Page 5 - HPP ANTIMICROBIAL GUIDELINE 2018

FOREWORD

I would like to take this opportunity to congratulate all contributors and reviewers
of the first edition Hospital Pulau Pinang Antimicrobial Guideline (HPP AMG) 2018.
The writing group has taken great effort in compiling and drawing up the most
appropriate antimicrobial therapy for each systemic infection taking into consideration
of our own hospital antibiogram and clinicians’ preference guided by evidence-based
medicine.

In the report of the National Surveillance on Antimicrobial Utilization 2017, HPP
was one of the 5 hospitals with the highest prescriptions of cephalosporins, especially
th
the 4 generation cephalosporin and carbapenems. The utilization of these antibiotics
continues to rise between the months of January to June 2018 as highlighted in the recent
Infection Control Meeting 3/2018. The utilization of IV vancomycin increased by 40
%, IV imipenem/cilastatin increased 21%, IV meropenem increased 13% and IV colistin
increased 25%. The rise in the rates of Multi Drug Resistant (MDR ) organisms eg.

Extended Spectrum Beta Lactamases (ESBL) Klebsiella pneumoniae, ESBL E.coli,
Carbapenem Resistant Enterobacteriaceae (CRE) and Carbapenem Resistant
Acinetobacter baumannii in this hospital is worrying to all clinicians.

This guideline aims to provide effective and appropriate treatment options for
common infections presenting to HPP. It encourages the use of narrow spectrum
antibiotics in mild to moderate infections but does not restrict broad spectrum antibiotics

in more severe infections. Antimicrobial audit will be carried out yearly in Point
Prevalence Study 2.0 from Ministry of Health in the month of October. It is imperative
to document the indication of initiating antimicrobial in the patient’s note clearly and a
review of the need to either de-escalate, stop or continue therapy must be done 48-72
hours after initiation. This guideline will be used in the audit for appropriateness of

therapy.

I sincerely hope that all the clinicians in HPP will give their support for this
guideline in the management of infections in order to reduce inappropriate antimicrobial
prescription.

Thank you.

Dato’ Dr. Norsidah BT. Ismail
D.S.P.N, P.K.T
MMC Full Reg. No: 27959
Pengarah Hospital
Hospital Pulau Pinang

HPP AMG