CTH Complete Thesis

UNIVERSITI TEKNOLOGI MARA
FUTURE PHARMACIST KNOWLEDGE ON ANTIBIOTIC AND THEIR

PERCEPTION AND KNOWLEDGE ON HALAL MEDICATION ISSUES
SPECIFICALLY ON ANTIBIOTIC
NURUL FHARIHA BT KAMARUDIN
BACHELOR OF PHARMACY (Hons)
2013
UNIVERSITI TEKNOLOGI MARA
FUTURE PHARMACIST KNOWLEDGE ON ANTIBIOTIC AND

THEIR PERCEPTION AND KNOWLEDGE ON HALAL
MEDICATION ISSUES SPECIFICALLY ON ANTIBIOTIC
NURUL FHARIHA BT KAMARUDIN
Dissertation submitted in partial fulfillment of the requirements

for the degree of
Bachelor of Pharmacy (Hons.)
2013
APPROVAL SHEET
I hereby recommend that the thesis prepared under my supervision by Nurul Fhariha Bt
Kamarudin (2009431346) entitled ‘Future Pharmacist Knowledge on Antibiotic and Their
Perception and Knowledge on Halal Medication Issues Specifically on Antibiotic’ be
accepted in partial fulfilment of the requirements for the degree of Bachelor of Pharmacy
from Faculty of Pharmacy, UiTM.
…………………… ………………………….
Date (Prof. Dr. Noorizan Bt Abd Aziz)
Deputy Dean
Faculty of Pharmacy
Universiti Teknologi MARA
………………….. ………………………….
Date (Professor Dr. Aishah Adam)
Dean
Faculty of Pharmacy
Universiti Teknologi MARA

ACKNOWLEDGEMENTS
In the name of ALLAH, the Most Gracious and The Most Merciful. Peace and blessing
of Allah Al Mighty to our beloved Prophet Muhammad SAW and his relatives also his
companions and his followers. Alhamdulillah and thankfulness to Allah SWT and with
His willingness allowed me to complete this final year project entitle “Future Pharmacist
Knowledge On Antibiotic And Their Perception And Knowledge On Halal Medication
Issues Specifically On Antibiotic”.
First and foremost, thank you to my supervisor Prof. Dr. Noorizan Abd. Aziz for
spending her precious time to guide me, provide information and suggestion, helping
and also motivate me to complete my research. A big thank to all my co- supervisors:
Assoc. Prof. Dr. Azmi Shariff, Assoc. Prof. Dr. Abdul Fatah, Assoc. Prof Dr. Mohamed
Haniki Nik Mohamed and Dr. Azrina Bt Azmi who were also willingly assisted me in
completing this research. A big thank to my beloved parents and to all my siblings on
their contribution giving me support physically and mentally. Not to forget all my
friends and to everyone who has contributed in this research including those students
who answered my questionnaire.
Thank you so much
Nurul Fhariha binti Kamarudin
Date; 20 Dec. 2012
ii
TABLE OF CONTENTS
Page
ACKNOWLEDGEMENT ii
LIST OF TABLES viii
LIST OF FIGURES x
FORMULA x
GLOSSARY x
ABSTRACT xii
CHAPTER 1 INTRODUCTION
1.1 Overview of antibiotic 1
1.2 Issues related with antibiotic 2
1.2.1. Mechanism of bacterial resistance 2
1.2.2. Classes of antibiotic 4
1.3 Halal issue 4
1.4 Problem statement 6
1.5 Significance of study 7
1.6 Objective of study 8
1.7 Hypothesis 8
iii
CHAPTER 2 LITERATURE REVIEW
2.1. Knowledge on antibiotic 9
2.2 Prescription 10
2.3 Usage and inappropriate use of antibiotic 11
2.4 Antibiotic resistances 13
2.5 Cost of antibiotic 15
2.6 Medication in Islamic perspective 16
2.7 The concept of halal , haram and masbooh 18
2.8 Is it permissible to use haram medication? 19
2.9 Awareness on status of pharmaceutical product 21
CHAPTER 3 MATERIALS AND METHOD
3.1 Methodology for objective one 22
3.2 Sample size 23
3.3 Subject selection 23
3.4 Location 24
3.5 Duration 24
3.6 Research tool (Questionnaire form) 25
3.6.1. Source 26
iv
3.7 Validity test 26
3.8 Reliability test 27
3.9 Statistical analysis 28
3.10 Methodology for objective two 28
3.11 Assessment of knowledge and perception 28
CHAPTER 4: RESULT
4.1. Result for objective one 30
4.1.1. Analysis of demographic data
4.1.1.1. University 30
4.1.1.2. Age 31
4.1.1.3. Race 31
4.1.1.4. Religion 33
4.1.2. Frequency
4.1.2.1. General knowledge on antibiotic 35
4.1.2.2. General knowledge of specific antibiotic and the
side effects 37
4.1.2.3. Knowledge on halalness of antibiotic and halal
concept 39
v
4.1.2.4. Perception and opinion on usage and status of
antibiotic 41
4.1.3. Association between demographic data with levels
4.1.3.1. Association between demographic data with
levels of knowledge on antibiotic 42
4.1.3.2. Association between demographic data
levels of knowledge on halalness of antibiotic
and halal concept 45
4.1.3.3. Association between demographic data with
levels of perception on usage and status
of antibiotic 48
4.1.3.4. Summarization of result 50
4.1.4. Analysis of open ended question 54
4.2. Result for objective two
4.2.1. Evaluation of antibiotics’ status 55
vi
CHAPTER 5: DISCUSSION AND LIMITATION
5.1. Discussion on result 56
5.2. Limitation
- Time and feedback from respondents 65
- Assessment of status and perception 66
- Knowledge and perception 67
CHAPTER 6: CONCLUSION 68
BIBLIOGRAPHY 70
APPENDICES
- Appendix A :Questionnaire form 79
- Appendix B :Application letters 83
- Appendix C :Approval letters 86
- Appendix D:Appreciation letters 89
- Appendix E :Table of antibiotic 93
- Appendix F: Application letter to Hospital
Tuanku Jaafar Seremban 100
- Appendix G :Table of antibiotic status 102
vii
LIST OF TABLES
1. Table 2.1: Expenditure of antibiotic (RM) 15
2. Table 4.0: Frequency of respondent from each university 30
3. Table 4.1: Table of number of respondent in respective age 31
4. Table 4.2: Frequency of race in respective university 31
5. Table 4.3: Number of respondents in each university relative to religion 33
6. Table 4.4: Frequency of answers on general knowledge on antibiotic 35
7. Table 4.5: Frequency of answer on General knowledge of specific
antibiotic and the side effects 37
8. Table 4.6: Frequency of answer on knowledge on halalness of
antibiotic and halal concept 39
9. Table 4.7: Frequency of answer on perception and opinion on
usage and status of antibiotic 41
10. Table 4.8: Association between gender and knowledge on antibiotic 42
11. Table 4.9: Association between university and knowledge on antibiotic 43
12. Table 4.10: Association between religion and knowledge on antibiotic 43
13. Table 4.11: Association between previous education and knowledge
on antibiotic 44
14. Table 4.12: Association between race and knowledge on antibiotic 44
15. Table 4.13: Association between gender and knowledge on antibiotic
viii
16. Table 4.14: Association between university and knowledge on
17. Table 4.15: Association between previous education and knowledge
on antibiotic and halal concept 46
18. Table 4.16: Association between university and knowledge on
19. Table 4.17: Association between race and knowledge on antibiotic
20. Table 4.18: Association between gender and level of perception on
21. Table 4.19: Association between university and level of perception
on usage and status of antibiotic 48
22. Table 4.20: Association between religion and level of perception on
23. Table 4.21: Relationship between previous education and perception on
usage and status of antibiotic. 49
24. Table 4.22: Association between race and level of perception on usage
and status of antibiotic 49
25. Table 4.23: Summarization of overall result 50
26. Table 4.24: Association between demographic data and pharmacy
students’ knowledge on antibiotic 51
ix
27. Table 4.25: Association between demographic data and
Pharmacy students’ knowledge on status of
medication (antibiotic) 52
28. Table 4.26: Association between demographic data and pharmacy
students’ perception on halal medication issues 53
29. Table 4.27: Status of antibiotic product 55
LIST OF FIGURE
1. Figure 3.1: Flow chart of study 22
2. Figure 3.2: Steps of validation test 27
FORMULA
1. Equation 3.1: sample size calculation 23
GLOSSARY
1. Allah: According to Islam, Allah is the Creator of the Universe.
2. Hadith: related to words and action by Prophet Muhamad
x
3. Halal: means permissible
4. Haram: opposite of halal due to originated from animal, pig or animal which is
slaughtered in the Islamic technique.
5. Masbooh: lies between halal and haram where the source of ingredients is
uncertain or doubtful.
6. Quran: holy book of Muslims
7. Ulama’: Muslim scholars who have high knowledge of Islam and are trained in
both Islam and Islamic law
xi
ABSTRACT
Antibiotic is the most prescribed anti- infective agent by both public and private
health care centre and resistance towards antibiotics is a serious problem. Thus it is
important for pharmacist and future pharmacists to have sufficient knowledge on
antibiotic. The demand and distribution of antibiotics to Muslim patient is also going
to increases. Because of that, pharmacist should also have knowledge on halal
concept in order to dispense halal antibiotics to Muslim. However, not many
pharmacist or health care professional that are really competent in prescribing the
Muslim patient with halal antibiotics.
The aims of this research study are to determine level of knowledge of future
Pharmacists on antibiotics and their knowledge and perception on Halal medication
(antibiotic) and also to determine the halal status of antibiotics that are commonly
used in Government hospitals.
The study is done by distribution of questionnaires to final year pharmacy students in

