NAG 2019: Clearer and structured guide for prescription of antibiotics
Published on: Friday, January 11, 2019
By: Bernama

KUALA LUMPUR: Government doctors will get a clearer and more structured guide to prescribing antibiotics under the third edition of the National Antibiotic Guideline (NAG 2019) as part of efforts to curtail antimicrobial resistance in this country. 

The Health Ministry is currently in the final phase of reviewing NAG 2014 (second edition of NAG) and is expected to publish NAG 2019 in the first quarter of this year.

NAG, the first edition of which was introduced in 2008, outlines principles of antibiotic therapy and rational antibiotic prescribing.

One of the core areas of focus of NAG 2019 will be on the prescription of antibiotics with regard to empirical treatment (treatment given without knowledge of the cause or nature of a patient’s disorder or based on the doctor’s observations and experience).

The Health Ministry’s national advisor for infectious diseases Datuk Dr Christopher Lee said NAG 2019 will provide government doctors and pharmacists clearer guidelines on empirical treatment.

“For example, when a patient shows signs of a bacterial infection, the doctor, based on the NAG, can prescribe an ordinary antibiotic first before sending the patient’s (blood or urine) sample to the lab for a bacteria culture test. A stronger antibiotic drug like carbapenem should only be prescribed based on the culture test result and if the patient shows no improvement,” he told Bernama in an interview recently.

(Bacteria culture tests are used to help diagnose certain types of infection. It usually takes about two or three days to get the results of a culture test from the laboratory.)

Dr Lee said based on a study of NAG 2014, it was found that there were many cases of government doctors prescribing strong or high-end antibiotics such as carbapenem to their patients even before getting the results of the bacteria culture test.

This practice has led to increasing resistance to high-end antibiotic drugs among Malaysians, he said.

Dr Lee, who is also a senior consultant (infectious diseases) and heads the Medical Department at Hospital Sungai Buloh, said doctors should first prescribe a low-end antibiotic for any bacterial infection but can give the patient a stronger one later if the patient shows no sign of improvement and the result of the bacteria culture test warrants it. 

He said NAG 2019 also focuses on giving clearer guidelines to government medical officers to control infections in hospitals, as well as cutting down the use of carbapenem as a strategy to aggressively counter the growing resistance to the antibiotic drug.

“It (carbapenem) will only be prescribed as an antibiotic of last resort and on a case by case basis,” he said, adding that NAG 2019 would restrain doctors from using strong antibiotic drugs in an arbitrary manner.

He also said that while NAG acted as a professional guide for the public healthcare sector, the private healthcare sector was also encouraged to develop its own guidelines on antibiotic usage but they have to be based on the Health Ministry’s existing antibiotic guideline.

Carbapenems are a group of antibiotics that are usually prescribed for the treatment of serious bacterial infections.

However, due to the overuse of these antibiotics, some germs or bacteria from the Enterobacteriaceae family, dubbed as superbugs, have developed high levels of resistance to carbapenems.

According to Dr Lee, there has been an increase in cases involving Carbapenem-resistant Enterobacteriaceae (CRE) in Malaysia. In 2013, the Health Ministry recorded 15 such cases but in 2017, the number of CRE cases had grown to 150. – Bernama



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