UMMC Antimicrobial Guidelines, 3rd Edition (2024) is now available!

Latest Updates

(Year 2023)

29-Dec-2023 (NO. SP PPUM: 636/2023)

Deletion of Drug from Formulary: Nifedipine 20mg M/R Tablet, Lisinopril 5mg, 10mg Tablet, Carvedilol 25mg Tablet

The Nifedipine 20mg M/R Tablet, Lisinopril Tablet and Carvedilol Tablet will be removed from our UMMC Formulary.The following will be the recommended conversion:-
❗️ Conversion:-Previously : Nifedipine 20mg M/R Tablet❗️Suggested : Nifedipine 10mg Tablet, Amlodipine 5mg Tablet
Previously : Lisinopril 5mg Tablet, Lisinopril 10mg Tablet❗️Suggested : Perindopril 4mg Tablet (dosage can range from 2mg to 8mg)
Previously : Carvedilol 25mg Tablet❗️Suggested : Bisoprolol 5mg Tablet
The Primary Care Specialist, Endocrinologist, Nephrologist, Geriatrician, and Cardiologist have collectively approved this conversion.The substitution will commence once our current stock is depleted, and patients will be referred back to their treating physicians at their respective clinics to initiate the conversion.

29-Dec-2023 (NO. SP PPUM: 635/2023)

Deletion of Drug from Formulary: Simvastatin 10mg, 20mg, 40mg Tablet

The Simvastatin Tablet will be removed from our UMMC Formulary and will be replaced with Atorvastastin Tablet.The following will be the recommended conversion:-
❗️ Conversion:-Previously : Simvastatin 10mg Once At Night❗️Now : Atorvastatin 5mg Once Daily
Previously : Simvastatin 20mg Once At Night❗️Now : Atorvastatin 10mg Once Daily
Previously : Simvastatin 40mg Once At Night❗️Now : Atorvastatin 20mg Once Daily

The Primary Care Specialist, Endocrinologist, Nephrologist, Geriatrician, and Cardiologist have collectively approved this conversion.The substitution will commence once our current stock is depleted, and it will automatically apply to prescription refills.

22-Dec-2023 (NO. SP PPUM: 624/2023)

Deletion of Drug from Formulary: Metformin 850mg Tablet

The Metformin 850mg Tablet will be removed from our UMMC Formulary.The following will be the recommended conversion:-
❗️ Conversion:-Previously : Metformin 1700/850mg Twice Daily❗️Now : Metformin 1000mg Twice Daily
Previously : Metformin 850mg Twice Daily❗️Now : Metformin 1000mg Twice Daily
Previously : Metformin 850mg Once Daily❗️Now : Metformin 1000mg Once Daily

This conversion was agreed with the Primary Care Specialist, Endocrinologist and Nephrologist.The replacement will begin upon depletion of our existing stock and it will be done automatically for prescription refills.

13-Dec-2023 (NO. SP PPUM: 600/2023)

Deletion of Drug from Formulary: Irbesartan 150mg, 300mg Tablet, Irbesartan 150mg, 300mg Hydrochlorothiazide 12.5mg Tablet

Irbesartan 150mg Tablet, Irbesartan 300mg Tablet, Irbesartan 150mg Hydrochlorothiazide 12.5mg Tablet and Irbesartan 300mg Hydrochlorothiazide 12.5mg Tablet will be removed from our UMMC Formulary.The following will be the recommended conversion:-❗️ Conversion:-Previously : Irbesartan 150mg Tablet, Irbesartan 300mg Tablet❗️Suggested : Losartan 50mg Tablet, Losartan 100mg Tablet, Telmisartan 40mg Tablet, Telmisartan 80mg Tablet
Previously : Irbesartan 150mg Hydrochlorothiazide 12.5mg Tablet, Irbesartan 300mg Hydrochlorothiazide 12.5mg Tablet❗️Suggested : Losartan 100mg Hydrochlorothizide 25mg Tablet

This conversion was agreed with the Primary Care Specialist, Endocrinologist, Nephrologist, Geriatrician and Cardiologist.The replacement will begin upon depletion of our current stock, and patients will be referred back to their treating physicians at their respective clinics to initiate a new antihypertensive treatment.