five universities, University Teknology MARA (UiTM), Universiti Malaya (UM),
Universiti Kebangsaan Malaysia (UKM), Universiti Sains Malaysia (USM) and
International Islamic University Malaysia (IIUM). The result was analysed by using
Statistical Package for the Social Sciences (SPSS) program software version 16.
All respondents have good knowledge on antibiotic. Poor knowledge on status of

antibiotic can be seen in all demographic parameter tested. More than 90 % of total
respondents have positive perception and opinion on usage and status of antibiotic.
Early exposure to the real practice life and continuous education and monitoring may
improves students’ knowledge.
The assessment of antibiotic status resulted in 10 prohibited antibiotic product, 13

halal and 12 mashbooh antibiotic products. 29 products’ status cannot be assessed
due to lack of information. Cooperation from drug manufacturers and support from
government may improve achievement toward halal medications in Malaysia.
xii
CHAPTER 1
INTRODUCTION
1.1. Overview of antibiotic
Antibiotics are common drug used in hospitalized patient especially in surgical
department and intensive care department (Goldmann et al., 1996). It is used to treat
infections or diseases caused by bacteria. Examples of diseases or infections that can
be treated with antibiotic are bacterial meningitis, neurosyphilis, endocarditis, burn
wounds, skin infection, pneumonia, anthrax, Lyme disease, bronchitis,
gastrointestinal infection, tuberculosis.
Common cold, sore throat, sinus infection, cough, acute bronchitis and flu cannot be
treated by antibiotic. This is because all these illnesses are caused by viral infection
not by bacterial infection. (“Best Practice For Antibiotics,” n.d.).
Antibiotics work by various kind of mechanisms. It may work by blocking important
processes in bacteria, killing the bacteria or prevent bacteria from multiplying
(Jaiswal, Pandey, & Sharma, 2012). This helps the body's natural immune system to
fight the bacterial infection. Prolong usage or inappropriate usage of antibiotics may
lead to development of antibiotic resistance. Examples of inappropriate use of
antibiotics are overuse, underuse and self- medication. Inappropriate prescription of
1
antibiotic is a worldwide problems (Steurer et al., 2011) and it happens in all health
departments (Al-Shami, Mohamed Izham, Abdo-Rabbo, & Al-Shami, 2011).
1.2. Issues related with antibiotics
Antibiotic resistance is when the antibiotic becoming less effective in killing bacteria
and treat the infection (“Best Practice For Antibiotics,” n.d.). Resistance may lead to
severe morbidity and mortality rate. Other negative impacts are more spending for
treatment, extension of hospital stay and adverse drug reactions (Cosgrove, 2006).
Common side effects that are related to antibiotic intake are diarrhea, vomiting and
feeling seek. It is rare for patient to experience serious side effects like deafness,
blood disorder, kidney problem, photosensitivity (Tejas, 2007) and many more. The
appropriate selection of antibiotic should consider few things. It should be the correct
antibiotic for the site of infection, the suspected organism and severity of infection. It
should also considering the resistance pattern of hospital microbial flora, patient’s
immune status and hospital resistance patterns.
1.2.1. Mechanism of bacteria resistance
Three main strategies adapted by antibiotic resistant pathogen are inactivation of
drug activity by enzymes reaction (Davies, 1994), modification of antibiotic target
or bind site (Spratt, 1994), and efflux of antibacterial agent out of bacterial cell
(Nikaido, 1994).
2
Alteration of target site
Resistant pathogens that function in this way will reduce the affinity of antibiotic to
bind to its binding site in the bacterial cells (Lambert, 2005). The culprits that are
responsible for this mechanism are inducible and constitutive enzyme (Sibanda &
Okoh, 2010).
Enzymatic inactivation
Antibiotic resistant bacteria produce hydrolytic enzyme in order to antagonize effect
of antibiotic (Wright, 2005) and usually the gene that coded for this enzyme is
carried on plasmid or other mobile genetic element (Sibanda & Okoh, 2010). This
enzyme is able to degrade antibiotic.
Gram negative bacteria that are resistant to Aminoglycoside have varieties of
enzymes which able to modify Aminoglycoside molecule by acetylation, adenylation
and phosphorylation (Over, Gür, Unal, & Miller, 2001).
Antibiotic efflux
Few studies indicate that almost all antibiotic resistant bacteria work by removing
antibiotic out of bacteria cell (Gill, Brenwald, & Wise, 1999). As a consequence of
this process, the amount of antibiotic in the bacteria is reduced (Marquez, 2005).
3
1.2.2. Classes of antibiotic
Antibiotic can be divided as Aminoglycosides, Penicillins, Cephalosporins,
Sulfonamides, Fluoroquinolones, Macrolides and Tetracyclines.
1.3. Halal issue
Out of 6.8 billion of total world population (Narcis, 2009), there is about 1.6 billion
of Muslim worldwide and it is expected to increase by 35% in the next 20 years.
Thus the expected Muslim population all around the world is 2.2 billion by 2030.
The growth rate of Muslim population is forecasted to grow twice than the Non-
Muslim population for the next two decades (The future of the global muslim
population projections for 2010-2030, 2011). From this numbers we can see how
huge the Muslim populations are.
Growth in Muslim population increases demand for halal food, beverages and
medication as well as antibiotic. Antibiotic is the most prescribed medications for
hospitalized patient especially in surgical department and intensive care department.
Muslim is bound to the Islamic regulation stated in Quran. They have to ensure that
anything that is going to be put in their mouth should be halal. Thus halal is the
essential aspect to be considered for food and medication intake.
4
However, not all pharmaceutical products are halal. This is due to the origin of the
ingredient used for the medication production. For example, any products with
gelatine will create suspicious in Muslim consumer because it is produced by animal.
Pig is the common source for gelatine. In Malaysia research has been done to
produce gelatine from other alternative for example, Halagel (M) Sdn. Bhd is already
producing halal hard gelatine capsules (Ismail, 2010) to shows that Malaysian
Muslim concern on the need of halal medications. However not all company is using
gelatin from Halagel. In a study done in Europe, Middle East and Asia in July 2007
on the awareness of halal and haram, the awareness towards pharmaceutical product
is the lowest where only 18% to 22% of the respondents are aware of the status of
their medication (Sungkar, 2008). This study revealed that only few respondents are
concern on halalness of their medication and most are not.
Food manufacturers in Malaysia need to apply for halal certificate from JAKIM in
order to display halal logo on their product. Products with Malaysia halal logo is
established and well accepted by Malaysian as well as people in international level
(Bahli, 2011). However it is still difficult for Muslim to get access to halal
medication because Malaysian Islamic Development Department, JAKIM do not set
a requirement for halal certification for pharmaceutical products (“MALAYSIA: List
out Medicines without Halal Certification, FOMCA,” 2011).
5
It is essential to develop halal certificate for pharmaceutical product since
medications is widely used in daily live. The usage of antibiotic in Malaysia for
example keeps increasing every year and inappropriate use of antibiotic is also
reported. Since the status of antibiotic is not known, Muslim who take antibiotic is
actually consuming haram or masbooh medications.
All Muslims should believe in Allah and are bonded to guidelines from Quran and
Hadith in all living aspects including food and medications consumption. Muslims
shall only consume halal food and avoid haram food as mentioned in the Quran and
in the hadith of the final Prophet Muhammad (Peace Be Upon Him).
1.4. Problem statement
Since antibiotic is widely used in all hospital departments especially in inpatient and
outpatient department, it is important for pharmacist and future pharmacists to have
sufficient knowledge on antibiotic. This is to ensure the appropriate prescription of
antibiotic to patient and to produce good outcome of antibiotic treatment to patient.
The knowledge must always be updated due to emergence of antibiotic resistance.
Muslim’s populations are increasing from years to years. Thus the demand and
distribution of antibiotics to Muslim patient is also going to increase. However
antibiotic that is prescribed to Muslims is not determined whether it is halal or not.
6
At the same time pharmacist also do not inform the status of antibiotic prescribed to
patient. These days, not many pharmacist or health care professional that is really
competent in prescribing the Muslim patient with halal antibiotics.
1.5. Significance of study
Based on the problems stated above, this study is going to determine level of
knowledge of future pharmacists about antibiotic and also to evaluate the knowledge
and perception of future pharmacist on concept of halal and haram. This study will
provide information whether pharmacist students have sufficient knowledge of
antibiotic. Result of this research will determine whether more comprehensive
subject on antibiotic and a new subject on halal medication or halal concept should
be introduced in pharmacy education program.
It is important to determine the halal status of any food or medication, provided most
of Malaysia’s populations are Muslim. Thus, pharmacist and other health care
professionals should take part in delivering the information to the public especially
Muslims. This study will also provide some information on the status of antibiotic
that is commonly used in hospital and will access the knowledge on antibiotics of
future pharmacists from different university.
7
1.6. Objectives of study
There are two objectives of this study. The first objective is to determine level of
