NATIONAL ANTIBIOTIC GUIDELINE

247 Pages·2015·3.24 MB·English

by  Mardhiyah Kamal

NATIONAL ANTIBIOTIC GUIDELINE

2014
SECOND EDITION
FULL WEB VERSION CAN BE DOWNLOADED FROM :
www.pharmacy.gov.my
www.moh.gov.my
DECEMBER 2014

This guideline is constantly being reviewed and will be updated periodically via
website or app

Copyright 2014 by MINISTRY OF HEALTH MALAYSIA. All rights reserved. No part of this
publication may be reproduced without permission in writing from the publisher.

Produced & Distributed by :
PHARMACEUTICAL SERVICES DIVISION
MINISTRY OF HEALTH MALAYSIA
LOT 36, JALAN UNIVERSITI
46350 PETALING JAYA
SELANGOR , MALAYSIA

TEL : [phone]
FAX : [phone]
WEBSITE : www.pharmacy.gov.my
MESSAGE FROM THE DIRECTOR GENERAL OF HEALTH MALAYSIA

The first edition of National Antibiotic Guideline was launched in 2008 with its primary aim to guide
clinicians in the Ministry of Health in their empirical choice of antimicrobial agents. Nevertheless,
local sensitivity patterns should also be taken into consideration where necessary.
This guide is important to enhance appropriate prescribing of antimicrobials to avoid dubious
indication and inappropriate duration. Even though treatment with antimicrobial agents has
contributed to the reduction of infectious disease, there is still a concern for the development of
antimicrobial resistance due to inappropriate use of antimicrobial. The emergence of antimicrobial
resistance will require the antimicrobial to be used appropriately and effectively.
2nd Edition of National Antibiotic Guideline 2014 is in line with the Protocol on Antimicrobial
Stewardship (AMS) Program in Healthcare Facilities, which was launched in 2014. Implementation
of AMS program will use this guideline as reference for audit purposes. Both guidelines will hopefully
benefit the clinicians and pharmacists in advocating good prescribing practice of antimicrobial and
subsequently can curb antimicrobial resistance and minimize healthcare cost.
I would like to congratulate all committee members, from various department, headed by Datuk Dr.
Christopher Lee, for their great collaborative effort in revising and updating the first edition of
National Antibiotic Guideline and thus, have come up with the 2nd edition with latest available
evidence as possible. This collaborative effort is a reflection of great team work among officers in the
Ministry of Health.
Certainly, this is not an easy job; all the effort that was put in to produce this guideline should be
appreciated. I strongly urge everyone in the Ministry of Health to make full use of this guideline as
reference in their routine work. However, it is important to note that this guideline does not replace
the need for consultation for expert advice and should always be tailored to each individual needs.
ADVISORS
Y.Bhg. Datuk Dr. Noor Hisham Abdullah
Director General of Health

Y.Bhg. Dato’ Eisah A. Rahman
Senior Director of Pharmaceutical Services

Y.Bhg. Dato’ Dr. Azman Bin Abu Bakar
Director Medical Development Division

MAIN EDITORIAL COMMITTEES

Datuk Dr. Christopher Lee K. C Ms. Rosminah Mohd. Din
Sungai Buloh Hospital (Chairman) Pharmaceutical Services Division, MOH

Dato’ Dr. Jamil Abdullah Dr. Benedict Sim Lim Heng
Sultanah Nur Zahirah Hospital Sungai Buloh Hospital

Dato’ Dr. N. Premchandran Dr. Zubaidah Abdul Wahab
Hospital Tengku Ampuan Afzan Sungai Buloh Hospital

Dr. Norazah Ahmad Dr. Suraya Hanim
Institute for Medical Research Sg. Buloh Hospital

Dr. Tan Kah Kee
Dr. Syamhanin Adnan
Tuanku Ja’afar Hospital
Hospital Selayang

Ms. Noraini Mohamad
Pharmaceutical Services Division, MOH Ms. Rohana Hassan
Kuala Lumpur Hospital
Ms. Mardhiyah Kamal
Pharmaceutical Services Division, MOH
WORKING COMMITTEES

Infectious Disease Physicians:

