MOH confirms shortages of certain antibiotics in public facilities

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KUALA LUMPUR, September 16 – The Ministry of Health (MOH) has confirmed that some antibiotics are lacking in its public health facilities, especially in Sabah and Sarawak.

Director General of Health Dr Noor Hisham Abdullah said the Health Ministry’s Pharmaceutical Services Program has taken note of CodeBlue’s report on the Malaysian Medical Association’s (MMA) ongoing investigation of government doctors into the shortage of antibiotics in government hospitals.

“We have so far only received a shortage notification for amoxicillin (capsule and syrup), while there are sufficient stocks for other antibiotics purchased by the Ministry of Health,” said the Dr Noor Hisham. code blue Tuesday.

Amoxicillin is a penicillin-type antibiotic that is used to treat a wide variety of bacterial infections.

Sabah State Director of Health Dr. Rose Nani Mudin also confirmed low stocks of “a few types” of antibiotics in Ministry of Health health facilities.

“JKN Sabah has mobilized drug supply from facilities with sufficient stock to help facilities that are short of antibiotics. This procurement process is underway and should arrive no later than the third week of September,” said Dr Rose Nani. code blue Tuesday.

An internal memo from the Duchess of Kent, Sandakan Hospital (HDOK) dated August 29, seen by code blue, announced stock shortages of Ampicillin Sodium Injection 1g and Sulbactam 500mg.

“We hope you can use the existing alternatives until stocks of Ampicillin Sodium Injection 1g and Sulbactam 500mg return to normal,” said the memo from HDOK’s Chief of Pharmacy to department heads. of the hospital.

Ampicillin-sulbactam (brand name Unasyn) is a broad spectrum injectable combination antibiotic used to treat certain infections caused by bacteria, including infections of the skin, female reproductive organs and abdomen.

An August 25 letter from local pharmaceutical company Unimed Sdn Bhd to HDOK, seen by code blue, declared a non-stock notification for Auropennz powder for injection 1.5g-1’s, which is an ampicillin-sulbactam combination antibiotic.

“Referring to the question above, we regret to inform you that Auropennz Powder for Injection 1.5g-1 is temporarily out of stock and our estimated arrival date is 2nd to the 4th week of October 2022,” the letter reads.

It is unclear whether Unimed, which distributes Auropennz, had sent the non-stock notification only to HDOK, but also to other public hospitals. Contacted, a Unimed representative said code blue yesterday: “We are unable to provide you with information about Auropennz at this time.”

Sarawak State Assistant Pharmacy Director Dr Nor Anizah Osman said among the affected antibiotic supplies at public health facilities in the state are amoxicillin syrup and amoxicillin injection. ampicillin-sulbactam.

“So far, there is no shortage of antibiotics. Just that there is a delay in delivering the supply of a few antibiotics, but that is still under control as we have other alternatives,” Dr Nor Anizah said. code blue yesterday.

When asked if prescribing alternative antibiotics could lead to increased antibiotic resistance or affect patient care in any way, she replied: “As long as it’s the same group drugs, there is no problem.”

Besides HDOK and in public health facilities in Sarawak, the shortage of ampicillin-sulbactam injectable antibiotics has also hit the Universiti Malaya Medical Center (UMMC), a teaching hospital in Kuala Lumpur under the Ministry of Health. Higher Education.

An internal UMMC email dated July 26 last year to staff members announced the discontinuation of Auropennz supply from Unimed, stating that stocks of the injectable antibiotic ampicillin-sulbactam 1.5 g had fallen to the minimum level in the UMMC due to late delivery of inventory by the supplier.

“New supplies for the drug are expected to arrive in two to three weeks,” said the July 26 email from the UMMC Chief of Pharmacy, as the Code blue.

“In accordance with this, the supply of sulbactam/ampicillin 1.5 g Inj. will be limited to patients who are culture positive for multidrug resistance Acinetobacter baumannii. Other antibiotics like Amoxicillin-Clavulanate 1.2g Inj. can be used as an alternative.

It is not clear if UMMC had already received new supplies of ampicillin-sulbactam as planned, given that the letter from Unimed indicated an estimated arrival date between the second and fourth week of October. UMMC did not respond to CodeBlue’s request for comment.

An HDOK specialist said prescribing alternative antibiotics to ampicillin-sulbactam is unlikely to increase antibiotic resistance.

“But that’s no excuse to disrupt supply every year,” he said. code blue on condition of anonymity, as he was not authorized to speak to the press.

“And it reflects the current system’s failure to plan ahead – a disease that has plagued the Malaysian healthcare system.”

Malaysian Association of Pharmaceutical Suppliers (MAPS) Secretary Dr Choe Tong Seng said shortages of medicines, beyond antibiotics, could arise from the side of suppliers or manufacturers all the way to end users. (hospitals, clinics and pharmacies) of the pharmaceutical supply chain if an appropriate inventory is not well managed.

“Often this could also be attributed to distance in geographic locations due to inefficient logistics etc.,” Dr. Choe said. Code blue.

“[Shortages of] the supply and availability of drugs, not just antibiotics, occurs when “demand and supply” for a specific hospital fluctuates due to patients and disease trend/variation for a specific season. So long term planning is important.

He also suggested that MMA include questions on “how hospitals should improve their inventory management” in their survey, such as level of stocking, actual and “predictive” purchases, collaboration with suppliers, etc.

A previous 2020 survey of government doctors conducted by Dr Timothy Cheng, then a specialist student at a public university in Malaysia, found that the majority of respondents complained of antibiotic shortages at their MOH hospital over the past the last year.

Doctors said frequent shortages of antibiotics were building up drug resistance, worsening patients’ conditions and lengthening hospital stays.

According 2019 MOH National Antimicrobial Guidelineampicillin/sulbactam 1.5-3g is listed as the treatment of choice for severe or life-threatening penetrating injuries caused by animal bites, with piperacillin/tazobactam listed as an alternative treatment.

Ampicillin/sulbactam 1.5-3 g is also the treatment of choice, alongside amoxicillin/clavulanic acid or cefuroxime, in the parenteral treatment of complicated urinary tract infections.

Ampicillin/sulbactam 1.5-3 g is further listed as the preferred treatment for ischemic limb ulcers with infection, in addition to being the preferred hospital treatment, among other antibiotics, for uncomplicated pyelonephritis (infection kidney).

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