knowledge of future Pharmacists on antibiotics and their knowledge and perception
on Halal medication (antibiotic) issues. The second objective is determining the
status of antibiotics that are commonly used in Government hospitals.
1.7. Hypothesis
Most of pharmacy student have sufficient knowledge on antibiotics and adequate
knowledge and perception on halal medication issues specifically on antibiotic.
Another hypothesis is all antibiotic used in Government hospital are permissible for
Muslim.
8
CHAPTER 2
LITERATURE REVIEW
Antibiotic is one of the medications that is widely used and most prescribed in
hospitals for treatment of infection (Tunger, Karakaya, Cetin, Dinc, & Borand,
2009). The use is started since Penicillin is discovered. Nowadays the use of
antibiotics is massive due to development and production of synthetic and semi
synthetic antibiotics. In most developed and developing countries the antibiotics are
most widely used in clinical medicine (Calva & Bojalil, 1996).
2.1. Knowledge on antibiotic
Based on a study in Korea, pharmacists are really aware on the emergence of
antibiotic resistance. Compared to physician, pharmacists are more concern on issue
of resistance. However, they have confusion in determining the causes of infection.
They misunderstood between virally caused infection and bacterial caused infection.
The same study in Korea revealed more than half of the pharmacist there prone to
prescribe antibiotic for treatment of common cold because they believe complication
caused by antiviral infection is treatable by antibiotic (Cho, Hong, & Park, 2004).
9
If the pharmacist themselves do not have sufficient knowledge on antibiotic, how can
they practice appropriate prescribing practice as stated in National Antibiotic
Guidelines. Therefore a drastic action should be taken to correct this phenomenon to
ensure any kinds of infections are treated correctly and reduce the cases of antibiotic
resistance. Thus, this study is can be used to see whether the level of antibiotic
knowledge of future pharmacist in Malaysia is better or the same as the Korea.
2.2. Prescription
Antibiotic is the most prescribe in hospitalized patient especially in surgical
department and intensive care department. Appropriate antibiotic prescription in
health institutional by general practitioners is important for the controlling of
antibiotic cost, control of infection and for better quality of care (Goldmann et al.,
1996). This prescribing principle is really concerning on the prescriber’s knowledge
on the risk of infection and the advantage of medicine. It is also important to
understand the pathophysiology of disease treated (Preeth & Shobana, 2011).
Large number of unnecessary prescription of antibiotics is contributed by antibiotic
used for treatment of respiratory tract infection (Costelloe, Metcalfe, Lovering, Mant,
& Hay, 2010). In a study in Yemen, inappropriate, ineffective and inefficient use of
drug happens in all health departments (Al-Shami et al., 2011).
10
In 2003, Ministry of Health said, there is propensity of doctors to ignore the
guidelines of prescribing and usage of antibiotics. This scenario will induce the
emergence of antibiotic resistance among Malaysians. There is certain condition
where doctors do not even ask the patient if the patient is sensitive to certain
antibiotics and prescribe high end antibiotic for infection (Kam, 2003). There is also
situation where over prescription occur in which three antibiotics were prescribed in
one prescription (Al-Shami et al., 2011). A study in government health clinic in
Negeri Sembilan stated that there is an over- prescription of antibiotic for treatment
of upper respiratory tract infections (Teng et al., 2003). This will also lead to
ineffective treatment.
2.3. Usage and inappropriate use of antibiotic
The usage of antibiotic is really at maximum level and widespread (Hem et al.,
2005). According to Malaysian Statistic on Medication 2005, antibiotic is the most
prescribed anti- infective agent by both public and private health care centre
(Malaysian statistics on medicines 2007, n.d.). But compared to other countries,
Malaysia has lower antibiotic usage compared to Greece, France, United State,
Europe, British, and Columbia (Patrick et al., 2004). However there is also lack of
compliance of antibiotic guideline issued by Ministry of Health (Ochoa, Eiros,
Inglada, Vallano, & Guerra, 2000).
11
The overuse of antibiotic is actually due to wrong patient expectation and attitudes
(Hedin et al., 2006). They do not really know and understand of the side effects that
will be experienced because of over consumption of antibiotic (Hem et al., 2005).
Another situation that can be considered as inappropriate use of antibiotic is self-
medication. Self- medication is a condition in which patient self- diagnoses the
disease or symptoms experienced and then continue use of prescribed drug for the
same disease in the future (Olayemi, Olayinka, & Musa, 2010). This problem occur
because antibiotic is available as over-the-counter product, lack access to healthcare
and due to poor regulatory practice. Patient keeps the left- over antibiotic for future
need and use antibiotics prescribed for other person. Self-medication is applied for
self-limiting disease that can be healed with appropriate medical and supportive care
like sore throat, cold and cough (Parimi, Pereira, & Prabhakar, 2002). This clearly
shows that antibiotic is inappropriately used to treat wrong diseases. Those diseases
are actually due to viral infection and antibiotic intake will not give any therapeutic
effects to patients.
In Malaysia, complex socioeconomic status, culture and behavior (Okeke,
Lamikanra, & Edelman, 1999) are the causes of self- medication. Less control on use
of antimicrobial drug (Parimi et al., 2002) and the availability of antibiotic as over-
the-counter will assist patient to obtain antibiotic without prescription. The purchase
of antibiotic without prescription is occurring due to patient demand and profit
interest of health care providers (Ling Oh et al., 2010).
12
Pharmacy and medical students is also practicing self- medication even though they
have knowledge of disease, usage and drawback of antibiotic. This is due to tight
academic schedule and they do not have time to follow lengthy waiting time for
consultation by doctor. While non- health student self- medicate because they
assume same symptoms can be treated with same antibiotic from over-the-counter
antibiotic or the left over antibiotics from the previous prescription (Olayemi et al.,
2010).
In Malaysia, a research done in University Sains Malaysia (USM) reveals major
factor that lead to self- medication in that university is the stocking of drugs at
student’s room and ease of purchasing the prescription-only-medicine from the
university private community pharmacist (Ali, Ibrahim, & Palaian, 2010).
2.4. Antibiotic Resistance
Antibiotic resistance is an alarming and increasing health problem since past two
decades (Levy & Marshall, 2004). This is a global problem and it is related to public
health concern (Maurice, Angela, & Chris, 1999). Resistance will lead to severe
morbidity and mortality rate. It is particularly more serious in hospitals where there
are hundreds of people with different ages, illnesses and patient with
immunosuppressant treatment. Resistance may also occur with the usage of life-
supporting devices that are already infected with bacteria (Diekema et al., 2004).
13
In 2000, Malaysia National antibiotic resistance surveillance program shows there is
resistance of Salmonella Typhi that was isolated from Malaysia government hospital
towards Ampicillin (10.6%), and Chloramphenicol (8.5%). Data on resistance of
antibiotic versus Fluoroquinolone is not yet reported. The recent record from
National Antimicrobial Resistance Surveillance data in 2007, showed high resistance
of gram negative bacterial against Ampicillin: Klebsiella spp. (99%), Enterobacter
spp. (93%), Escherichia coli (69%), Proteus spp. (48%) and Haemophilus influenzae
(20%) (Gray et al., 2006).
There is no recent data recorded on community antibiotic resistance. There is one
research recorded that there is less antibiotic resistance towards Staphylococcus
Aureus. Some gram negative aerobic bacilli show resistance against Gentamicin.
Methicillin Resistant Staphylococcus Aureus, MRSA is also encountered (Norazah
A, Lim, Munirah S. N, & Kamel, 2003). Besides that, there is high resistance on
Fusidic Acid; 11.8%. This huge number of resistance may increase usage of Fusidic
Acid in general practice (Mason, Howard, & Magee, 2003). In 2008, MRSA exhibit
elevated resistant to fusidic acid (Malaysian statistics on medicines 2007, n.d.).
Another alarming antibiotic resistance is the resistance towards respiratory
pathogens. In Malaysia itself, there is 40% of Staphylococcus Pneumonia is
insensitive to Penicillin but the bacteria strain is still responding to Amoxicillin
Clavulanate (Rohani, Parasakthi, Raudzah, & Yasim, 1999). In other countries in
Europe and Asia, the resistance of S. Pneumonia is also high (Lim, 2003).
14
2.5. Cost of antibiotics
There are various factors that may influence the cost of antibiotic. Resistance
towards antibiotics may increase the cost expensed for antibiotic. When the patient
does not response to the first line antibiotic then he should take second line antibiotic
as alternative (Simoens, 2011). Second line antibiotic is usually more expensive than
the first line antibiotic (Haber, Levin, & Kramarz, 2010).
It is also related to patient compliance in term of frequency of dosing, adverse effects
and period of treatment (Kardas, 2002). Besides that the spending on antibiotic may
also increase if there is failure of treatment where patient might require longer
antibiotic treatment or hospitalisation (Simoens, 2011). Based on a research done by
Hospital Sultan Haji Ahmad Shah, Temerloh (HoSHAS) the cost of antibiotic
utilised is generally increasing from year to year. This means the government needs
to spend more money for the expenses of antibiotic (Syed Zainuddin, 2012).
Table 2.1 Expenditure of antibiotics (RM)

