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This study examined the factors associated with a high risk of opioid misuse among patients receiving opioid treatment for their non-cancer pain in Malaysian pain clinics. The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R), a validated instrument for predicting the risk of aberrant drug-related behaviors, were used as a proxy to indicate risk of opioid misuse. Data analysis was stratified into high-risk and low-risk patient groups. Patient factors assessed included pain intensity, pain interference with daily activities, and health-related quality of life. Prescription opioid exposure was examined via patient medical and prescription records review. Among the 61 patients recruited, 62.3% scored ≥18 on the SOAPP-R, which indicates a high risk for opioid misuse. Factors associated with a high risk of opioid misuse were found to be high level of pain interference with daily activities, poorer mental health, and younger age. High-risk patients were found to be prescribed a lower mean daily opioid dose of <20 mg/day compared to low-risk patients (20–49 mg/day). This highlights the need for further research to distinguish aberrant drug-related behaviors due to inadequate pain management from that of actual prescription opioid misuse among non-cancer pain patients attending pain clinics. [ABSTRACT FROM AUTHOR]

Background: It was reported that opioid consumption in developing countries was stagnated or decreased, but precise data on the consumption are unclear. This study examined the trends and patterns of opioid consumption in Malaysia and other four Southeast Asian countries. Materials and Methods: Data of five strong opioids consumption (morphine, oxycodone, fentanyl, pethidine, and methadone) between 2005 and 2014 from Malaysia, Singapore, Indonesia, Thailand, and Vietnam were extracted from the Pain and Policy Studies Group. Defined daily doses per 1000 inhabitants per day (DDD/1000 inhabitants/day) was used for calculating the annual amount of opioid use. Results: The total consumption of five strong opioids was increased in all five Southeast Asian countries during a 10-year study period. Malaysia was recorded with the largest increase of the opioid consumption (993.18%), followed by Indonesia (530.34%), Vietnam (170.17%), Singapore (116.16%), and Thailand (104.66%). Malaysia also had the highest total strong opioid consumption (11.2 DDD/1000 inhabitants/day), primarily for methadone. Among the opioids used for pain management, fentanyl was primarily used in Malaysia and Singapore but the greatest increase in these two countries was for oxycodone. Fentanyl was also primarily used in Indonesia while morphine was predominantly used in Thailand and Vietnam. Conclusion: Growing trends of strong opioids consumption in all five Southeast Asian countries demonstrated in this study may indicate improved access to opioid analgesics in these countries. Given the increasing trends, it is important to ensure that the utilization of opioids is according to the guideline to prevent the negative consequences of opioids particularly when used in chronic non-cancer pain. [ABSTRACT FROM AUTHOR]

Background: Analgesic is commonly used in children but little is known about its patterns of utilization. This study explored the patterns of analgesic prescribing in children. Materials and Methods: This cross-sectional study used prescription databases of tertiary hospital settings in Malaysia from 2010 to 2016. Prescriptions for nine NSAIDs (diclofenac, ketoprofen, etoricoxib, celecoxib, ibuprofen, indomethacin, mefenamic acid, meloxicam, and naproxen), tramadol, and five other opioids (morphine, oxycodone, fentanyl, buprenorphine, and dihydrocodeine) prescribed for children aged <18 years were included. Number of annual patients and prescriptions were measured and analyzed using Stata v15. Results: During a 7-year study period, a total of 5040 analgesic prescriptions of the nine NSAIDs, tramadol, and five other opioids were prescribed for 2460 pediatric patients (81.8% NSAIDs patients, 17.9% tramadol patients, and 0.3% opioid patients). Ibuprofen was the primary analgesic in young children less than 12 years old (=2 years old [y.o.] [75%], 3-5 y.o. [85%], and 6-12 y.o. [56.3%]). However, there was a wide range of analgesics used in older children (>12 y.o.) with the majority for naproxen (13-15 y.o. (28.2%) and 16-17 y.o. (28.2%). Other frequently prescribed analgesics for older children included ibuprofen (20.6%) and diclofenac (18.2%) for 12-15 y.o. and diclofenac (26.7%) and tramadol (17.6%) for 16-17 y.o. Conclusion: Ibuprofen was the primary analgesic for children less than 12 y.o., whereas there was a wide range of analgesics prescribed for children age >12 y.o. including naproxen, diclofenac, and tramadol. [ABSTRACT FROM AUTHOR]

