEPD. This implies that the EEPD exhibits a significant ameliorating (p < 0.05 in 200 and p < 0.01 in 400 mg/kg) effect in AChE inhibition on scopolamine-induced amnesia and is proven to have a beneficial effect on treating memory and learning impairment.

Summary 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.

Introduction To identify and assess the characteristics, risk and outcome of neonates treated with empiric antibiotics for suspected early onset sepsis (EOS). Material and methods This is a retrospective study conducted at a Malaysian government hospital. Records of neonatal patients admitted within 72 h of life and prescribed with empirical antibiotic therapy for suspected EOS were reviewed. Results Three hundred and twenty-three cases met the inclusion criteria and were divided into gestational age (premature < 36 weeks; term ≥ 37 weeks) and birth weight (low birth weight (LBW) < 2.5 kg; normal body weight (NBW) ≥ 2.5 kg) groups. Premature (n = 197) and LBW (n = 194) neonates required significantly longer hospital stay, a higher degree of ventilator support and more surfactant (p = 0.001). More than 90.0% of premature and LBW neonates were diagnosed with respiratory distress syndrome, congenital pneumonia and presumed sepsis. Term (n = 123) and NBW (n = 129) neonates had greater maternal risk factors, especially meconium-stained amniotic fluid (MSAF) and perinatal asphyxia. The incidence of demonstrated EOS was 3.1%. Crystalline penicillin plus gentamicin was the standard therapy for all groups and was started within 24 h of life, with a mean treatment duration of ∼4 days. The treatment success rate was 89.0%, and only LBW neonates showed a higher risk of overall treatment failure (OR = 3.75; 95% CI: 1.22–11.53). Seventy-four percent of term and NBW neonates discharged well, while 42.0% of premature and LBW neonates required referral. Conclusions Crystalline penicillin plus gentamicin prescribed within 24 h of life is effective in the prevention of EOS. However, low birth weight neonates have a higher risk of treatment failure.

Background: For the past 10 years, the pharmacist workforce in Malaysia has experienced radical changes in demography, job scope and expectations as well as remuneration due to a drastic surge in the number of pharmacists employed in the public sector. Aim: To investigate the level of job satisfaction amongst pharmacists working in the public sector in Malaysia. Methods: A cross-sectional survey was conducted amongst registered pharmacists working in three of the most populated states in Malaysia. A validated questionnaire consisting of three sections was used to investigate intrinsic and extrinsic factors of job satisfaction and their overall job satisfaction. Results: Analysis of responses from 161 pharmacists revealed significant differences in job satisfaction with age and length of service. Pharmacists within the age group of 35–45 years were more satisfied with their jobs than younger pharmacists. Findings also showed that pharmacists who had been working for more than 7 years tended to be more satisfied with their jobs. Type of institution, position held and gender did not appear to influence job satisfaction. Intrinsic factors such as autonomy, contribution, creativity and challenge had significant impact on job satisfaction; creativity had the strongest impact as compared with other factors. Extrinsic factors such as salary, supervision feedback and job atmosphere also had significant impact on job satisfaction. Conclusion: Only 52% of the pharmacists who responded were satisfied with their current jobs. The study outcomes indicate the major factors that affect pharmacists’ job satisfaction. Factors affecting job satisfaction could be used by policy makers and pharmacy managers to design retention strategies.

Background: Studies concerning epilepsy in the context of pharmaceutical care in Malaysia are lacking. Optimal pharmacotherapy management is necessary to achieve good seizure control. Aim: To determine the pharmaceutical care issues in hospitalised epileptic patients. The factors associated with uncontrolled seizure and hospitalisation and the drug-related problems encountered are also described. Methods: A cross-sectional study was conducted on 65 hospitalised epileptic patients until discharge. Prediction of dose adequacy and adherence, assessment of drug-related problems, adherence and outcome measurement of seizure control were analysed. Results: Overall, 56.9% of patients defaulted from antiepileptic drug doses prior to seizure attack. The remaining 43.1% were affected by emotional stress, fever, weather and alcohol. The drug-related problems identified were non-adherence to medication (64.6%), dose inadequacy(51.9%),under-reportingofadverseeffects(76.2%),under-utilisationoftherapeuticdrugmonitoringservices(41.5%)andinappropriateness of therapy in patients with liver disease. Nevertheless, medication adherence was found to be the major factor for uncontrolled epilepsy (odds ratio = 7.06, confidence interval =1.29–38.56, p = 0.019). Among the non-adherers, only 19% received medication counselling upon discharge (p = 0.043). Conclusion: Pharmacists need to address the drug-related problems in order to optimise drug therapy and achieve the desired treatment goal.

