MOH Confirms Shortage Of Certain Antibiotics In Public Facilities

MOH’s PSP notifies shortage only for amoxicillin, but a distributor states ampicillin-sulbactam powder for injection is out of stock, estimating new arrivals by the 2nd-4th week of October.

KUALA LUMPUR, Sept 16 – The Ministry of Health (MOH) has confirmed that certain antibiotics are running short in its public health care facilities, including in Sabah and Sarawak.

Health director-general Dr Noor Hisham Abdullah said MOH’s pharmaceutical services programme has taken note of CodeBlue’s report on the Malaysian Medical Association’s (MMA) ongoing survey for government doctors on an antibiotic shortage in public hospitals.

“We have received notification of shortage only for amoxicillin (capsule and syrup) so far, while there are sufficient stocks for other antibiotics procured by the MOH,” Dr Noor Hisham told CodeBlue Tuesday

Amoxicillin is a penicillin-type antibiotic that is used to treat a wide variety of bacterial infections.

Sabah state health director Dr Rose Nani Mudin similarly confirmed low stocks of “a few types” of antibiotics in MOH health care facilities.

“JKN Sabah has mobilised supply of medicines from facilities with sufficient stock to help facilities that are short of antibiotics. This procurement process is ongoing and is expected to arrive latest by the third week of September,” Dr Rose Nani told CodeBlue Tuesday

A Duchess of Kent, Sandakan Hospital (HDOK) internal memo dated last August 29, as sighted by CodeBlue, announced stock supply disruptions of ampicillin sodium 1g & sulbactam 500mg injection. 

“We hope that you will be able to use existing alternatives until stocks of ampicillin sodium 1g & sulbactam 500mg injection return to normal,” said the memo by HDOK’s chief pharmacy officer to the hospital’s heads of department.

Ampicillin-sulbactam (brand name Unasyn) is a broad-spectrum injectable combination antibiotic used to treat certain infections caused by bacteria, including infections of the skin, female reproductive organs, and abdomen.  

An August 25 letter by local pharmaceutical company Unimed Sdn Bhd to HDOK, as sighted by CodeBlue, stated a no-stock notification for Auropennz powder for injection 1.5g-1’s, which is an ampicillin-sulbactam combination antibiotic.

“In reference to the above matter, we regret to inform you that Auropennz powder for injection 1.5g-1’s is temporarily out of stock and our estimation arrival date is 2nd – 4th week of October 2022,” said the letter.

It is unknown if Unimed, which distributes Auropennz, had sent the no-stock notification only to HDOK, but other public hospitals as well. When contacted, a Unimed representative told CodeBlue yesterday: “We are unable to provide you any information on Auropennz at the moment.”   

Sarawak deputy state director for pharmacy, Dr Nor Anizah Osman, said among the affected antibiotic supplies in the state’s public health care facilities are amoxicillin syrup and ampicillin-sulbactam injection.

“So far, there is no problem with a shortage of antibiotics. Just that there is late delivery of supply for a few antibiotics, but this is still under control because we have other alternatives,” Dr Nor Anizah told CodeBlue yesterday

When asked if prescribing alternative antibiotics could lead to increased antibiotic resistance or affect patient care in any way, she said: “As long as it’s from the same group of medicines, there’s no problem.”

Besides HDOK and across Sarawak public health care facilities, shortage of the ampicillin-sulbactam injection antibiotic has also hit Universiti Malaya Medical Centre (UMMC), a teaching hospital in Kuala Lumpur under the Ministry of Higher Education.

An internal UMMC email dated last July 26 to staffers announced the disruption of supply of Unimed’s Auropennz, saying that stocks of the 1.5g ampicillin-sulbactam injection antibiotic had fallen to the minimal level in UMMC due to late stock delivery from the supplier.

“New supplies for the medicine are expected to arrive in two to three weeks,” said the July 26 email by UMMC’s chief pharmacy officer, as sighted by CodeBlue. 

“In line with that, supply of sulbactam/ ampicillin 1.5g Inj. will be restricted to patients with positive culture for multidrug resistant Acinetobacter baumannii. Other antibiotics like Amoxicillin-Clavulanate 1.2g Inj. can be used as an alternative.”

It is unclear if UMMC had already received new stocks of ampicillin-sulbactam as expected, given that Unimed’s letter stated an estimated arrival date of the second to fourth week of October. UMMC did not respond to CodeBlue’s request for comment.

An HDOK specialist said prescribing alternative antibiotics to ampicillin-sulbactam would not likely increase antibiotic resistance.

“But that’s not an excuse to disrupt supply on a yearly basis,” he told CodeBlue on condition of anonymity, as he was not authorised to speak to the press.

“And it reflects the failure of the current system to plan ahead – a disease that has plagued the Malaysian health care system.” 

Malaysian Association of Pharmaceutical Suppliers (MAPS) secretary Dr Choe Tong Seng said drug shortages, beyond antibiotics, could occur from the side of suppliers or manufacturers to the end users (hospitals, clinics, and pharmacies) of the pharmaceutical supply chain if proper inventory is not managed well. 

“Oftentimes, it could also be attributed to distance in geographical locations because of inefficient logistics etc,” Dr Choe told CodeBlue.

“[Shortages of] supply and availability of drugs, not only antibiotics, do happen as ‘demand and supply’ for a specific hospital fluctuates due to patients and the disease trending/ variation for a specific season. So, forward planning is important.”

He also suggested that MMA include questions in its survey on “how the hospitals should enhance their inventory management”, like level of stocking, actual and “predictive” purchases, collaboration with suppliers etc. 

A previous 2020 survey for government doctors run by Dr Timothy Cheng, then a specialist student at a public university in Malaysia, found that the majority of respondents complained about antibiotic shortages in their MOH hospital over the past year.

Doctors said frequent shortages of antibiotics enhanced drug resistance, worsened patients’ conditions, and lengthened hospital stays.

According to MOH’s National Antimicrobial Guideline 2019, ampicillin/sulbactam 1.5-3g is listed as the preferred treatment for severe or life-threatening penetrating injuries from animal bites, with piperacillin/tazobactam listed as an alternative treatment.

Ampicillin/sulbactam 1.5-3g is also the preferred treatment, besides amoxicillin/clavulanate or cefuroxime, in parenteral therapy for complicated urinary tract infections (UTIs).

Ampicillin/sulbactam 1.5-3g is further listed as the preferred treatment for ischaemic limb ulcers with infection, besides being the preferred inpatient treatment, among other antibiotics, for uncomplicated pyelonephritis (kidney infection). 

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