Introduction: Patients receiving continuous ambulatory peritoneal dialysis (CAPD) are commonly associated with peritonitis. However, little is known about the utilization of antibiotics for the treatment of peritonitis in these patients. Objectives: This study aimed to evaluate the patterns of intraperitoneal (IP) antibiotic utilization for the treatment of peritonitis in CAPD patients. Materials and Methods: This is a retrospective study conducted at a tertiary hospital setting in Malaysia. Medical records of CAPD patients who were diagnosed with peritonitis and registered with National Kidney Registry from 2013 to 2018 were reviewed. Types of antibiotics used and its dose and duration were recorded and reported using the anatomical therapeutic chemical/defined daily dose (ATC/DDD) system. Results: A total of 105 peritonitis episodes were recorded from 72 patients. The most common first-line empirical antibiotic combinations used were ceftazidime/cefazolin (40%, n = 42), followed by cefepime/cefazolin (30.5%, n = 32) and ceftazidime/cloxacillin (25.7%, n = 27). The definitive therapy for culture-proven CAPD-related peritonitis (CAPD-P) showed that vancomycin was the most frequently prescribed antibiotic (31.7%, n = 26/82), followed by amikacin (14.6%, n = 12/82), meropenem (11%, n = 9/82) and ampicillin (11%, n = 9/82). Ciprofloxacin was among the least prescribed definitive antibiotics for CAPD-P (2.4%, n = 2/82) but the DDD/100 patient-days estimates showed that it had the highest therapeutic intensity. Conclusion: There are various IP antibiotics used for CAPD-P and the most common empirical therapy was the combination of ceftazidime and cefazolin while vancomycin is predominantly used for definitive therapy. Future studies to evaluate the clinical outcomes of the antibiotic use should be conducted to have a better insight on the efficacy of the peritonitis treatment. [ABSTRACT FROM AUTHOR]

Introduction: The clinical use of opioids for long-term for noncancer pain indications remains a controversy. More studies are needed for evidence-based guidelines in noncancer pain management involving opioids. The primary objective of this study was to investigate the clinical outcomes of the short-term and long-term opioid use among patients with noncancer pain. Materials and Methods: This is a retrospective cross-sectional study where patients (aged =18 years) with noncancer pain treated with opioids were recruited from three pain clinics in Malaysia. Data on patients' opioid use were collected from prescription records. The individual days covered with opioids per patient were calculated and based on this, patients were classified as short-term (<90 days) or long-term (=90 days) opioid user. Outcome measures included pain intensity and pain interference with daily activities assessed by Brief Pain Inventory - Short Form (BPI-SF), health-related quality of life (HRQoL) assessed by 36-Item Short Form Health Survey version 2 (SF-36v2). These measures were compared between short-term and long-term opioid users. Results: Of the 61 noncancer pain patients recruited, 49.2% (n = 30/61) were shortterm and 50.8% (n = 31/61) were long-term opioid users. There were no statistically significant differences in the mean scores of pain intensity, pain interference with daily activities, and HRQoL between short-term and long-term opioid users in this study. Conclusion: Findings of this study imply that long-term opioid therapy does not provide significant pain relief or improvement in patients' functional capability and HRQoL in noncancer pain patients. Future prospective studies with larger sample sizes are needed to support the findings of this study. [ABSTRACT FROM AUTHOR]

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common analgesics used for pain relief. Adverse effects of NSAIDs range from gastrointestinal tract disturbances to increased risk of bleeding, renal injury, and myocardial infarction. In Malaysia, the research productivity of NSAIDs is not well explored. Objective: This study examined research productivity of NSAIDs in Malaysia. Materials and Methods: This bibliometric study included all published research articles on NSAIDs from 1979 to 2018, which were conducted in Malaysia. The search databases such as Google Scholar, PubMed, ScienceDirect, and Scopus were used. Search terms included NSAIDs and specific drug names such as ibuprofen, celecoxib, and naproxen. Growth of publication, authorship pattern, citation analysis, journal index, type of studies, and geographical distribution of institutions publishing articles on NSAIDs were measured. Results: Overall, 111 articles were retrieved from 1979 to 2018. The annual productivity of articles throughout the study fluctuated in which the highest productivity was in 2018, 12.61% (n = 14). Majority of articles were multiple authored, 99.10% (n = 109), and University of Science Malaysia (USM) produced the highest number of articles (30 articles). Most of the articles were International Scientific Indexing-indexed, 52.25% (n = 58), and the main issue studied in most of the articles was the drug formulation of NSAIDs. Conclusion: The growth of NSAID research in Malaysia was slow, and the majority of research involved laboratory studies. Clinical studies evaluating the clinical outcomes of NSAIDs in patients, particularly using large healthcare databases are still lacking. [ABSTRACT FROM AUTHOR]