Antibiotic 2007 2008 2009
Cefuroxime 5795.00 19175.00 34810.00
Ceftriaxone 114757.80 135511.20 148818.10
Ceftazidime 103773.60 94990.80 101290.50
Cefoperazone 92623.00 129151.00 103840.00
Cefotaxime +sulbactam 72010.00 7020.00 111800.00
Cefepime 76270.00 113090.00 42900.00
Ciprofloxacin 25960.00 28504.00 27000.00
Piperacillin+tazobactam 37345.00 112941.40 131296.00
Imipenem 292813.60 438199.20 190196.00
Meropenem 176860.30 414303.10 997923.20
Vancomycin 13459.60 28652.80 43304.80
(Syed Zainuddin, 2012)
15
2.6. Medications in Islamic perspective
In Islam, it is compulsory for every Muslims to ensure everything they eat or
consume is halal. Allah command us to eat pure and wholesome food in the Quran
mean,
“O you people! Eat of what is on earth lawful and good; and do not follow the
footsteps of the evil one (Shaytan) for he is to you an avowed enemy”. (Surah2:168)
Allah remind Muslim not to take any food that is unhealthy, impure, prohibited
(haram) in Islam and animals that is slaughtered not in the name of Allah. Below are
Allah commands in Quran regarding to the prohibition of consumption of some food
for Muslim.
“Forbidden to you (for food) are: dead meat blood the flesh of swine and that on
which has been invoked the name of other than Allah that which has been killed by
strangling or by a violent blow or by a headlong fall or by being gored to death; that
which has been (partly) eaten by a wild animal; unless you are able to slaughter it
(in due form); that which is sacrificed on stone (altars); (forbidden) also is the
division (of meat) by raffling with arrows: that is impiety…”. (Surah 5:4),
16
So, it is clear that Allah prohibit Muslim from taking any meat that is slaughtered not
in the name of Allah and any products that is produced from this meat. But nowadays
some Muslim just easily ate any meat as long as it is not pig. However, the most
important thing is how the animal being slaughtered. If it is not be done by the name
of Allah, then it is prohibited to eat that animal even if it is a chicken. Muslim should
aware of what they eat especially the source of it to ensure good health and noble
soul.
Then he (the Prophet) mentioned (the case of) the man who, having journeyed far, is
dishevelled and dusty and who stretches out his hands to the sky (saying): "O Lord!
O Lord!" (while) his food was unlawful, his drink was unlawful, his clothing was
unlawful, and he is nourished with unlawful things, so how can he be answered?”
[Muslim]
The main source of Islamic Law is Quran and it is the words of Allah. Thus is is also
Allah’s Law which is a must for all Muslim to follow. Muslim should not have doubt
of it since Allah knows what is the best for Muslim and there is no better law than the
one created by Allah.
17
2.7. The concept of halal, Haram and masbooh.
Islam set a must for Muslim to seek for halal food in their entire live. Halal is
something that is permissible and lawful for Muslims. Halal food is where:
1. There is no prohibited ingredients or forbidden substance taken from animal
2. Do not contains any filth as stated in Islamic Law
3. Not being process by using utensils or apparatus and machines which having
filth residue on it
4. Do not contact with anything that stated in (1), (2) and (3) during preparation,
storage, or processing (“islamic laws (syariah laws),” 2010).
These guide lines can also be apply for pharmaceutical products in which the
ingredients to be used are certified halal, there is no mixing of non- halal ingredient
with halal ingredient, the packaging, and container should also certified halal, the
transport used to transport the product is only used for transportation of halal
products only. Lastly the product must be labelled with halal logo (“Halal
Pharmaceuticals: How About Pharmaceutical and Cosmetics,” n.d.).
18
Haram is the opposite of halal. Allah prohibited Muslim from doing or consume
anything that is haram. Haram means unlawful or prohibited. Examples of
prohibited food are (“what is haram,” n.d.):
1. Pig
2. Blood
3. Carrion
4. Halal animal which do not slaughtered a stated in Islamic Law
Any medications derived from these origins are considered haram.
The third category is musbooh. It lies in between halal and haram. Musbooh product
is suspicious and questionable due to its unknown or uncertain status of sources of
ingredients. Further information and studies needed in order to classify it into halal
or haram.
2.8. Is it permissible to use haram medication?
Allah will not send any diseases that can’t be cured. But Muslim must be aware of
the source of the medication. Is it halal, haram or musbooh? As recorded in the
hadith and Quran, it is prohibited to use haram medication and only halal drugs are
permitted.
19
Certain conditions where use of haram medication is permitted:
1. There is no other drug from permissible ingredients available
2. The treatment must be critical and used only for patient healthiness
3. It is permissible only in certain treatment interval which is recommended by
doctor
4. Only the expert Muslim doctors who are outwardly upright and god- fearing
are able to prescribe the prohibited drug.
These standards are also recommended by many of Hanafi Fuqaha.
In surah al- baqarah Allah permit Muslim to take prohibited food in certain
condition. Allah almighty says:
“He (Allah) has only forbidden you dead meat, and blood, and the flesh of swine,
and that on which any other name has been invoked besides that of Allah. But if one
is forced by necessity, without wilful disobedience, nor transgressing due limits, then
he is guiltless. For Allah is Most Forgiving and Most Merciful.” (Surah al-Baqarah,
V: 173) (Ibn Adam, n.d.).
Some ulama’ and other scholars also give guideline for the usage of impermissible
drug/ medication.
20
“Seeking treatment with unlawful medication is permissible when one is certain of
being cured, similar to consuming dead-meat when dying of hunger and drinking
alcohol when dying of thirst.” (Umdat al-Qari, 2/649)(Ibn Adam, n.d.).
2.9. Awareness on status of pharmaceutical product
In a study done in Europe, Middle East and Asia in July 2007, the awareness of halal
and haram of pharmaceutical product is the lowest with only 18% to 22% of the
respondent are aware of the status of medication. It is different when compared to
determination to find halal meat or food. There are 94 and 98% of Muslim
respondents are highly determined and willing to find halal meat products
(Muhammad, 2008).
This study shows that most of people did not see pharmaceutical products as
something that should be formulated as halal. They do not treat medications the
same as food in which they should consider the source of ingredients and the
presence of halal certificate.
21
CHAPTER 3
METERIALS AND METHOD
3.1. Methodology for objective one
The first phase is the construction of questionnaire. It involves the cross sectional
analysis where a subset of population was observed to study the relationship between
different variables at a point of time. The questionnaire contains 42 questions with
5sections.
Figure 3.1 flow chart of study
22
3.2. Sample size
The sample size required is calculated as follow in order to determine minimum
number of questionnaire form that needs to be collected back from the respondents to
obtain the best result for this study.
n= (Z/Δ)2 p (1-p)…………………………………………………………...(3.1)
Z= 1.96
Δ= 0.05
p= 0.50
n= (1.96/0.05)2 0.50 (1-0.50)
n= 385
Thus with confidence level of 95%, the sample size required is 385 respondents.
3.3. Subject selection
The respondents chosen for this survey must meet few criteria. Subject who are
selected in this study should be final year pharmacy student from Universiti
Teknology MARA (UiTM), Universiti Kebangsaan Malaysia (UKM), Universiti
Malaya (UM), Universiti Sains Malaysia (USM) and International Islamic University
Malaysia (IIUM). Both male and female are included. There is no race limitation.
23
Those who are excluded from this study are pharmacy student from year 1, 2 and
year 3. Students from other courses and from universities other than stated are also
excluded.
3.4. Location
The study was conducted in five universities, which are UiTM, UKM, UM, USM
and IIUM. The locationfor second objective of study was conducted in inpatient
department of Hospital Tuanku Jaafar, Seremban and Hospital Pulau Pinang.
Antibiotics leaflet were collected in this department during my hospital attachment.
3.5. Duration
The research is conducted from March 2012 to December 2012. The first phase of
my research took a long time. Duration for first phase of the study include from
questionnaire formation, data collection, data analysis and report writing. I took a
long time to create the questionnaire especially for questionnaire on Part 2 and Part 3
which is about ‘General knowledge on antibiotic and the side effects’.
Validation and reliability studies took long time to be completed. This is because the
test is done during the Gawai Festival (1 week holiday). Thus it is hard to recollect
the questionnaire from the student. In addition, I need to do the reliability study on
final year pharmacy student which also required much time because they are doing
24
their hospital attachment. This means they were not available the faculty and it is
difficult for me to recollect the questionnaire.
Data collection will also consume a lot of time because the questionnaires were
distributed during mid semester holiday and during the examination period. The
distribution and collection of questionnaire took about 3 months to be completed.
Thus only 3 weeks left to key in all the data in SPSS, analysis of data and thesis
writing.
3.6. Research tool (Questionnaire form)
The questionnaire consists of 42 questions with 5 sections. Part one is the
demographic section where it comprises of 7 questions regarding university, gender,
age, race, religion, cGPA, previous education. Part two is about general knowledge
on antibiotic and it consist of comprises of 10 questions. The question are basically
about general knowledge on antibiotics with response options (yes, no, unsure).
Section 3 is regarding general knowledge of specific antibiotic and the side effects
which also consist of 10 questions. The questions asked are based on knowledge of
specific antibiotic: route of administration, resistance, side effects. The response
option is the same with section 2. Then part 4 is also comprises 10 questions and
more focusing on knowledge on halalness of antibiotic and halal concept.
25
The last part is part 5which is on perceptions and opinion on usage and status of
antibiotics. The questions are designed in likert scale form and consist of 2 open
ended questions.
3.6.1. Source
The questionnaires formed are based on discussion with supervisor and colleagues.
Information was also taken from standard references like MIMS, BNF, lecture notes
and internet.
3.7. Validity test
Validity test is going to be done for 6 experts. The purpose of this validation test is to
know whether the questionnaire prepared do reflect the knowledge on antibiotic and
halal concept. The questionnaire is formed based on few references; MIMS, BNF,
and internet. The validity test required the experts to evaluate on appropriateness of
the questions and their answer will be analyzed using likert scale. The consistency of
the answer will is confirmed by reliability test.
The result was analyzed by using Cronbach alpha. The result calculated is more than
0.07. The questionnaire was modified based on comments from experts. So, I
proceed to distribute the questionnaire for reliability test.
26
Figure 3.2 : Step of validation test
3.8. Reliability test
This test is done to know whether the questionnaire developed is understandable by
student and to evaluate the consistency of understanding by time, between one to two
weeks.
Steps for reliability test.
The test is done based on questionnaire that was agreed by experts.
1. 10% of the respondent/ subject were selected to evaluate their
understanding of the questionnaire
2. Corrections was made based on from subjects
3. Distribution of questionnaire and collect the answer
4. Redistribute the questionnaire to the same subjects after 1 to 2 weeks
and recollect the answer
5. Analyze the reliability (consistency of students’ answer) by using
Cronbach alpha.
27
3.9. Statistical analysis
Data obtained in this study is analyzed by using Statistical Package for the Social
Sciences (SPSS) program version 16. The test that is used to analyze the data is chi-
square test in which to determine the significance level of the data.
3.10. Methodology for objective two
The status of antibiotic is based on the leaflet collected from Hospital Pulau Pinang
and Hospital Tuanku Jaafar Seremban. Remington, Martindale, chemical website
(http://www.freepatentsonline.com/) and Wikipedia is used for the assessment of the
origin of the substance.
The product is halal if the ingredients are not from animal. However the antibiotic is
considered masbooh if the source of ingredients is from animal and the way of
slaughtering is unidentified. A product cannot have final assessment if there is a
substance with unknown status. But any addition of haram substances in the
formulation will make the product haram regardless the status of other substances.
3.11. Assessment of knowledge and perception
Level of knowledge of respondents on the antibiotic and their perception on halal
usage and status of antibiotic is assessed by analyzing their answer.
28
- Good knowledge on antibiotic is defined when subjects are able to
answer 50% of question on antibiotic correctly.
- Good perception is defined when subjects can answer 50% questions
on halal usage and status of antibiotic.
29
CHAPTER 4
RESULT
The constructed questionnaire passed the reliability and validity test where both the
analysed values are more than 0.07 which is 0.904 and 0.808 respectively. Thus the
questionnaire is validated and can be use for further research.
4.1. Results for objective one
4.1.1. Analysis of demographic data
4.1.1.1. University
Table 4.0: Frequency of respondent from each university