Dr. Suresh Kumar Dr. Anusha Shunmugarajoo
Sg. Buloh Hospital Raja Permaisuri Bainun Hospital

Dr. Thahira Jamal Dr. Cheng Joo Thye
Kuala Lumpur Hospital Raja Permaisuri Bainun Hospital

Dr. Suraya Hanim Dr. Leong Kar Nim
Sg. Buloh Hospital Pulau Pinang Hospital

Dr. Rosnida Mohd Noh Dr. Lee Heng Ghee
Sg. Buloh Hospital Queen Elizabeth I Hospital

Dr. Yasmin Abdul Ghani Dr. Dzawani Muhamad
Sg. Buloh Hospital Sg. Buloh Hospital

Pharmacists:

Ms. Rohana Hassan Ms. Rahela Ambaras Khan
Kuala Lumpur Hospital Sg. Buloh Hospital

Dr. Syamhanin Adnan Ms. Pang Chia Wen
Hospital Selayang Sg. Buloh Hospital

Dr. Norkasihan Ibrahim
Kuala Lumpur Hospital Ms. Thong Kah Shuen
Raja Permaisuri Bainun Hospital
Ms. Siti Hir Huraizah Md. Tahir
Melaka Hospital Ms. Norirmawath Saharuddin
Raja Permaisuri Bainun Hospital
Ms. Norliza Mat Ariffin
Selayang Hospital Ms. Ng Poh Lee Geetha
Tengku Ampuan Rahimah Hospital
Ms. Farizan Abdul Ghaffar
Serdang Hospital Ms. Tay Chan Yen
Kuala Lumpur Hospital
Ms. Puteri Juanita Zamri
Selayang Hospital Ms. Anitha Ramadas
Kuala Lumpur Hospital
Ms. Sharifah Nor Sazlin
Sultan Haji Ahmad Shah Hospital Ms. Siti Shahida
Kuala Lumpur Hospital

Ms. Izyana Munirah Idham Ms. Maisarah Abdul Hamid
Sg. Buloh Hospital Kuala Lumpur Hospital

Ms. Yew Shi Fen Ms. Goh Chia Mein
Sg. Buloh Hospital Kuala Lumpur Hospital
Ms. Lee Mei Wah
Kuala Lumpur Hospital

TDM Committee

Clinical Microbiologists:

Dr. Rohaidah Hashim
Institute for Medical Research Dr. Norazlah Bahari
Selayang Hospital
Dr. Adilahtul Bushro
Sg. Buloh Hospital Dr. Azizah Mustafa
Selayang Hospital
Dr. Muhammad Nazri Aziz
Sg. Buloh Hospital Dr. Lailatul Akmar Mat Nor
Serdang Hospital
Dr. Tuan Suhaila Tuan Soh
Sg. Buloh Hospital Dr. Nurzam Suhaila
Kuala Lumpur Hospital
Dr. Aniz Suriani Mohd Ali
Putrajaya Hospital Dr. Sahlawati Mustakim
Tengku Ampuan Rahimah Hospital
Dr. Suhaila Md Hanapiah
National Cancer Institute Dr. Hazilawati Hussin
Ampang Hospital
Dr. Noor Hasliza Zainol
Tengku Ampuan Rahimah Hospital
CONTRIBUTORS H. GASTOINTESTINAL
A. SURGERY Dato’ Dr. Muhammad Radzi
Dato’ Dr. Wan Khamizar Wan Khazim
Dato’ Dr. Jamil Abdullah

Dato’ Dr. Mohamed Yusof
I. ORAL HEALTH
Dato’ Zakaria Zahari
Dr. Sivakama Sunthari
Mr. Zainal Ariffin Azizi
Dr. Sherrie Chong Mei Yee
Dato’ Dr. Lim Lay Hooi
Dr. Sharifah Tahirah
Mr. Rohan Malek Johan Thambu
Dr. Renukanth Raman
Mr. Krishnan a/l Raman