01-Dec-2023 (NO. SP PPUM: 577/2023)

Medication Supply Disruption: Lignocaine 10% w/v Oral Spray, Ethyl Chloride 88mg/100mL Spray

Pharmacy is currently facing supply disruption for both Lignocaine 10% w/v Oral Spray and Ethyl Chloride 88mg/100mL Spray.Stocks for Lignocaine 10% w/v Oral Spray are expected to resume by end of Dec-2023.Stocks for Ethyl Chloride 88mg/100mL Spray are expected to resume by end of Mar-2024.

Lignocaine 10% w/v Oral Spray:-Its use should be restricted for critical cases only.Suggested alternative: None.
Ethyl Chloride 88mg/100mL Spray:-Suggested alternative: Lidocaine 25mg Prilocaine 25mg Cream.

24-Nov-2023 (NO. SP PPUM: 560/2023)

Medication Supply Disruption: Human Albumin 20% Injection, Furosemide 40mg Injection

Pharmacy is currently facing supply disruption for both Human Albumin 20% Injection and Furosemide 40mg Injection and unfortunately the purchasing can only be done next year (year 2024).Existing stocks in the pharmacy is at a critical level.

Human Albumin 20% Injection:-Reserved for critical cases only such as replacement after large volume parecentesis and symptomatic hypoalbuminemia.Suggested alternative: None.
Furosemide 40mg Injection:-Ward stock supply will be temporarily ceased and reserved for critical wards or area only.Suggested alternative: Furosemide 40mg Tablet.

01-Nov-2023 (NO. SP PPUM: 517/2023)

Medication Supply Disruption: Propofol 200mg/20mL Injection

Pharmacy is currently facing supply disruption for Propofol 200mg/20mL Injection and unfortunately the supplier is unable to predict when the supply will resume.Existing stocks in the pharmacy is at a critical level and supplies will be reserved for critical cases only.Suggested alternative: Ketamine 200mg/20mL Injection

19-Oct-2023 (NO. SP PPUM: 486/2023)

Medication Supply Disruption: Potassium Dihydrogen Phosphate 10mmol/mL Injection

Pharmacy is still facing supply disruption for Potassium Dihydrogen Phosphate 10mmol/mL Injection and unfortunately the supplier is unable to predict when the supply will resume.Existing stocks in the pharmacy is at a critical level and supplies will be reserved for patients who are unable to tolerate orally only.Suggested alternative: Neutral Phosphate Solution
❗️ Point of Concern:-10mL of Neutral Phosphate Solution contains 5.4mmol of Phosphate and 9.7mmol of Sodium

05-Oct-2023 (NO. SP PPUM: 457/2023)

Medication Supply Disruption: Oseltamivir 75mg Capsule

Pharmacy is currently facing supply disruption for Oseltamivir 75mg Capsule. The stocks are expected to resume around end of Oct-2023.Existing stocks will be reserved for patients who are warded and:-
(a) have severe, complicated or progressive diseaseor(b) at high risk for influenza complications

03-Oct-2023 (NO. SP PPUM: 454/2023)

Deletion of Drug from Formulary: Atenolol 50mg, 100mg Tablet

The Atenolol Tablet will be replaced with Metoprolol Tablet effective immediately.
❗️ Conversion:-Previously : Atenolol 50mg Once Daily❗️Now : Metoprolol 50mg Twice Daily
Previously : Atenolol 100mg Once Daily❗️Now : Metoprolol 100mg Twice Daily

This conversion was agreed with the Primary Care Specialist, Endocrinologist, Nephrologist, Geriatrician and Cardiologist.It will be done automatically for prescription refills.

27-Sep-2023 (NO. SP PPUM: 441/2023)

Medication Supply Disruption: Human Albumin 5% Injection

Pharmacy is currently facing supply disruption for Human Albumin 5% Injection and unfortunately the supplier is unable to predict when the supply will resume.As an alternative, the raw materials to prepare Human Albumin 5% Injection will be provided along with preparation instructions as follows:

08-Sep-2023 (NO. SP PPUM: 397/2023)

Medication Supply Disruption: Immunoglobulin 2.5g Injection

Pharmacy is currently facing supply disruption for Immunoglobulin 2.5g Injection. The stocks are expected to resume in Oct-2023.Existing stocks in the pharmacy is at a critical level and supplies will be reserved for patients who have Idiopathic Thrombocytopenia Purpura, Kawasaki disease and are critically ill only.

