1.1 Preface

The use of antibiotic is the single most important factor leading to antibiotic resistance around the world. As antibiotic resistance grows, the antibiotics used to treat infections do not work as well or at all. The loss of effective antibiotic treatments will not only cripple the ability to fight routine infectious diseases but will adversely affect treatment of infectious complications in patients with other diseases. This will have a huge impact in terms of increased treatment costs, prevention costs, and morbidity and mortality that result from resistance. Hence, using antibiotic judiciously is essential to avoid losing its efficacy and to ensure optimal patient outcome.

In view of the change in antibiotic resistance pattern, rising antibiotic cost and the introduction of new antibiotics selecting an optimal antibiotic regime can be challenging. In response to these challenges, the Antibiotic Guidelines Working Committee was formed to formulate a guideline according to local antibiogram, practices and needs. The committee consists of Infectious Disease Specialists, Medical Microbiologists, and Pharmacists.

This guideline is written with the aim to optimize antibiotic selection, dosage as well as treatment duration. With this, we hope to ensure that every patient on antibiotic gets optimal therapy. I would like to congratulate all the expert contributors and reviewers for your kind contribution in developing the guideline. Last but not least, I would like to thank the core working committee for their hard work in editing and putting the guideline together. I hope that the guideline will be widely used and enforced by all levels of healthcare professionals in the hospital.

Sincerely,

Professor Dato' Ikram Shah

The UMMC 2014 Antimicrobiotic Guideline has been updated from the original guideline that was produced several years ago and reflects the change in antimicrobial pattern of common infections that are encountered at UMMC.

The Guideline serves not only the function of rational antimicrobial selection from a powerful array of choices, but also as guidelines for cost-effective use in the era of ever-increasing antimicrobial resistance.

Although general guidelines can be written, not every patient will fit these guidelines and the Infectious Diseases Unit and Pharmacy Department are on hand to provide any advice that may be required for any individual patient.

It is essential that basic principles of antibiotic use are adhered for example the decision to prescribe an antibiotic must first be based on clinical evidence of infection and establishment of a provisional diagnosis that will give an indication of the most likely causative organisms, and the most suitable empiric treatment. Whenever possible, appropriate cultures must be taken before instituiting antibiotic therapy.

Often empiric broad-spectrum coverage is appropriate before culture and susceptibilities are known. However, once culture and susceptibilities are known, therapy should be reviewed to change the patient's antimicrobials to the narrowest spectrum possible (de-escalation) or have doses adjusted based on pharmacokinetic and pharmacodynamic principles. This will decrease needless broad-spectrum antibiotic pressure, a factor in the emergence of resistant strains. This will also decrease unnecessary drug costs and potential adverse effects.

Once antibiotic has been commenced, its need, dosage, route of administration and duration of treatment must be reviewed daily based on any new clinical, physical or laboratory evidence that is encountered.

In other words, every effort must be made to ensure that a patient’s antibiotic treatment is optimized without resorting to indiscriminate use of broad spectrum antibiotics that has been one of the main drivers of antibiotic resistance at UMMC and worldwide.

These Guidelines have only been made possible through the hard work and commitment of a large number of people particularly Associate Professor Dr Sasheela Ponnampalavanar, Ms Tan Ching Hooi and Dr Rukumani Devi A/P Velayuthan.

It is our hope that these guidelines will be utilized by all levels of medical practitioners within UMMC to ensure more rational use of these agents for the health of our patients and the community.

Sincerely,