Dr. Rica Farah
J. TROPICAL INFECTIONS
Mr. Johari Siregar Adnan
Dr. Suresh Kumar

Ms. Anitha Ramadas
B. PAEDIATRIC

Dr. Tan Kah Kee
K. OBSTETRIC & GYNAECOLOGY
Dr. Revathy Nallusamy Dr. J. Ravichandran
Dr. Jayaseelan P. Nachiappan Dr. Vairavan@Ramesh
Dr. Fong Siew Moy
Dr. Nik Khairulddin Nik Yusoff L. RESPIRATORY
Dr. Wong Ke Juin Dr. Ashari Yunus
Dr. Suryati Adnan Mr. Fariz Ariffin
Dr. Thahira Jamal
Dr. Choo Chong Ming M. OTORHINOLARINGOLOGY
Dr. Melati Hj Abdul Ghani
C. OPTHALMOLOGY Dato' Dr. Majid Md. Nasir
Dr. Shamala Retnasabapathy
Datin Dr Siti Sabzah Mohd Hashim
Dr. Siti Nor Roha Daman Huri
Dr Zulkiflee Salahuddin
Dr. Jamalia Rahmat
Dr. Shelina Oli Mohamed Dato' Dr. Narizan Ariffin
Dr. Norlaila Talib Dr. Norleza Ahmad Norhan
Mr. Tan Chee Chin
D. INFECTION IN INTENSIVE CARE UNIT
(ICU) N. CARDIOVASCULAR INFECTIONS
Datin Dr. Sivasakhti Velayuthapillai Dato’ Dr. Omar Ismail
Dr. Tai Li Ling Dato’ Dr. Mohd Hamzah

E. DERMATOLOGY O. INFECTIONS INIMMUNOCOMPROMISED
Datuk Dr. Roshidah Baba
PATIENTS
Dr. Rohna Ridzwan
Dato’ Dr. Chang Kian Meng
Dr. Choon Siew Eng
Dr. Chew Lee Ping
Dr. Sabeera Begum
Prof. Dr. Gan Gin Gin
Dr. Noorzalmy Azizan
Prof. Dr. Fadilah
Dr. Tarita Taib
Dr. Goh Kim Yean
Dr. Tang Jyh Jong
Dr. Chew Teng Keat
Ms. Azura Kasim
Dr. Chua Hock Hin

Dr. Suresh Kumar
F. NEPHROLOGY
Dr. Benedict Sim
Datuk Dr. Ghazali Ahmad
Dr. Norkasihan Ibrahim
Dato’ Dr. Ong Loke Meng
Dato’ Dr. Tan Chwee Choon
Dr. Wong Hin Seng P. ORTHOPEADIC
Dato’ Dr. N. Premchandran
G. NEUROLOGY Dato’ Dr. Zulkiflee Osman
Dato’ Dr. Mohd. Hanip Mohd. Rafia Dr. Tajuddin
Dr. Chye
EXTERNAL REVIEWERS

Prof. Dr. Adeeba Kamarulzaman
University Malaya Medical Centre

Prof. Madya Dr. Sasheela Vanar
University Malaya Medical Centre

Prof. Dr. Zamberi Sekawi
University Putra Malaysia

Dr. Petrick Periyasamy
National University of Malaysia Hospital
CONTENTS

INTRODUCTION TO THE GUIDELINES
PRINCIPLES OF ANTIBIOTIC THERAPY AND RATIONAL ANTIBIOTIC PRESCRIBING
ANTIMICROBIAL STEWARDSHIP
ANTIBIOTIC RESISTANCE DATA (2011-2013)
ANTIBIOTIC UTILISATION DATA (2009-2013)

SECTION A : ADULT

Cardiovascular Infections
Central Nervous Infections
Chemoprophylaxis
Surgical
Non-surgical
Gastrointestinal Infections
Infections in Immunocompromised Patients:
Hematology
Human Immunodeficiency Virus (HIV)
Solid Transplant
Obstetrics & Gynaecological Infections
Ocular Infections
Oral / Dental Infections
Otorhinolaryngology Infections
Respiratory Infections
Lower Respiratory Tract Infections (LRTI)
Sexually Transmitted Infections
Skin & Soft Tissue Infections
Surgical Infection
General Surgery
Bone & Joint Infections
Urology
Neurosurgery
Diabetic Foot
Tropical Infections
Tuberculosis Infections
Urinary Tract Infections