Opioid analgesics have been widely used for the treatment of pain. In USA, it was reported an increase in opioid prescribing is parallel with the increase of opioid use disorders such as misuse, abuse, and opioids overdose-related death. Little is known about the opioid situation and its related research in Malaysia. Therefore, this bibliometric study provided an overview on the productivity of opioid research in Malaysia. All published articles on opioid research in Malaysia from 2006 to 2018 were included, where they were retrieved from online databases. Then, the data were analysed, presented and discussed using standard bibliometric indicators, such as growth of publications, number of citation journals, geographical distribution, and issues addressed in the publications. Total of 78 research articles on opioids published between 2006 and 2018 were identified. The relative growth rate (RGR) of publications during the study period was 12.24%. The most common issue studied was the methadone maintenance therapy. Most articles were published in the indexed journals (98.72%) and the predominant journal was the Drug and Alcohol Dependence (11.54%). The article on buprenorphine and naltrexone reported the highest citations of 85. It can be concluded that research evaluating opioids in pain management particularly in patients with non-cancer pain in Malaysia is limited and requires further exploration. [ABSTRACT FROM AUTHOR]

Introduction: Little is known whether the duration of opioid use influences the concentrations of pro- and anti-inflammatory cytokines. Objectives: This study examined the plasma concentration of pro-inflammatory cytokine, interleukin 6 (IL-6), and anti-inflammatory cytokine, interleukin 10 (IL-10), in short-, and long-term opioid users with noncancer pain. Materials and Methods: Adult patients with opioid therapy for noncancer pain were recruited from pain clinics at two tertiary hospital settings in Malaysia between February 2016 and March 2017. They were stratified into short- or long-term users based on opioid prescriptions ≥ 90 days per year. A 10 mL blood sample was taken for the analysis of plasma concentrations of IL-6 and IL-10 and were quantified using a highly sensitive multiplex assay. Results: Of 38 patients recruited, 24% (n = 9/38) and 76% (n = 29/38) were respectively short- and long-term opioid users. Short-term use of opioid was associated with higher levels of IL-6 (mean ± SD, 173.9 ± 13.7 pg/mL) and IL-10 (50 ± 5.8 pg/mL), whereas long-term use of opioids was associated with lower levels (no significant difference) of both cytokines IL6 (125 ± 16.1 pg/mL) and IL10 (41.3 ± 6.7 pg/mL). There was strong correlation between IL-6 and IL-10 within the same group (r² = 0.72, P < 0.05) and (r² = 0.76, P < 0.05) for short- and long-term users, respectively. Conclusion: The duration of opioid use may modulate the level of pro-inflammatory cytokines in which it was higher in short-term use and lower in long-term use, but the effect of pain relief was similar as both cytokines were well correlated. [ABSTRACT FROM AUTHOR]

Introduction: Non-vitamin K antagonist oral anticoagulants (NOACs), such as dabigatran and rivaroxaban, are now available for stroke prevention in patients with atrial fibrillation (AF) and are often clinically preferred over vitamin K antagonists (VKAs), such as warfarin. Data describing adherence and persistence to NOACs in real-life clinical practice in Malaysia are scarce. This study aimed to assess adherence and persistence to NOACs in patients with AF in two tertiary-care referral centers: Hospital Kuala Lumpur (HKL) and Hospital Serdang (HSDG). Materials and Methods: This was a retrospective cohort study that included all patients with AF who were treated with NOACs (dabigatran or rivaroxaban) in HKL and HSDG. Data were obtained from medical records and pharmacy databases. Adherence was assessed using proportion of days covered (PDC) over a 1-year duration. High adherence was defined as PDC ≥80%. A gap of >60 days between two consecutive refills was used to define non-persistence. Result: There were 281 patients who met the inclusion criteria, with 54.1% (n = 152) male. There were 75.1% (n = 211) patients on dabigatran and others on rivaroxaban. Only 66.9% (n = 188) of patients achieved high adherence with PDC ≥80% and 69.8% (n = 196) were persistence with >60- day gap over 12 months. Adherence and persistence were both influenced by treatment center, whereas polypharmacy only influenced adherence. Conclusion: Overall adherence and persistence to NOACs were suboptimal and varied between treatment centers, potentially due to institution-specific administrative and clinical practice differences. Clinical care and outcomes can potentially be optimized by identifying factors affecting adherence and persistence and by implementing interventions to improving them. [ABSTRACT FROM AUTHOR]

The overuse of antibiotics has led to various healthcare problems such as the emergence of resistance in infectious microbes and mortality due to antibiotic resistant healthcare associated infections (HAIs). An antimicrobial stewardship (AMS) program is the set of interventions used worldwide to enhance the rational use of antibiotics especially for the hospitalized patients. This review aimed to describe the characteristics of the implemented AMS programs in various hospitals of the world mainly focusing on the interventions and patients outcomes. The literature about AMS program was searched through various databases such as PubMed, Google Scholar, Science Direct, Cochran Library, Ovid (Medline), Web of Science and Scopus. In this review the literature pertaining to the AMS programs for hospitalized patients is sorted on the basis of various interventions that are categorized as formulary restriction (pre-authorization), guideline development, clinical pathway development, educative interventions and prospective audit. Moreover a clear emphasis is laid on the patient outcomes obtained as a result of these interventions namely the infection control, drop in readmission rate, mortality control, resistance control and the control of an overall cost of antibiotic treatment obtained mainly by curbing the overuse of antibiotics within the hospital wards. AMS program is an efficient strategy of pharmacovigilance to rationalize the antimicrobial practice for hospitalized patients as it prevents the misuse of antibiotics, which ultimately retards the health threatening effects of various antibiotics. [ABSTRACT FROM AUTHOR]