21-Aug-2023 (NO. SP PPUM: 359/2023)

Medication Supply Disruption: Co-Amoxiclav 1200mg Injection

Pharmacy is currently experiencing a supply disruption for Co-Amoxiclav 1200mg Injection. The stocks are expected to resume by early Sep-2023. Suggested alternative: Ampicillin-Sulbactam 1500mg Injection

11-Aug-2023 (NO. SP PPUM: 343/2023)

Medication Supply Disruption: Sodium Chloride 0.18% Glucose 4.23% Infusion (500mL)

The pharmacy is currently experiencing a supply disruption for Sodium Chloride 0.18% Glucose 4.23% Infusion (500mL). The stocks are expected to resume within 1-2 weeks from now.
As an alternative, the raw materials to prepare this intravenous drip will be provided along with preparation instructions as follows:

Considering the unavailability of ward stock supplies, affected wards are requested to contact the Inpatient Pharmacy for alternative supply for each patient requiring the use of this intravenous drip.

02-Aug-2023 (NO. SP PPUM: 326/2023)

Medication Supply Disruption: Nimodipine 10mg/50mL Injection

Pharmacy is currently facing supply disruption for Nimodipine 10mg/50mL Injection.Stocks are expected to resume in Oct-2023.

02-Aug-2023 (NO. SP PPUM: 324/2023)

Medication Supply Disruption: Rocuronium 10mg/mL Injection

The pharmacy is currently experiencing a supply disruption for Rocuronium 10mg/mL Injection, with stocks expected to resume in Oct-2023. The existing stocks in the pharmacy are set to expire in Jun/Jul-2023.
Fortunately, a study conducted by the manufacturer has demonstrated that the product remains stable and effective for up to 36 months from the date of production (please refer to the attached study report sent via email). Therefore, our current stock of Rocuronium 10mg/mL Injection can be utilized until Jun-2024.
Considering its urgency, the Pharmacy Department recommends continuing the use of Rocuronium 10mg/mL Injection with expired dates until the stock supply resumes.

07-Jul-2023 (NO. SP PPUM: 288/2023)

Prescribing Template Changes for Oral Rehydration Salts (Adult Patients)

To standardize the current practice for paediatric patients, our Pharmacy Department has made the following changes to the prescribing template for Oral Rehydration Salts for adult patients:-
❗️ Changes:-Previously : no dose during prescribing❗️Now : default dose as 200mL during prescribing

Note: 1 sachet of Oral Rehydration Salts is to be diluted in 200mL of drinking water.
This change applies only to the prescribing template for Oral Rehydration Salts for adults; there are no changes to the current prescribing template for pediatrics.

03-Jul-2023 (NO. SP PPUM: 280/2023)

Medication Supply Disruption: Potassium Dihydrogen Phosphate 10mmol/mL Injection

Pharmacy is currently facing supply disruption for Potassium Dihydrogen Phosphate 10mmol/mL Injection and unfortunately the supplier is unable to predict when the supply will resume.Existing stocks in the pharmacy is at a critical level and supplies will be reserved for patients with hypernatremia only.Suggested alternative: Sodium Glycerophosphate 21.6% Injection and Neutral Phosphate Solution
❗️ Point of Concern:-One vial of Sodium Glycerophosphate 21.6% Injection (20mL) contains 20mmol Phosphate and 40mmol Sodium

E.g. If the patient's phosphate requirement is 10mmol, the amount of Sodium Glycerophosphate 21.6% Injection required is 10mL (i.e. half a vial).Every 10mmol of Phosphate is to be diluted in 100mL diluent.

22-Jun-2023 (NO. SP PPUM: 266/2023)

Medication Supply Disruption: Pantoprazole 40mg Injection

Pharmacy is currently facing supply disruption for Pantoprazole 40mg Injection and unfortunately the supplier is unable to predict when the supply will resume.Suggested alternative: Esomeprazole 40mg Injection

09-Jun-2023 (NO. SP PPUM: 235/2023)

Medication Supply Disruption: Co-Trimoxazole 480mg Injection

Pharmacy is currently facing supply disruption for Co-Trimoxazole 480mg Injection and unfortunately the supplier is unable to predict when the supply will resume.Existing stocks in the pharmacy is at a critical level and supplies will be reserved for patients who are not able to tolerate orally only.Suggested alternative: Co-Trimoxazole 480mg Tablet
❗️ Conversion to Oral:-Previously : Co-Trimoxazole 480mg Injection❗️Now : Co-Trimoxazole 480mg Tablet