Spontaneous adverse drug reactions (ADRs) reporting is a useful source of drug safety information in infants as only adult patients are routinely tested in clinical trials. This study was aimed to evaluate the spontaneously reported ADRs using WHO Adverse Reaction Terminology and to identify the common drugs associated with ADRs in children under 2 years of age. A retrospective analysis of ADR data for children below 2 years old from 2000 to 2013 was conducted using the data extracted from Malaysia’s national pharmacovigilance database, QUEST2 System. From 2000 to 2013, Malaysia’s National Pharmaceutical Control Bureau received a total of 11,932 reports for children from various healthcare facilities in Malaysia. 14.0% (n = 1667) of the ADRs reported for those children were related to children under 2 years old. The data retrieved was analyzed in terms of age, gender, source of reporting, type of reporters, suspected medicines and characteristics of ADRs (category, onset, severity, and outcomes). A total of 1312 ADRs reported in 907 ADR reports were analyzed. The most common ADRs reported were skin appendage disorders (60.1%), and the most frequently reported symptoms were rash (n = 215), maculopapular rash (n = 206), urticaria (n = 169), erythematous rash (n = 76), and pruritus (n = 58). In general, drugs from antibacterials for systemic use (58.8%) appeared to be the most common contributors to ADRs in children below 2 years old. Penicillins and other β-Lactam Antibacterials accounted for more than 40% of all drugs implicated in ADRs. The majority of ADRs were subacute reactions that occurred within 24 h of exposure to the drug. A high proportion of ADRs was classified as mild, and most victims had no sequela. Only one fatality was seen. There were 10 cases for each symptom, namely erythema multiforme and Stevens–Johnson Syndrome, observed in this study. A large proportion of ADRs in children under 2 years old were mainly caused by drugs from antibacterial for systemic use, with most of the ADRs manifesting in skin reactions. This study also reveals rare cutaneous ADRs experienced by Malaysian children under the age of 2, which constitutes a crucial cause of harm among children.

Despite limited evidence on safety and efficacy of drug use in neonates, drugs are extensively used in this age group. However, the availability of information on drug consumption in neonates, especially inpatient neonates, is limited. This paper systematically reviews published studies on drug utilization in hospitalized neonates. A systematic literature review was carried out to identify observational studies published from inception of databases used till August 2016. Four search engines, namely Medline, CINAHL, Embase, and PubMed, were used. Publications written in English that described drug utilization in neonatal wards were selected. Assessment of the data was based on the category of the study design, the objective of study and the method used in reporting drug consumption. A total of 20 drug utilization studies were identified, 12 of which focused on all drug classes, while the other eight evaluated antimicrobials. Studies were reported in Europe (n = 7), the United States (n = 6), India (n = 5), Brazil (n = 1), and Iran (n = 1). Substantial variance with regard to study types (study design and methods), data source, and sample size were found among the selected studies. Of the studies included, 45% were cross-sectional or retrospective, 40% were prospective studies, and the remaining 15% were point prevalence surveys. More than 70% of the studies were descriptive studies, describing drug consumption patterns. Fifteen per cent of the descriptive studies evaluated changes in drug utilization patterns in neonates. Volume of units was the most prevalent method used for reporting all drug categories. The ATC/DDD system for reporting drug use was only seen in studies evaluating antimicrobials. The most commonly reported drugs across all studies are anti-infectives for systemic use, followed by drugs for the cardiovascular system, the nervous system and the respiratory system. Ampicillin and gentamicin were the most prescribed antimicrobials in hospitalized neonates. The present review reveals that neonates are exposed to a high number of drugs and various methods are used to report drug consumption in this age group. The best measure of drug consumption to quantify prevalence of drug use in neonates remains to be identified and additional research in this area is warranted.