Introduction: Analgesic is commonly used in children but little is known about its patterns of utilization. Objectives: This study explored the patterns of analgesic prescribing in children at public tertiary hospital outpatient settings. Materials and Methods: This cross-sectional study used prescription databases from 2010 to 2016. Prescriptions for nine NSAIDs (ketoprofen, diclofenac, celecoxib, etoricoxib, ibuprofen, indomethacin, meloxicam, mefenamic acid and naproxen), tramadol and five other opioids (morphine, fentanyl, oxycodone, dihydrocodeine, and buprenorphine) prescribed for children age < 18 years old were included. Number of patients and prescriptions were measured and analysed using Stata v1.5. Results: During a 7-year study period, a total of 5040 analgesic prescriptions of the nine NSAIDs, tramadol, and the five other opioids were prescribed for 2460 paediatric patients (81.8% NSAIDs patients, 17.9% tramadol patients, and 0.3% opioid patients). In younger children, ibuprofen was the primary analgesic (=2 years old (y.o) (75%), 3-5 y.o (85%) and.6-12 y.o (56.3%)). There was a wide range of analgesics used in older children with the majority being naproxen (13 to 15 y.o (28.2%) and 16 to 17 y.o (28.2%). Others included (ibuprofen (20.6%) and diclofenac (18.2%) for 12 to 15 y.o) and (diclofenac (26.7%) and tramadol (17.6%) for 16-17 y.o). Conclusion: Ibuprofen was the primary analgesic for children less than 12 years old while there was a wide range of analgesics prescribed for children age above 12 years old including naproxen, diclofenac and tramadol. [ABSTRACT FROM AUTHOR]

Introduction: A thorough understanding of the use of antimicrobial agents and phenomenon of resistance is a key attribute expected in medical and pharmacy graduates. Hence, it would be of significant relevance to appraise knowledge, attitude and perception of those who would enter in the healthcare sector as guardian of antimicrobial use. Objectives: To appraise the knowledge, attitude and perception of final year medical and pharmacy students about antimicrobial use and resistance. Materials and Methods: Cross sectional study using a validated questionnaire. Descriptive statistics was used to measure the median and differences in both groups were measured through Chi-Square test using SPSS version 23.0. Results: A total n=580 students responded to the survey of which n=143 were medical and n= 437 were pharmacy students. Only 28.4% and 18.2% of medical and pharmacy students were familiar with the term "Antimicrobial stewardship", respectively. 70.7% of pharmacy and 73.5% of medical students agreed that strong knowledge of antimicrobials is important in clinical career. Both groups urged more education on antimicrobial resistance and appropriate use of antimicrobials. There was statistically significant difference between knowledge scores of both groups. Conclusion: Generally, there were some gaps in the knowledge especially in the pharmacy students, in scenario-based questions. Authors suggest universities to incorporate a dedicated module or postgraduate diploma on this topic for the students who wish to pursue a clinical career in pharmacy. [ABSTRACT FROM AUTHOR]

Introduction: In this era of antimicrobial resistance, knowledge of antibiotics and antimicrobial stewardship (AMS) is paramount for rational use of medications. AMS is considered a core element in the current clinical guidelines in the developed world. However, in Pakistan, the notion, scope and implementation of AMS remain skimpy. Objectives: To appraise the knowledge and perception of Medical Officers (MOs) and Hospital Pharmacists (HPs) about antibiotics and AMS. Materials and Methods: Cross sectional study using a validated questionnaire. Descriptive statistics was used to measure the median and difference in both groups was measured through Mann Whitney U test using SPSS version 23.0. Results: A total of (n= 343) responded to the survey of which n= 308 (89.8%) were MOs and n= 35 (10.2%) were HPs. The perceptions of HPs regarding potential benefits of AMS programs were positive and significantly higher (77.1%) as compared to 52%. Further, 61.4% and 68.6% of MOs and HPs respectively, favored the incorporation of AMS programs in community pharmacy. The overall score showed statistically significant difference (p=0.271) of perceptions among MOs and HPs and the overall score revealed that knowledge of MOs and PPs was statistically significantly different (p=0.145). Conclusion: The knowledge of antibiotic stewardship is better in HPs than MOs, however, the perceptions on AMS are generally positive in both groups. [ABSTRACT FROM AUTHOR]