University UiTM UKM USM IIUM UM
Frequency 101 55 118 42 59
Percentage 26.9 14.7 31.5 11.2 15.7
Total respondent for this research is 375 students. Most of the students are
from USM and UiTM with 118 (31.5%) and 101 (26.9%) student
respectively. The lowest response was from IIUM where only 42 (11.2%)
students participated in answering the questionnaire. The rest were 55
(14.7%) student from UKM and 59 (15.7%) from UM. From the data it
was calculated that the female respondent, 277 (73.9 %) who were
30
participated in this study are more than male, 98 (26.1%) respondent. The
ratio is about 3:1.
4.1.1.2. Age
Table 4.1: Table of number of respondent in respective age
Age 21 22 23 24 25 26 27 Missing
data
Frequency 28 229 75 23 5 4 1 10
Percentage, % 7.5 61.1 20.0 61.1 1.3 1.1 0.3 2.7
Based on the analysed data majority of the respondents were at the age of
22 years old. The older respondent was 27 years old (1 student) and the
younger was at 21 years old (28 students). However there are 10 missing
data and thus the age of those respondents was undetermined.
4.1.1.3. Race
Table 4.2: Frequency of race in respective university

University UiTM UKM USM IIUM UM Total
Race
Malay 100 30 75 42 29 276
(99.0%) (54.5 %) (63.6 %) (100 %) (49.2 %) (73.6%)
Chinese 25 36 27 88
(45.5 %) (30.5 %) (45.8 %) (23.5%)
India 5 1 6
(4.2 %) (1.7 %) (1.6 %)
Kadazan 2 1 3
(1.7 %) (1.7 %) (0.8%)
Iban 0
(0 %)
Others 1 1 2
(1.0 %) (1.7 %) (0.5 %)
Total 101 55 118 42 59 375
31
The respondents who were participated in this research are mostly Malay students
with 276 students out of 375 respondents and it is represented about 73.6% of total
respondent. This value is mainly contributed by UiTM and USM with 100 and 75
Malay respondents respectively.
Chinese is the second highest race who was participated in this study with 88 or
23.5% out of total respondent. There was no Chinese found in UiTM and IIUM.
These Chinese are mostly from USM, 75 students. The other 62 Chinese students
were from UKM with 25 and 27 students respectively.
There were only 6 (1.6%) Indian can be found. 5 were from USM and another 1
person was from UM. Only 3 respondents are Kadazans and it is representing 0.8%
of total race. One other race (0.5%) is in UiTM and UM with 1 student each
university. There was no Iban respondents found in this study.
32
4.1.1.4. Religion
Table 4.3: Number of respondents in each university relative to religion

University UiTM UKM USM IIUM UM Total
Religion
Islam 101 30 75 42 29 277
(100%) (54.5%) (63.0%) (100%) (49.2%) (73.9%)
Christian 7 9 3 19
(12.7%) (7.6%) (5.1%) (5.1%)
Buddhist 18 28 23 69
(32.7%) (23.7%) (39.0%) (18.4%)
Others 6 4 10
(5.1%) (6.8%) (2.7%)
Total 101 55 118 42 59 375
Based on the analysed data, 277 (73.9%) of the participated subjects are
Muslim. More than half of the total subjects are Muslim. Subjects from
UiTM and IIUM are all Muslim.
Buddhist respondents were found more than the Christian. 69 subjects
which are 18.4% of total respondents are Buddhist. 28 were from USM, 23
from UM and the other 18 students were from UKM.
Christian respondents are highest in USM which is 9 students and this
represents 7.6 % of total USM subjects. 5.1 % of 357 respondents are
Christian. Other Christian subjects can be found in UM and UKM. 7
subjects from UKM and another 3 are from UM.
33
Other religions also participated in completing the questionnaire. There are
2.7 % of subjects which is 10 students with religion other than stated
above. They were 6 and 4 students from USM and UM respectively. The
religion that can be identified is Hindu since the respondents stated in the
questionnaire.
Most of the subjects were from Matriculation which is 69.1 % out of total
respondents or 259 out of 375 respondents. 65 subjects were from
Foundation and 34 from Diploma. Only 9 subjects were from STPM.
34
4.1.2. Frequency
4.1.2.1. General knowledge on antibiotic
Table 4.4: Frequency of answers on general knowledge on antibiotic

Question Right wrong/ Not
answer unsure answered
(%) answer (%)
(%)
1. Most of antibiotics effective against 1 or 2 bacteria. 233 140 2
(62.1) (37.5) (0.5)
2. All oral antibiotics should be taken during empty 268 107 0
stomach. (71.5) ( 28.5) (0.0)
3. Many antibiotics are also antiviral. 304 69 2
(81.1) (18.4) (0.5)
4. Antibiotic is drug of choice for common cold. 275 98 2
(73.3) (26.1) (0.5)
5. Antibiotics should be prescribed by doctors. 335 35 5
(89.3) (9.3) (1.3)
6. You don’t have to continue taking antibiotics once 332 42 1

infections are gone. (88.5) (11.2) (0.3)
7. Antibiotic resistance associated with frequent use of 327 46 2

antibiotic. (87.2) (12.3) (0.5)
8. In most cases antibiotic should be taken more than 2 152 220 3
weeks to prevent relapse. (40.5) (58.7) (0.8)
9. If diarrhea occurs, stop antibiotic immediately. 126 246 3
(33.6) (65.6) (0.8)
10. Dose of antibiotics used depends on the site of severity of 27 348 0
the infection. (7.2) (92.8) (0.0)
Part 2 is used to assess general knowledge of students on antibiotics. Most subjects
answered the questions correctly. Majority of respondents know what antibiotic is
and they can differentiate between bacterial caused infection and viral caused
infection. Majority of subject got confused on the statement “Dose of antibiotics used
depends on the site of severity of the infection”. It is actually the route of
administration that correlates with the site of infection (Lim, n.d.).
35
For the duration of course of antibiotic treatment, the duration is depends on the type
of infection certain patient is having. The optimum duration of antibiotic treatment is
unknown. Some infection can resolve with short course of treatment but some may
require longer antibiotic treatment. For example, minimum treatment duration for
Tuberculosis is 4 – 6 months while Endocarditis and Osteomylitis only require
4weeks course of treatment (Lim, n.d.). However 58.7 % subjects agreed antibiotic
treatment of more than 2 weeks able to prevent relapse.
Most respondent choose to stop taking antibiotic if they experience diarrhea.
However it is important to inform the doctor and let them decide. In certain cases,
diarrhea can resolve if course of antibiotic is completed. In other cases the doctor
might decide to change to other antibiotic (Tresca, 2012).
36
4.1.2.2. General knowledge of specific antibiotic and the side effects
Table 4.5: Frequency of answer on General knowledge of specific antibiotic and the side effects

