Officially launched on 26th September 2019 THIRD EDITION FULL WEB VERSION CAN BE DOWNLOADED FROM : www.pharmacy.gov.my www.moh.gov.my SEPTEMBER 2019 This guideline is constantly being reviewed and will be updated periodically via website ISBN 978-967-5570-78-0 Copyright© 2019 by MINISTRY OF HEALTH MALAYSIA. All rights reserved. No part of this publication may be reproduced without permission in writing from the publisher. Publisher and Distributor : PHARMACEUTICAL SERVICES PROGRAMME MINISTRY OF HEALTH MALAYSIA LOT 36, JALAN UNIVERSITI 46350 PETALING JAYA SELANGOR , MALAYSIA Tel : 603-78413200 Fax : 603-79682222 Website : www.pharmacy.gov.my MESSAGE FROM THE DIRECTOR GENERAL OF HEALTH MALAYSIA The NATIONAL ANTIMICROBIAL GUIDELINE is one of the most exciting initiatives that Ministry of Health (MOH) is proud of since its first launch in 2008. The threat brought on by antimicrobial resistance is a key factor driving this reference update, which the secretariat to this day has made every effort to ensure is in accordance with the latest scientific evidence. The third edition of NATIONAL ANTIMICROBIAL GUIDELINE was produced through series of discussions held between the Editorial Board and the team of each discipline. It involved a structured and intensive discussion process to ensure that the content was carefully reviewed and coordinated for consistency. Some new topics have been introduced in this issue, such as `clinical pathways for primary care physicians’, ‘approach to antimicrobial allergies’, while some were revised, such as ‘surgical prophylaxis’. I also which to express my sincerest congratulations and heartfelt gratitude to all those involved in the preparation of this latest edition, led by Datuk Dr. Christopher K.C. Lee, for their commitment during the preparation process. Well done and congratulations. This NATIONAL ANTIMICROBIAL GUIDELINE is undoubtedly one of the essential documents which will benefit all MOH employees irrespective of their expertise and workplace as infections can occur to their patients at anytime and anywhere. I am sure many will look forward to having this updated edition. To all MOH health care workers, let us make this NATIONAL ANTIMICROBIAL GUIDELINE as one of our primary reference in our daily practice. Datuk Dr. Noor Hisham Abdullah Director General of Health Malaysia ADVISORS YBhg. Datuk Dr. Noor Hisham Abdullah Director General of Health YBrs. Dr Ramli Zainal Senior Director of Pharmaceutical Services YBhg. Dato’ Dr. Bahari Dato’ Tok Muda Awang Ngah Director of Medical Development Division Dr. Roshayati Mohamad Sani Director of Pharmacy Practice and Development Division MAIN EDITORIAL COMMITTEE Datuk Dr. Christopher Lee K. C Ms. Rozita Mohamad Deputy Director General of Health (Chairman) Pharmacy Practice and Development Division, MOH Dato’ Dr. Mahiran Mustafa Dr. Benedict Sim Lim Heng Raja Perempuan Zainab II Hospital Sg. Buloh Hospital Datin Dr. Salbiah Hj Nawi Dr. Syamhanin Adnan Kuala Lumpur Hospital Sg. Buloh Hospital Dr. Suresh Kumar Chidambaram Ms. Noraini Mohamad Sg. Buloh Hospital National Cancer Institute Dr. Norazah Ahmad Dr. Thahira Jamal Mohamed Institute for Medical Research Kuala Lumpur