Background Spontaneous reporting on adverse drug reactions (ADR) has been established in Malaysia since 1987, and although these reports are monitored by the Malaysia drug monitoring authority, the National Pharmaceutical Control Bureau, information about ADRs in the paediatric patient population still remains unexplored. The aims of this study, therefore, were to characterize the ADRs reported in respect to the Malaysian paediatric population and to relate the data to specific paediatric age groups. Methods Data on all ADRs reported to the National Pharmaceutical Control Bureau between 2000 and 2013 for individuals aged from birth to 17 years old were analysed with respect to age and gender, type of reporter, suspected medicines (using the Anatomical Therapeutic Chemical classification), category of ADR (according to system organ class) as well as the severity of the ADR. Results In total, 11,523 ADR reports corresponding to 22,237 ADRs were analysed, with half of these reporting one ADR per report. Vaccines comprised 55.7% of the 11,523 ADR reports with the remaining being drug related ADRs. Overall, 63.9% of ADRs were reported for paediatric patients between 12 and 17 years of age, with the majority of ADRs reported in females (70.7%). The most common ADRs reported were from the following system organ classes: application site disorders (32.2%), skin and appendages disorders (20.6%), body as a whole general disorders (12.8%) and central and peripheral nervous system disorders (11.2%). Meanwhile, ADRs in respect to anti-infectives for systemic use (2194/5106; 43.0%) were the most frequently reported across all age groups, followed by drugs from the nervous system (1095/5106; 21.4%). Only 0.28% of the ADR cases were reported as fatal. A large proportion of the reports were received from healthcare providers in government health facilities. Discussion ADR reports concerning vaccines and anti-infectives were the most commonly reported in children, and are mainly seen in adolescents, with most of the ADRs manifesting in skin reactions. The majority of the ADR reports were received from nurses in the public sector, reporting ADRs associated with vaccine administration. The low fatality rate of ADR cases reported could potentially be caused by reporting bias due to the very low reporting percentage from the private healthcare institutions. This study indicates that ADR rates among Malaysian children are higher than in developed countries. Constant ADR reporting and monitoring, especially in respect to paediatric patients, should be undertaken to ensure their safety.

The pharmacoinformatics course (PHC500) aims to expose Malaysian UiTM undergraduate pharmacy students to the multidisciplinary field of pharmacoinformatics. The content of the course comprises of topics such as drug information and pharmacy information systems with practice relevant skills. This information is expected to be relevant to these graduates in their future responsibilities in the various fields of pharmacy. Aim: The current study will present a critical review of PHC500 by assessing the programme content and the teaching methods adopted. Its effectiveness is also measured by considering the feedback of students. Results and discussion: 89 out of 121 of the respondents thought that the course was well conducted and the course contents were interesting. Approximately 90 % of respondents also believed that the course content was relevant to their future needs as practising pharmacists. However, they would prefer a shorter duration and less labour-intensive assignment due to the fact that it is a one-credit-hour course. The course curriculum was reorganised in order to better reflect these course outcomes and student learning. The student feedback on the effectiveness and delivery of this course is very positive. Conclusion: The success of the programme will ensure students receive the technical skills and knowledge to allow them to confidently address pharmacy issues within this era of information. The current study showed the importance that the clinical curriculum for PHC500 be revised. The adopted approach to practice-based learning could potentially be used as a blueprint to allow a common focus for successful outcome-based education (OBE).

Objectives: The aim of this study is to assess glycemic control and its relationship with patient characteristics, health-care system factors, and self-care management in type II diabetes patients.Methods: A retrospective cross-sectional study was conducted among 330 type II diabetes patients who met the inclusion criteria and whose medical records covered a period of 1 year. Data concerning patient characteristics, health-care system factors, self-care management, and available last reading of hemoglobin A1c (HbA1c) were collected through personal interviews and a medical records’ review using structured questionnaires and data collection forms. Good glycemic control was defined as HbA1c ≤7%. To assess the results, the Statistical Package for Social Sciences (version 16) was used to undertake descriptive, univariate, and multivariate analyses.Results: The mean±standard deviation age was 60±9.7 years. More than half of the participants were male (51.2%), and the majority had additional chronic diseases (88.5%). Of the total 271 participants whose HbA1c levels have been monitored, 16.7% had good glycemic control. Multivariate analysis showed that unemployment was significantly related to a decreased odds of good glycemic control (odds ratio=0.34; 95% confidence interval=0.12-0.98; p

Background: Adherence to medications is an important factor that contributes to therapeutic success. With the current increase in the elderly population, information relating to adherence to treatment and quality of life (QoL) of diabetic elderly patients will help the healthcare provider to improve their treatment. Thus, this study aims to determine the factors affecting adherence to medications and the consequence of non adherence to QoL. Materials and Methods: This was a cross-sectional study using validated Morisky Medication Adherence Scale (MMAS) Questionnaire. This study was conducted to assess the level of adherence on oral hypoglycemic medications (OHM) and quality of life of the Type 2 diabetes mellitus (T2DM) elderly patients in an urban health centre in Malaysia. A retrospective medication record review was also conducted to collect and confirm data on patients’ demographics, diagnosis, treatments, and outcomes. Results: One hundred and seventy nine patients were recruited in this study. Median adherence score was 7.75 (IQR 6.50- 8.00). Good adherer was observed in 48.00% of the participants. A Chi-square test indicated significant correlation between adherence and HbA1c (p= 0.010). The mean elderly diabetes mellitus Problem Areas in Diabetes (PAID) score was 6.30 ±SD 8.50. A significant inversed association was observed between PAID score and the level of adherence (r = - 0.175, p< 0.05). A highly significant difference in the low adherence group (p = 0.002). PAID score significantly correlated with age (years), female gender and HbA1c (p