(%) answer (%)
(%)
1. Chloramphenicol is effective against MRSA 116 258 1

(30.9) (68.8) (0.3)
2. Tetracycline is drug of choice for a 7 years old child 232 140 3
with conjunctivitis. (61.9) ( 37.3) (0.8)
3. Patients who is penicillin-allergic, should avoided 169 202 4
receiving imipenem (45.1) (53.9) (1.1)
4. Aztreonam has a similar spectrum (coverage of 69 300 6
organism) as Ampicillin. (18.4) (80.0) (1.6)
5. Parenteral penicillin more appropriate than oral form 291 80 4
for critically ill patient. (77.6) (21.3) (1.1)
6. Majority patients do not develop serious side effects of 215 158 2

antibiotics (57.3) (42.1) (0.5)
7. Nausea and diarrhea are common side effects of 289 83 3

antibiotics.. (77.1) (22.1) (0.8)
8. Cephalexin and Erythromycin can cause 102 266 7
pseudomembranous colitis. (27.2) (70.9) (1.9)
9. Erythromycin can cause discoloration of teeth in 55 317 3
children below 8 years old. (14.7) (84.5) (0.8)
10. Vancomycin can cause Redman syndrome 213 161 1
(56.8) (42.9) (0.3)
This part is to test on general knowledge of specific antibiotic and the side effects.
Based on the analyses data, majority of the subjects gave wrong answers to question
1, 3, 4, 8 and 9. 68.8% and 53.9 % answered “no” to question 1 and 3 respectively.
Many subjects do not know Chloramphenicol is effective in treatment of Methicillin
Resistant Staphylococcus Aureus (MRSA). Early treatment with chloramphenicol
may shorten hospital stay and may prevent emergence of Vancomycin Resistant
Staphylococcus Aureus (VRSA) (Kaleem et al., 2010).
37
300 respondents answered Aztreonam having same spectrum as Ampicillin which is
not true. Aztreonam do not have activity against gram negative organism while
Ampicillin is able to cover some gram positive organism (Chanu Rhee, 2011).
Both Cephalexin and Erythromycin may cause pseudomembraneous colitis (“Axcel
Erythromycin,” n.d., “cefalexin Drug Information,” n.d.). However 266 out of 375
respondents were unable to answer the question correctly. Only 55 respondents know
Tetracycline may cause discoloration of teeth in children below 8 years old.
Tetracycline 61.9% subjects agree Tetracycline is a drug of choice in children with
conjunctivitis at age of 7 years. The other 37.3 % did not agree with that statement.
Besides that 291 respondent answered perenteral Penicillin is better than oral form in
critically ill patient. Only 80 subjects said no. majority of subjects, 57.3 % agree the
common side effects of antibiotics are nausea and diarrhea. 213 or 56.8% of total
respondents agree Vancomycin may cause Redman Syndrome.
38
4.1.2.3. Knowledge on halalness of antibiotic and halal concept
Table 4.6: Frequency of answer on knowledge on halalness of antibiotic and halal concept
(%) answer (%)
(%)
1. Pamecil® (Ampicillin capsule) is lawful for Muslim 10 316 49
(2.7) (84.3) (13.1)
2. Augmentin® tablet ( Amoxicillin + Clavulanic Acid) 164 166 45
is haram for Muslim (43.7) (44.3) (12.0)
3. Muslim patient may take Meronem® IV injection/ 122 204 49
infusion (Meropenem) (32.5) (54.4) (13.1)
4. Magnesium stearate is a halal pharmaceutical 15 315 45
ingredient (4.0) (84.0) (12.0)
5. Methylhydroxypropyl methycellulose is masbooh 39 288 48
(10.4) (76.8) (12.8)
6. Sodium Metabisulphite prohibited for Muslim 46 277 52

(12.3) (73.9) (13.9)
7. Muslim may take masbooh antibiotic for life saving 182 147 46
purposes even if alternative is available (48.5) (39.2) (12.3)
8. The use of antibiotic should be stopped if it is 196 132 47
haram, if no alternative is available (52.3) (35.2) (12.5)
9. Product that use parts of animals (skin, bone) that is 203 126 46
slaughtered not in the name of Allah is permitted for (54.1) (33.6) (12.3)
Muslim
10. Concept of halal/haram/mushbooh is applicable to 166 161 48
non-ingested products (cream, nasal spray) (44.3) (42.9) (12.8)
Questions in part 4 are regarding knowledge on halalness of antibiotic and halal
concept. In this part, there are a lot if missing values. More than 10 % missing value
can be seen in each question. This is maybe due to majority of non Muslims who do
not know about the halal concept. Thus they skip and left this part unanswered.
39
Based on the table, majority of the respondents did not know the status of antibiotic
and also the raw materials used in the formulation. Only 2.7% and 4.0% subjects
know Ampicillin and Magnesium Stearate are both mashbooh. 84.3% and 84.0 % of
subjects gave wrong answer to question 2 and 4 respectively.
288 students do not know Methylhydroxypropyl Methycellulose is permissible for
Muslim and only 12.3% out of 375 respondents know Sodium Metabisulphite is
halal and can be taken by Muslim patient.
For the part of halal concept, about half of respondents can answer the questions
correctly. 182 subjects said “no” to this statement “Muslim may take masbooh
antibiotic for life saving purposes even if alternative is available” and another 147
agree with this statement. 52.3 % respondent does not agree the use of non halal
antibiotic should be stopped if there is no alternative available.
Only 203 students know anything that was derived from parts of animal that
slaughtered without the name of Allah is prohibited to Muslim. Another 126 subject
answered it is halal for Muslim.
40
Lastly, only 166 out of 375 respondents know the halal concept is also
applicable to non ingested product like cream and nasal spray.
4.1.2.4. Perception and opinion on usage and status of antibiotic
Table 4.7: Frequency of answer on perception and opinion on usage and status of antibiotic
Question Good Poor Not

perception perception answered
(%) (%) (%)
1. Halal antibiotic should be prescribed to Muslim 307 28 40
patients (81.9) (7.5) (10.7)
2. Muslim may take haram antibiotic for severe illness 63 271 41
even if it’s effectiveness is doubtful. (16.8) (72.3) (10.9)
3. Pharmacists (both Muslims and non Muslims) should 321 14 40
respect patient’s religion, thus they should aware (85.6) (3.7) (10.7)
about the issue of halal/haram in medicines.
4. Pharmacist should inform prescriber regarding status 301 34 40
of non halal antibiotic prescribed to Muslim patient. (80.3) (9.1) (10.7)
5. All muslim healthcare practitioners should have deep 297 38 40
knowledge on the halal concept. (79.2) (10.1) (10.7)
6. Non-Muslim pharmacist/health care professionals 297 37 41