Hospital Ms. Mardhiyah Kamal Dr. Izwan Effendy Pharmacy Practice and Development Division, MOH Puchong Health Clinic Ms. Hazimah Hashim Ms. Anitha Ramadas Pharmacy Practice and Development Division, MOH Kuala Lumpur Hospital Ms. Rohana Hassan Ms. Izyana Munirah Idham Kuala Lumpur Hospital Sg. Buloh Hospital WORKING COMMITTEE Infectious Disease Physicians Dr. Low Lee Lee Dr. Chow Ting Soo Sultanah Bahiyah Hospital Pulau Pinang Hospital Dr. Yasmin Mohamed Gani Dr. Ker Hong Bee Sg. Buloh Hospital Raja Permaisuri Bainun Ipoh Hospital Dr. Leong Chee Loon Dr. Giri Shan Rajahram Kuala Lumpur Hospital Queen Elizabeth II Hospital Dr. Tay Kim Heng Dr. Khairil Erwan Bin Khalid Selayang Hospital Kuala Lumpur Hospital Dr. Anusha Shunmugarajoo Dr. Tonnii Sia Loong Loong Tengku Ampuan Rahimah Hospital Sungai Buloh Hospital Dr. Cheng Joo Thye Dr. Wong Peng Shyan. Raja Permaisuri Bainun Hospital Pulau Pinang Hospital Dr. Leong Kar Nim Dr. Ismaliza Ismail Pulau Pinang Hospital Serdang Hospital Dr. Nadiah Hanim Zainul Dr. Gan Wee Fu Sultanah Bahiyah Hosiptal Sg. Buloh Hospital Dr. Anilawati Mat Jelani Dr. Alif Adlan Mohd Thabit Hospital Raja Perempuan Zainab II Sg. Buloh Hospital Dr. Guan Han Lin Dr. Shaharudeen Kamaludeen Pulau Pinang Hospital Sg. Buloh Hospital Dr. Nor Arisah Misnan Pharmacists: Raja Permaisuri Bainun Hospital Dr. Siti Hir Huraizah Md. Tahir Dr. Ahmad Kashfi Abdul Rahman Melaka Hospital Sultanah Nur Zahirah Hospital Ms. Farizan Abdul Ghaffar Dr. Noorlina Nordin Serdang Hospital Sultanah Nur Zahirah Hospital Dr. Wardati Mazlan Kepli Dr. Chua Hock Hin Serdang Hospital Umum Sarawak Hospital Dr. Rahela Ambaras Khan Dr. Ang Peng Peng Kuala Lumpur Hospital Sg. Buloh Hospital Dr. Norkasihan Ibrahim Dr. Lim Kah Chuan Kuala Lumpur Hospital Kuala Lumpur Hospital Mr. Tan Chee Chin Dr. Noralfazilta Amran Sultanah Aminah Hospital Sg. Buloh Hospital Ms. Kong Su Shan Ms. Fong Siew Li Ampang Hospital Sg. Buloh Hospital Ms. Pang Chia Wen Ms. Ghauvishini Apalasamy Sg. Buloh Hospital Sg. Buloh Hospital Ms. Hannah Md Mahir Mr. Loo Wei Yong Sg. Buloh Hospital Sg. Buloh Hospital Ms. Thong Kah Shuen Antibiotic Working Committee, Pharmacy Practice and Raja Permaisuri Bainun Hospital Development Division, MOH Ms. Norirmawath Saharuddin Pharmacokinetic Working Committee, Pharmacy Raja Permaisuri Bainun Hospital Practice and Development Division, MOH Ms. Ng Poh Lee Geetha Clinical Microbiologists: Tengku Ampuan Rahimah Hospital Dr. Sahlawati Mustakim Ms. Siti Mahanim Shaik Ismail Tengku Ampuan Rahimah Hospital Tengku Ampuan Rahimah Hospital Dr. Zahrul Laili Abd Hadi Ms. Michelle Liew Chee Hui Raja Permaisuri Bainun Hospital Kuala Lumpur Hospital Dr. Ahneez Abdul Hameed Ms. Chew Chia Zin Selayang Hospital Kuala Lumpur Hospital Dr. Norazlah Bahari Ms. Subasyini Sivasupramaniam Selayang Hospital Woman and Child Kuala Lumpur Hospital Dr. Nurul Huda Adli@Umur Ms. Chin Suk Yen Kuala Lumpur Hospital Woman and Child Kuala Lumpur Hospital Dr. Nurzam Suhaila Che Hussin Mr. Toh Chin Chiang Kuala Lumpur Hospital Woman and Child Kuala Lumpur Hospital Dr. Suhaila Md Hanapiah Ms. Sabariah Pakeer Oothuman National Cancer Institute Kuala Lumpur Hospital Dr. Nor Zanariah Zainol Abidin