Retrospective Audit on Cloxacillin Prescription in Primary Health Care Facilities in Kuala Selangor, Malaysia
Introduction: Cloxacillin is the second most prescribed antibiotic for skin and soft tissue infection in Malaysia. A similar pattern was seen in Kuala Selangor, in which our district demonstrated that the Defined Daily Dose (DDD) of Cloxacillin is high (3.0-8.7) compared to the recommended value from World Health Organization (WHO). However, resistant patterns for Cloxacillin are alarming. This study focuses on appropriate use of Cloxacillin to prevent further antimicrobial resistance. Methodology: This is a retrospective cross-sectional audit, conducted in seven public health clinics in Kuala Selangor district from January 2020 to March 2020. All Cloxacillin prescriptions within this duration were selected. Audit format was adapted from the antimicrobial stewardship protocol (AMS). Appropriate Cloxacillin use is based on accuracy of diagnosis, indication of antibiotic, correct usage (pharmacological name, dose, frequency and duration). Results: A total of 259 prescriptions were collected. Majority were for age 40 years old, 48.6% (n=126) and male, 63.7% (n=165). Cloxacillin was prescribed most for infection of the skin and subcutaneous tissue 64.1% (n=166). Diagnosis was accurate in 63.7% (n=165). Those accurate diagnosis, had correct indication 79.4% (131/165); correct usage 51.5% (85/165); correct name 69.7% (115/165); correct frequency 55.2% (91/165); correct dose 55.8% (92/165), and correct duration 47.3% (78/165). Appropriate Cloxacillin use was 41.8% (69/165). Conclusion: Measures to improve appropriate Cloxacillin use and adherence to the National Antibiotic Guideline (NAG) and Antimicrobial Stewardship (AMS) protocol is crucial.
Keywords: Cloxacillin, Skin and soft tissue infection, Malaysia, antimicrobial resistance
2. Ministry of Health Malaysia. National Antibiotic Guideline Third Edition 2019.
3. Ministry of Health Malaysia. Medicines Formulary 2015.
4. Ministry of Health Malaysia. Malaysia Health System Research (MHSR) Contextual Analysis. 2016.
5. Shamsuddin S, Akkawi ME, Zaidi ST, et al. Antimicrobial drug use in primary healthcare clinics: a retrospective evaluation. Int J Infect Dis. 2016; 52:16-22. https://doi.org/10.1016/j.ijid.2016.09.013
6. Tan GH, Low QW, Lim HC, et al. Inappropriate antibiotic utilization: Outpatient prescription review of a regional secondary hospital in Kedah, Malaysia. Journal of Pharmacy Practice and Community Medicine. 2017; 3(4):215-219. https://doi.org/10.5530/jppcm.2017.4.62
7. Ab Rahman N, Teng CL, Sivasampu S. Antibiotic prescribing in public and private practice: A cross-sectional study in primary care clinics in Malaysia. BMC Infect Dis. 2016; 16:208. https://doi.org/10.1186/s12879-016-1530-2
8. Ministry of Health Malaysia. Protocol on Antimicrobial Stewardship Program in Healthcare Facilities. 2014.
9. Meena DK, Jayanthi M. Monitoring antibiotic use in public health care facilities of South Indian Union Territory: A step to promote rational use of antibiotics. Cureus. 2021; 13(10):e18431. https://doi.org/10.7759/cureus.18431
10. Che Roos NA, Bakar MA, Haque M. Knowledge, attitude and practice among Malaysian medical students, doctors, other health professionals and common people regarding antibiotic use, prescribing and resistance: A systematic review. Adv Hum Biol. 2019; 9:179-93. https://doi.org/10.4103/AIHB.AIHB_42_19
11. Lim AH, Thian SY, Hor YY, et al., Antibiotic prescribing pattern in primary care practice in Federal Territory Kuala Lumpur and Putrajaya, International Journal of Infectious Diseases. 2020; 101(S1) (2021) 8-119. https://doi.org/10.1016/j.ijid.2020.09.264
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