should also be exposed with the concept of halal and (79.2) (9.9) (10.9)
haram
7. Syllabus on antibiotic should be introduced to all level 303 32 40
of pharmacy students (80.8) (8.5) (10.7)
8. Antibiotics syllabus give a positive impact on 302 33 40
pharmacy students (80.5) (8.8) (10.7)
9. Pharmacy courses should be included a syllabus on 258 77 40
halal and haram status of medications. (68.8) (20.5) (10.7)
10. Reference books on halal medication are needed in 258 77 40
teaching and learning. (68.8) (20.5) (10.7)
Basically majority of the respondent have good perception towards usage
and status of antibiotic. Only for question 2, most of the subjects have poor
perception toward the statement: “Muslim may take haram antibiotic for
severe illness even if its effectiveness is doubtful”. 271 subjects agree
41
Muslims may take haram antibiotic even though the effectiveness is
doubtful.
Most of respondents agree syllabus on antibiotic should be introduced to
all level of pharmacy students and the reference books on halal medication
are needed in teaching and learning in pharmacy teaching school.
4.1.3. Association between demographic data with levels
4.1.3.1. Association between demographic data with levels of
knowledge on antibiotic.
Table 4.8: Association between gender and knowledge on antibiotic
Level of Knowledge
Total p-value
Poor Good
Gender Male Count, n 36 53 89 0.845
(%) (27.1) (26.1) (100.0)
Female Count, n 97 150 247
(%) (72.9) (73.9) (100.0)
Total Count, n 133 203 336
(%) (39.59) (60.42) (100.0)
42
Table 4.9: Association between university and knowledge on antibiotic
Level of Knowledge
Total p-value
Poor Good
University UiTM Count, n 37 55 92 0.183
(%) (40.2) (59.8) (100.0)
UKM Count, n 21 22 43
(%) (48.8) (51.2) (100.0)
USM Count, n 37 10 107
(%) (34.6) (65.4) (100.0)
IIUM Count,n 11 27 38
(%) (28.9) (71.1) (100.0)
UM Count,n 27 29 56
(%) (48.2) (51.8) (100.0)
(%) (39.6) (60.4) (100.0)
Table 4.10: Association between religion and knowledge on antibiotic
Level of Knowledge
Total p-value
Poor Good
Religion Islam Count, n 104 142 246 0.367
(%) (42.3) (57.7) (100.0)
Christian Count, n 5 12 17
(%) (29.4) (70.6) (100.0)
Buddhist Count, n 20 43 63
(%) (31.7) (68.3) (100.0)
Others Count,n 4 6 10
(%) (40.0) (60.0) (100.0)
(%) (39.6) (60.4) (100.0)
43
Table 4.11: Association between previous education and knowledge on antibiotic
Level of
Knowledge Total p-value
Poor Good
Previous Matriculation Count, n 0.536
96 135 231
education
(%) (41.6) (58.4) (100.0)
Foundation Count, n 20 39 59
(%) (33.9) (66.1) (100.0)
Diploma Count, n 13 18 31
(%) (41.9) (58.1) (100.0)
STPM Count,n 1 6 7
(%) (14.3) (85.7) (100.0)
(%) (39.6) (60.4) (100.0)
Table 4.12: Association between race and knowledge on antibiotic
Level of Knowledge
Total p-value
Poor Good
Race Malay Count, n 104 141 245 0.493
(%) (31.0) (42.0) (100.0)
Chinese Count, n 25 55 80
(%) (7.4) (16.4) (100.0)
India Count, n 2 4 6
(%) (0.6) (1.2) (100.0)
Kadazan Count,n 1 2 3
(%) (0.3) (0.6) (100.0)
(%) (50.0) (50.0) (100.0)
(%) (39.6) (60.4) (100.0)
Based on above results, I found no significant difference between all
demographic data (gender, university, race, religion and previous
education) and respondents’ knowledge on antibiotic.
44
knowledge on halalness of antibiotic and halal concept.
Table 4.13: Association between gender and knowledge halalness of antibioric and halal concept
Level of Knowledge
Total p-value
Poor Good
(%) (80.6) (19.4) (100.0)
(%) (82.8) (17.8) (100.0)
(%) (81.9) (18.1) (100.0)
Table 4.14: Association between university and knowledge halalness of antibioric and halal concept
Level of Knowledge
Total p-value
Poor Good
(%) (79.3) (20.7) (100.0)
(%) (80.1) (11.9) (100.0)
(%) (84.1) (15.9) (100.0)
IIUM Count,n 23 10 33
(%) (60.6) (39.4) (100.0)
UM Count,n 28 4 32
(%) (87.5) (12.5) (100.0)
(%) (81.9) (18.1) (100.0)
45
Table 4.15: Association between religion and knowledge halalness of antibioric and halal concept
Level of Knowledge
Total p-value
Poor Good
(%) (80.4) (19.6) (100.0)
(%) (66.7) (33.3) (100.0)
(%) (97.0) (3.0) (100.0)
(%) (75.0) (25.0) (100.0)
(%) (81.9) (18.1) (100.0)
Table 4.16: Association between previous education and knowledge halalness of antibioric and halal
concept
Level of Knowledge
Total p-value
Poor Good
Previous Matriculation Count, n 0.073
159 25 184
education
(%) (86.4) (13.6) (100.0)
(%) (72.2) (27.8) (100.0)
(%) (75.0) (25.0) (100.0)
STPM Count,n 3 2 5
(%) (60.0) (40.0) (100.0)
(%) (81.9) (18.1) (100.0)
46
Table 4.17: Association between race and knowledge halalness of antibioric and halal concept
Level of Knowledge
Total p-value
Poor Good
(%) (80.3) (19.7) (100.0)
Chinese Count, n 37 5 42
(%) (88.1) (11.9) (100.0)
(%) (100.0) (100.0) (100.0)
(%) (100.0) (0.0) (100.0)
(%) (100.0) (0.0) (100.0)
(%) (62.6) (37.4) (100.0)
Based on above results, I also found no significant difference between
demographic data (gender, university, race, religion and previous
education) and subjects’ knowledge on status of antibiotic asked.
More than half or 50% of total subject have poor knowledge on the status
of antibiotic and their raw material. Majority of students also have poor
knowledge on halal concept. For the non Muslim who do not have
knowledge concept of halal, they can skip this part. Thus the value
obtained here are from subjects who claims know the concept of halal.
47
perception on usage and status of antibiotic.
Table 4.18: Association between gender and level of perception on usage and status of antibiotic
Level of Knowledge
Total p-value
Poor Good
(%) (8.5) (91.5) (100.0)
(%) (8.1) (91.9) (100.0)
(%) (8.2) (91.9) (100.0)
Table 4.19: Association between university and level of perception on usage and status of antibiotic
Level of Knowledge
Total p-value
Poor Good
(%) (1.0) (99.0) (100.0)
(%) (13.7) (86.3) (100.0)
(%) (6.9) (93.1) (100.0)
IIUM Count,n 0 4 4
(%) (0.0) (100.0) (100.0)
UM Count,n 11 46 57
(%) (19.3) (80.7) (100.0)
(%) (8.2) (91.8) (100.0)
Table 4.20: Association between religion and level of perception on usage and status of antibiotic
Level of Knowledge
Total p-value
Poor Good
(%) (1.7) (98.3) (100.0)
(%) (18.8) (81.2) (100.0)
(%) (26.1) (73.9) (100.0)
(%) (25.0) (75.0) (100.0)
(%) (8.2) (91.8) (100.0)
48
Table 4.21: Association between previous education and level of perception on usage and status of
antibiotic
Level of Knowledge
Total p-value
Poor Good
Previous education Matriculation Count, n 24 215 239 0.175
(%) (10.0) (90.0) (100.0)
(%) (0.0) (100.0) (100.0)
(%) (2.9) (97.1) (100.0)
STPM Count,n 1 8 9
(%) (11.1) (88.9) (100.0)
(%) (8.2) (91.8) (100.0)
Table 4.22: Association between race and level of perception on usage and status of antibiotic
Level of Knowledge
Total p-value
Poor Good
(%) (1.7) (98.3) (100.0)
Chines Count, n 20 64 84
(%) (23.8) (76.2) (100.0)
(%) (20.0) (80.0) (100.0)
(%) (33.3) (66.7) (100.0)
(%) (50.0) (50.0) (100.0)
(%) (8.2) (91.8) (100.0)
Research done found significant difference between university, race and
religion on students’ perception on level of perception on usage and status
of antibiotic.
49
4.1.3.4. Summarization of result
Table 4.23: Summarization of overall result
N= 375 Poor Good

Knowledge on :
General antibiotic 94 (25.1%) 262 (69.9%)
Specific antibiotic 213 (56.8%) 127 (33.9%)
Overall knowledge on (general antibiotic + specific antibiotic) 133 (35.5%) 203 (54.1%)
Halal :
Knowledge 230 (61.3%) 51 (13.6%)
Perception 27 (7.2%) 302 (80.5%)
50
Table 4.24: Association between demographic data and pharmacy students’ knowledge on antibiotic
N= 375 Item Poor Good P value
Gender vs overall Male 36 (40.4%) 53 (59.6%) 0.845
Female 97 (39.3%) 150 (60.7%)
University vs UiTM 37 (40.2%) 55 (59.8%) 0.183

overall
UKM 21 (48.8%) 22 (51.2%)
USM 37 (34.6%) 70 (65.4%)
IIUM 11 (28.9%) 27 (71.1%)
UM 27 (48.2%) 29 (51.8%)
Race vs overall Malay 104 (42.4%) 141 (57.6%) 0.493
Chinese 25 (31.2%) 55 (68.8%)
India 2 (33.3%) 4 (66.7%)
Kadazan 1 (33.3%) 2 (66.7%)
Others 1 (50.0%) 1 (50.0%)
Religion vs Islam 104 (42.3%) 142 (57.7%) 0.376

overall
Christian 5 (29.4%) 12 (70.6%)
Buddhism 20 (31.7%) 43 (68.3%)
Others 4 (40.0%) 6 (60.0%)
Previous Matriculation 96 (41.6%) 135 (58.4%) 0.536

education vs
overall Foundation 20 (33.0%) 39 (66.1%)
Diploma 13 (41.9%) 18 (58.1%)
STPM 1 (14.3%) 6 (85.7%)
51
Table 4.25: Association between demographic data and pharmacy students’ knowledge on status of
medication (antibiotic)
Gender vs halal Male 54 (80.6%) 13 (19.4%) 0.760
knowledge
Female 176 (82.2%) 38 (17.8%)

halal knowledge
UKM 37 (88.1%) 5 (11.9%)
USM 69 (84.1%) 13 (15.9%)
IIUM 23 (69.7%) 10 (30.3%)
UM 28 (87.5%) 4 (12.5%)
Race vs halal Malay 188 (80.3%) 46 (19.7%) 0.632

knowledge
Chinese 37 (88.1%) 5 (11.9%)
India 2 (100.0%) 0 (0.00%)
Kadazan 1 (100.0%) 0 (0.00%)
Others 2 (100.0%) 0 (0.00%)
Religion vs halal Islam 189 (80.4%) 46 (19.6%) 0.074

knowledge
Christian 6 (66.7%) 3 (33.3%)
Buddhism 32 (97.0%) 1 (3.00%)
Others 3 (75.0%) 1 (25.0%)

education vs halal
knowledge Foundation 39 (72.2%) 15 (27.8%)
Diploma 24 (75.0%) 8 (25.0%)
STPM 3 (60.0%) 2 (40.0%)
52
Table 4.26: Association between demographic data and pharmacy students perception on halal
medication issues
Gender vs Male 7 (8.5%) 75 (91.5%) 0.900
perception
Female 20 (8.1%) 227 (91.9%)

