Vol. 7 No. 2 (2021): Malaysian Journal of Pharmacy

Published: 31 Dec 2021

In this issue:

  • Obituary: Professor Dr. Mohamed Azmi bin Ahmad Hassali (1974-2021)
  • An Evaluation of Interventions by Clinical Pharmacists in a Tertiary Hospital
  • Effectiveness of Pharmacist-Led Audit-and-Feedback Intervention in Promoting Appropriate Third-Generation Cephalosporin Use at a Tertiary Public Hospital in Malaysia
  • A Qualitative Study Exploring Pharmacists’ Perspectives on the Conceptualization and Operationalization of Patient-Centred Care in the Hospital Pharmacy Setting
  • Knowledge of Malaysian University Students on Methods of Contraception, Assessed Using a Validated Instrument (Knowledge on Methods of Contraception)
  • Public Knowledge and Attitudes Towards Antibiotics Usage in Perlis: A Cross-Sectional Study
  • Utilisation of Third-Generation Cephalosporins and the Occurrence of ESBL Microorganisms in a Malaysian General Hospital
  • Assessment of Vancomycin Pharmacokinetic Parameters among Malaysian Adult Patients in Penang with Different Kidney Functions
  • Trends in the Utilization of Psychotropic Drugs in Serdang Hospital
  • First Year Pharmacy Students’ Perceptions on ODL during the Covid-19 Pandemic: A Thematic Analysis
  • Knowledge, Attitude and Practice of Malaysian Private Hospital Pharmacists on Medication Review
  • Use of Alirocumab for the Secondary Prevention of Cardiovascular Disease in a Patient with End-stage Renal Disease on hemodialysis
  • Stability Study of an Extemporaneous Isoniazid Oral Suspension Prepared using Commercially Available Tablets with X-Temp® Oral Suspension System
  • Patterns of Prescription Medicines Sale Through E-Marketplace in Malaysia and Associating Factors

Patterns of Prescription Medicines Sale Through E-Marketplace in Malaysia and Associating Factors

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    Abstract

    Introduction: Self-diagnose and obtaining various health products via the Internet were extremely risky practices as it may increase the risks of patient injury or even death. Objective: This study aims to explore the patterns of prescription medicines sale through e-marketplace (specifically: Shopee) in Malaysia as well as the associated factors. Method: Cross-sectional study secondary data of 983 Advertisement Screening Reports (reported from 1st January 2020 – 30th June 2020) in Johor State were collected. Descriptive statistics using frequency, percentages and/ bar charts using Microsoft Excel 2013 were used to report on the patterns of prescription medicines sale through e-marketplace (specifically: Shopee) in Malaysia based on types of prescription medicines that are being advertised, registration status of prescription medicine that are being advertised as well as frequently violated Malaysia’s law related to prescription medicine by sellers on Shopee. Factors associated were explored by Simple and Multiple Logistic Regressions using IBM SPSS Version 22. Results and Discussion: 796 out of 852 (93.4%) prescription medicines samples were not registered with the Drug Control Authority, Malaysia’s Health Ministry. Hormones (62.6%, while sex hormones which were anabolic steroids showed the highest frequency; 58.3%) were the highest prescription medicines sold through the e-marketplace in Malaysia, followed by antibiotics, clomiphene (fertility drug), sibutramine (slimming pill) and prostaglandin and its synthetic derivatives (abortion pill) denote 4.8%, 2.2%, 1.8%, 0.4% respectively. The unregistered prescription medicines were found to be the highest to violate Section 13(a) of Poison Act 1952 which include 766 samples. Multiple logistic regression tests indicate that sellers who violated Regulation 7(1)(a) of Control of Drug and Cosmetic Regulations 1984 (Adjusted OR: 728.63; 95%CI; 194.69, 2726.96%; p = 0.000) have higher chance to sell unregistered medicines through e-marketplace compared to those who violated Section 13 (a) of Poison Act 1952 (Adjusted OR: 0.012; 95%CI; 0.002, 0.058%; p = 0.000), and Section 4B of Malaysia Advertisement and Sale Act 1956 (Adjusted OR: 0.060; 95%CI; 0.014, 0.260%; p = 0.000). Conclusion: The findings in this study may give a brief idea for improving the current practice in order to curb the freely illegal prescription medicines sale through e-marketplace (specifically: Shopee) without the supervision of professionals.