Ms. Nur Salima Shamsudin Tuanku Jaa’far Hospital Selayang Hospital Dr. Hazilawati Hussin Mr. Wong E-Jinq Kuala Lumpur Women and Child Hospital Sultanah Bahiyah Hospital Dr. Roslinda Jaafar Sultan Haji Ahmad Shah Hospital CONTRIBUTORS A. SURGERY H. ORAL HEALTH Datuk Dr. Johari Siregar Adnan Dato’ Dr. Shah Kamal Khan Jamal Din Dato’ Dr. Fitzgerald Henry Dr. Ganasalingam Sockalingam Dato’ Dr. Rohan Malek Mr. Jiffre Din I. TROPICAL INFECTIONS Mr. Lee Yuk Loong Dr. Ahmad Kashfi Abdul Rahman Ms. Nor Aishah Mohd Ariff Ms. Anitha Ramadas Dr. Salima Ibrahim Dr. Izety Shezlinda Noran J. OBSTETRIC & GYNAECOLOGY Dr. Salmi Mohamed Sukur Dr. J. Ravichandran Jeganathan Dr. Hafizan Mohd Tajri Dr. Muniswaran Ganeshan Dr. Naresh Govindarajanthran Dr. Carol Lim Mr. Jasjit Singh Nijhar Dr. Sahiri Nor Mr. Louis Ling Leong Liung Ms. Syakirah Samsudin K. RESPIRATORY Dr. Goon Ai Khiang B. PAEDIATRIC Dr. Megat Razeem Abdul Razak Dr. Thahira Jamal Mohamed Dr. Lalitha Pereirasamy Dr. Aina Mariana Abdul Manaf Dr. Wong Ke Juin L. OTORHINOLARINGOLOGY Mr. Yusof Abdullah Dr. Jothi Shanmuganathan Ms. Nurdaliza Mohd Badarudin Ms. Hazlina Mohd Khalid M. CARDIOVASCULAR INFECTIONS Dr. Mohd Sapawi Mohamed C. OPHTHALMOLOGY Dr. Asri Ranga Abdullah Ramaiah Dr. Shamala Retnasabapathy Dr. How Ann Kee Dr. Norlaila Talib Dr. Abdul Muiz Jasid Dr. Jamalia Rahmat Dr. Ahmadi Salleh Dr. Hanizasurana Hashim Dr. Syed Rasul Syed Hamid Dr. Vanitha Hema Latha Dr. Nor Fariza Ngah N. INFECTIONS IN IMMUNOCOMPROMISED D. DERMATOLOGY PATIENTS Dr. Suganthi Thevarajah Dr. Jameela P.N.A Sathar Dr. Noor Zalmy Azizan Ali Azizan Dr Benedict Sim Lim Heng Dr. Azura Mohd Affandi Dr. Tang Min Moon O. ORTHOPEADIC Dr. Khor Yek Huan Dr. Felix Loong Yew Seng Dr. Latha Selvarajah Dr. Manoharan Krishnan E. NEPHROLOGY Dr. Mohammad Fauzlie Dr. Sunita Bavanandan Dr. Shahnaz Shah Firdaus Khan P. CLINICAL PATHWAYS IN PRIMARY CARE Dr. Loh Chek Loong Dr. Izwan Effendy Ismail Dr. Wan Nor Azlin Wan Idris F. NEUROLOGY Dr. Husni Hussin Dr. Santhi Datuk Puvanarajah Dr. Ho Bee Kiaw Dr. Hiew Fu Liong Dr. Khairul Azmi Ibrahim Dr. Vickneswari Ayadurai Dr Izan Hairani Ishak G. GASTOINTESTINAL Dr. Jemah Sajari Dr. Kiew Kuang Kiat Dr. Salmiah Md Sharif Dr. Hamiza Sahar All Head of Services EXTERNAL REVIEWERS Prof. Madya Dr. Sasheela Vanar University Malaya Medical Centre Dr. Petrick Periyasamy National University of Malaysia Hospital Prof Dr. Victor Lim International Medical University Prof. Dr. Edmund Ong Newcastle University Medicine Malaysia Dr. Jayaseelan Nachiappan Raja Permaisuri Bainun Hospital Associate Prof. Dr. Mohd bin Makmor Bakry The National University of Malaysia Dr. Muhammad Nazri Aziz KPJ Lablink Medical Laboratory, Kuala Lumpur CONTENTS INTRODUCTION TO THE GUIDELINE PRINCIPLES OF ANTIBIOTIC THERAPY AND RATIONAL ANTIBIOTIC PRESCRIBING ANTIBIOTIC RESISTANCE DATA ANTIBIOTIC UTILISATION DATA SECTION A : ADULT A1. Cardiovascular Infections A2. Central Nervous Infections A3. Chemoprophylaxis A3.i Surgical A3.ii Non-surgical A4. Gastrointestinal Infections A5. Infections in Immunocompromised Patients: A5.i Hematology B5.ii Human Immunodeficiency Virus (HIV) A6. Obstetrics & Gynaecological Infections A7. Ocular Infections A8. Oral