15-May-2023 (NO. SP PPUM: 200/2023)

Medication Supply Disruption: Pantoprazole 40mg Injection

Pharmacy is currently facing supply disruption for Pantoprazole 40mg Injection and unfortunately the supplier is unable to predict when the supply will resume.Supplies will be reserved for upper gastrointestinal bleed cases only.Suggested alternative: Ranitidine 50mg Injection, Omeprazole 20mg Capsule

05-May-2023 (NO. SP PPUM: 188/2023)

Deletion of Drug from Formulary: Ceftriaxone 250mg Injection

Since Ceftriaxone 250mg Injection will be removed from our UMMC Formulary, all doses of Ceftriaxone 250mg Injection will be supplied using Ceftriaxone 1g Injection.❗️ Diluent Required for Reconstituting a Solution with a Concentration of 250mg/mL:-Previously : 250mg requires 0.9mL❗️Now : 1g requires 3.6mL

This replacement will begin after our existing Ceftriaxone 250mg Injection stocks expires at the end of May-2023 .

18-Apr-2023 (NO. SP PPUM: 173/2023)

Medication Supply Disruption: Fluticasone 125mcg Inhaler

Fluticasone 125mg Inhaler will be temporarily replaced with Budesonide 200mcg Inhaler effective immediately.
1 puff of Fluticasone 125mcg Inhaler is equivalent to 1 puff of Budesonide 200mcg Inhaler
This conversion was agreed with the Respiratory Medicine Specialist and will be done automatically for prescription refills.

24-Feb-2023 (NO. SP PPUM: 090/2023)

Deletion of Drug from Formulary: Fesoterodine 4mg Tablet, Fesoterodine 8mg Tablet

Pfizer (Malaysia) Sdn. Bhd. has discontinued the distribution of Fesoterodine 4mg and 8mg Tablets in Malaysia since 1st September 2022 and patients who are currently being treated with that medication will be replaced with Solifenacin 5mg Tablet but with a quota of 100 patients only.❗️ Conversion:-Previously : Fesoterodine 4mg Tablet❗️Now : Solifenacin 5mg Tablet

Our Urologists had agreed to this conversion.

24-Feb-2023 (NO. SP PPUM: 090/2023)

Medication Supply Disruption: Promethazine 50mg/2mL Injection

Pharmacy is currently facing supply disruption for Promethazine 50mg/2mL Injection while stocks are expected to resume in Apr 2023.Suggested alternative: Chlorphenirame 10mg InjectionChlorphenirame 10mg Injection will also temporarily be used as a replacement for Promethazine 50mg/2mL Injection in the resus box.

15-Feb-2023 (NO. SP PPUM: 069/2023)

Change in Strength: Salicylic Acid in Emulsifying Ointment

❗️ New Strength:-Previously : Salicylic Acid 30% in Emulsifying Ointment❗️Now : Salicylic Acid 20% in Emulsifying Ointment
Dermatology Team had agreed to the change. This new strength is a commercially available product.

03-Feb-2023 (NO. SP PPUM: 051/2023)

Medication Supply Disruption: Cholecalciferol 400units/mL Solution, Cholecalciferol 500,000units Powder

Pharmacy is currently facing supply disruption for Cholecalciferol 400units/mL Solution and Cholecalciferol 500,000units Powder while stocks are expected to resume in May 2023.Suggested alternative: To purchase Vitamin D from retail pharmacies.

25-Jan-2023 (NO. SP PPUM: 031/2023)

Medication Supply Disruption: Potassium Dihydrogen Phosphate 10mmol/10mL Injection

Pharmacy is currently facing supply disruption for Potassium Dihydrogen Phosphate 10mmol/10mL Injection. The manufacturer is unable to predict when stocks will resume.Supplies will be reserved for critical cases only: it is recommended to use Neutral Phosphate Solution if patients are able to tolerate orally.

09-Jan-2023 (NO. SP PPUM: 011/2023)

Medication Supply Disruption: Furosemide 20mg/2mL Injection

Pharmacy is currently facing supply disruption for Furosemide 20mg/2mL Injection. The manufacturer is unable to predict when stocks will resume.The existing stocks in the Pharmacy are currently at the critical level and ward stock supply will be temporarily ceased and reserved for critical wards or area only.Suggested alternative: Furosemide 40mg Tablet.

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