    Utilisation of Third-Generation Cephalosporins and the Occurrence of ESBL Microorganisms in a Malaysian General Hospital

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      Abstract

      Introduction: Bacteria had undergone an evolution since the introduction of antibiotics as a way of adaptation. The recent increase in cases of extended-spectrum beta-lactamases (ESBLs) and broad-spectrum antibiotics usage worldwide are of great concern. Objective: This study aims to establish the relationship between third-generation cephalosporin antibiotics usage and the occurrence of ESBL microorganisms in a state hospital in Malaysia. Method: A cross-sectional study utilising data from January 2014 to June 2017 for six-monthly uses of cefoperazone, cefotaxime, ceftazidime, ceftriaxone was expressed in defined daily dose (DDD) per 100 bed-days, while 6-monthly positive cultures of ESBL-producing Escherichia coli, Klebsiella pneumoniae were expressed as the frequency of infection and coloniser cases. Individual trends of antibiotics use-positive culture ESBL over time were analysed descriptively and by linear regression. Result: None of the third-generation cephalosporin use shows a significant trend over time. The most prescribed third-generation cephalosporin was ceftriaxone. The emergence of ESBL E. coli showed a significant reducing trend over time (r2 = 0.931, p < 0.001). No significant correlation was found between antibiotic use and the emergence of ESBL organisms. Conclusion: Our study found no significant correlation between third-generation cephalosporin use and the emergence of ESBL organisms in our setting. The association between third-generation cephalosporin use and ESBL emergence should not be considered universal, as the selection pressure of third-generation cephalosporin might be affected by other factors specific to the institution. The reducing trend of E. coli emergence may be due to the antimicrobial stewardship programme already in place. Additionally, ESBL-producing organisms may appear susceptible to third-generation cephalosporins in our laboratory yet be functionally resistant in vivo.

      Assessment of Vancomycin Pharmacokinetic Parameters among Malaysian Adult Patients in Penang with Different Kidney Functions

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        Abstract

        Introduction:  Vancomycin is indicated for highly resistant gram-positive systemic infections. The targeted trough and 24-hour area under the concentration-time curve (AUC24) level of vancomycin must be achieved for efficacy and safety. Local population-based pharmacokinetic parameters including the elimination rate constant (Ke), half-life (t1/2), volume of distribution (Vd) and vancomycin clearance (Clvanco) can allow better vancomycin dosing determination. Objective: This study aims to determine the pharmacokinetic parameters in the Malaysian adult patients in Penang based on different kidney functions. Method: This was a retrospective, single-centered study conducted in the Clinical Pharmacokinetics Department, Penang General Hospital from 1 January 2016 to 31 December 2017. This study included adult patients who had been treated with intravenous vancomycin under therapeutic drug monitoring. The patients’ personalised vancomycin pharmacokinetic parameters were determined using a series of pharmacokinetic equations. Result: From the recruited 26 patients, 73.1% were male and 46.2% were above 50 years old. A total of 34.6% patients had the actual body weight / ideal body weight ratio of more than 1.0. The median total daily dose was 34.72 mg / kg. The median for Cmax (peak serum concentration) was 26.0 mg /L while Cmin (trough serum concentration) was 14.20 mg / L. The median for AUC24 is 412.08 mg*hr / L. The overall median for Ke and t1/2 were 0.091 hr-1 and 7.62 hours, respectively. The median Vd was 0.90 L / kg. It was found that with increasing creatinine clearance, the Ke and Vd increased while the t1/2 decreased. Conclusion: The vancomycin pharmacokinetic data from this study varied according to different degree of creatinine clearances.

        Trends in the Utilization of Psychotropic Drugs in Serdang Hospital

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          Abstract

          Introduction: The prevalence of mental health issues in Malaysia has tripled from 10.7 % in 1996 to 29.2 % in 2015. This was reflected by an increasing usage of psychotropic drugs over the past two decades. Thus, this study was carried out to explore the utilization trends of psychotropic drugs prescribed in Serdang Hospital. Method: This observational retrospective quantitative study was conducted using 11-year data from January 2008 to December 2018. Dispensing data was obtained using the electronic hospital information system (eHIS) in Serdang Hospital. Defined daily doses per 1000 populations per year metric (DDDs / 1000 / year) were used to compare the popularity of psychotropic classes and individual drugs. A comparison of the frequency and distribution of the drugs over time was made using Microsoft Office Excel 2013. Result: Total utilization of psychotropic drugs increased markedly by 859.2 % (from 75.9 to 727.8 DDDs / 1000 / year) from 2008 to 2018. Antidepressants were the most frequently dispensed class, with a significant increase by 1828.6 % (from 20 to 385.9 DDDs / 1000 / year). On the other hand, attention deficit hyperactivity disorder (ADHD) medication was the least dispensed class, from no usage in 2008 to 4.3 DDDs / 1000 / year in 2018. In 2018, out of 27 psychotropic drugs, sertraline (26.4 %) was the most frequently dispensed drug with 192.3 DDDs/1000/year. Conversely, clobazam (0.2 %) was the least dispensed drug with 1.2 DDDs / 1000 / year. Conclusion: Psychotropic drug utilization in Serdang Hospital increased markedly over the study period. All six classes contributed to the increment. Appropriate use of psychotropic drugs should be investigated in future.