perception
UKM 7 (13.7%) 44 (86.3%)
USM 8 (6.90%) 108 (93.1%)
IIUM 0 (0.00%) 4 (100.0%)
UM 11 (19.3%) 46 (80.7%)
Race vs Malay 4 (1.7%) 231 (98.3%) 0.000

perception
Chinese 20 (23.8%) 64 (76.2%)
India 1 (20.0%) 4 (80.0%)
Kadazan 1 (33.3%) 2 (66.7%)
Others 1 (50.0%) 1 (50.0%)
Religion vs Islam 4 (1.7%) 232 (98.3%) 0.000

perception
Christian 3 (18.8%) 13 (81.2%)
Buddhism 18 (26.1%) 51 (73.9%)
Others 2 (25.0%) 6 (75.0%)

education vs
perception Foundation 0 (0.00%) 40(100.0%)
Diploma 1 (2.90%) 33 (97.1%)
STPM 1 (11.1%) 8 (88.9%)
53
4.1.4. Analysis of open ended question.
Generally for question 1: “what would you suggest to improve efficiency of antibiotic
teaching program”, most of subjects suggest encouraging and exposing students to
more real case situations that are related to antibiotic in hospital. Tutorials, case
based learning and hospital attachment or practical should be more emphasizes on
antibiotic cases. Some of the respondents also suggest to lengthen teaching time in
order to improve the efficiency of antibiotic teaching program. Apart from that there
are also suggestion to include antibiotic subject in syllabus and transforms the
antibiotic topic into a subject instead of as a subtopic. Some students give opinion,
the effectiveness of teaching/ guidance from lectured together with students’
initiatives may help for better efficiency in antibiotic teaching program.
Question 2 is asking about the possible methods and ways that might be used by
students in order to prescribe and dispense only halal medications to Muslim patient
when they work as pharmacist in the future. Some subjects suggest that adequate
knowledge and awareness on halal concept and status of medication is essential to
ensure dispensing of halal medication to Muslim patient.
Some respondents said the knowledge should always keep updated to access the
status of medication. Besides that, some answered the implementation of halal
guideline and having a database on status of medication are also good methods to
54
ensure Muslim patient in hospital provided with halal medication. However, there is
one negative opinion towards this question.
4.2. Result for objective two
4.2.1. Evaluation of antibiotics’ status
Table 4.27: status of antibiotic product
STATUS OF ANTIBIOTIC PRODUCT AMOUNT

Permissible (halal) 13
Mashbooh 12
Prohibited (haram) 10
Cannot be assessed 29
Total 64
64 leaflets collected from hospital. 29 products’ status cannot be assessed
and only 13 out of 64 products are halal. Assessment of the status showed
12 mashbooh antibiotic products, 10 prohibited products and 13 halal
antibiotic products. Apart from that the status of 29 out of 64 (45.31%)
antibiotic products cannot be assess. This is because either no data
available on origin of raw materials use or the excipients in formulation
are not listed in the antibiotic leaflet. This shows that the available data is
not enough to assess the medication status.
55
CHAPTER 5
DISCUSSION AND LIMITATION
5.1. Discussions on Result
Antibiotic is an important subject that should be mastered by each pharmacy student.
This is because pharmacist must play a big role in determining the most suitable and
effective antibiotic in treatment of infectious disease. Besides that, it is essential for
pharmacy students to know how to select the right antibiotic with regards to it route
of administration, dose and duration of treatment by application of evidence based
medicine (Hidayat, Patel, & Veltri, 2012). Therefore it is important for pharmacy
students to have good and adequate knowledge on antibiotic. However based on the
collected data and analysed result, most of student have poor knowledge on specific
antibiotic.
This research finding shows final year pharmacy students have poor knowledge on
specific antibiotic but good knowledge on general antibiotic. However most of them
have good knowledge on antibiotic. While for halal part, majority of subjects do not
know status of antibiotic asked but they have positive perception on halal medication
issues.
56
There is no significant difference can be seen between demographic data (gender,
university, race, religion and previous education) on students’ knowledge on
antibiotic. However, Elkami et.al in their study stated there is significant difference
between knowledge on pharmacovigilance of adverse drug reaction with university
the student belong to because different university have different curricular (Elkalmi
et al., 2011). This is because the syllabus of antibiotic in all 5 universities was taught
during second year of study. Thus, most students cannot remember what they have
studied. This situation is the same for all the university tested. That is why there is no
significant difference between the level of knowledge and university.
Some students suggested the topic of antibiotic should be converted into a subject
and should be teach in every semester. Thus students will have more exposure on
antibiotic lecture. Since more time will be allocated for teaching of antibiotic subject,
it will improve students understanding and will help them in memorizing the theory
and facts related to specific antibiotic.
Based on a study done by Gilligan et al, student who already done internship at
hospital or involved in handling cases regarding certain topic should have more
knowledge compared to one who do not undergo internship before (Gilligan,
Warholak, Murphy, Hines, & Malone, 2011). From this statement, students who are
previously from Diploma should be more knowledgeable since they already did their
practical in hospital compared to students who were graduated from Matriculation
and Foundation. However my research shown that level of knowledge of Diploma
57
student is the same as students form Foundation and Matriculation. This is because
antibiotic is too many to learn and to memorise and it was already 3 years since
Diploma students did their practical. Thus it is hard for them to memorise or they
did not really expose to dispensing of antibiotic during their internship period. These
finding can be supported by a study done for traditional medicine where the
researcher also revealed no significant different between knowledge of pharmacy
student and exposure to traditional/ complementary medicines (Jamal, Paraidathathu,
& Azmi, 2011). While research done by Jamal et al on 2011 also consistent with my
finding where there is no significant difference between previous education and
knowledge (Jamal et al., 2011).
Knowledge on antibiotic can be improved and retained by conducting an internship
session where students need to present cases to health care professionals. Gilligan et.
al. stated that this method may slightly improve knowledge retention among students.
Continuous Problem base learning method in each semester can also lead to better
knowledge level of student. A study stated the student’s performance in problem
based learning (PBL) sequence keep increasing from semester to semester (Dolder,
Olin, & Alston, 2012). Active learning method which includes critical thinking and
development of self directed learning in infectious disease helps increase in students
awareness on antibiotic resistance problem and educate on better evaluation of
literature regarding infectious disease (Hidayat et al., 2012).
58
The research findings can be supported by few statements from previous research.
For example a Shehadeh et al., 2012 and Ahmed, hassali, & aziz, 2009 also found no
significant difference between gender and knowledge in their research (Ahmed,
Hassali, & Aziz, 2009; Shehadeh et al., 2012). Eventhough their research does not
focus on knowledge of antibiotic but the finding is consistent with result obtained.
These research finding can be further supported by a study done by Borrego et al
where he found no significant difference between gender, race, religion and
education level on knowledge in his study (Borrego et al., 2006).
The analysed data shows significant difference between general knowledge on
antibiotic and race and religion. As reported by Ahmed et. al. different level of
knowledge can be seen in different race. For example Malay is knowledgeable in
some aspect of Human Immunodeficiency Virus (HIV) while Chinese shows better
knowledge in other aspect of HIV (Ahmed et al., 2009). It is shown that high number
of Muslim and Malay subject have good knowledge in this part. This is because the
number of Muslim and Malay subject is the highest when compared to other races
and religions. Other races other than Chinese, Indian and Kadazan and religions
other than Christian and Buddhist only have few students with good knowledge in
this part since very few of them participated in this study.
59
Almost all subjects in each university, race and religion have poor knowledge on the
status of antibiotic and chemical substances used for formulation of antibiotic.
No significant difference also found between religion and knowledge on halal
medication. Majority of subjets do not know status of antibiotic asked. Even though
Muslim respondents are supposed to know the status better compared to non-Muslim
respondents but since there is no available data on medication status, their knowledge
on medication status is the same regardless the religion. Reason to this situation is
because there is lack of information available regarding the status of pharmaceutical
product. Besides the available information such as website, books and so on are not
well established. Thus students do not know where and how to get access to the
information. Therefore they are not really exposed to the information related to
status of pharmaceutical product.
In addition the use of halal logo on pharmaceutical product is not allowed. Only
traditional product, dietary supplements and cosmetics are allowed to print halal logo
onto their labels (Drug Registration Guidance Document (Malaysia), 2010). This can
also be a limitation why students are not aware or recognise status of pharmaceutical
products available in the market or hospital.
60
Majority respondents have good perception and knowledgeon halal medication
issues. This is consistent with result form a research done in Pakistan where
Pakistani pharmacy student shows positive perception towards use of complementary
and alternative medicine (CAM) and most of them agreed they need to have good
knowledge on CAM as future pharmacist (Hussain et al., 2012). A study by Elkemi
et. al. also shows positive student’s perception on importance of pharmacovigilance
and its inclusion as a core subject in pharmacy program (Elkalmi et al., 2011).
Majority of respondents agreed that all the healthcare professional whether Muslim
or non- Muslim should aware of issues on halal/ haram medication and should
respect patient’s religion. Research done by Golnaz R. revealed non- muslim
countries have strong demand for halal product and many non- muslim populations
are also prone to buy and use halal product(Golnaz, Zainalabidin, Mad Nasir, &
Eddie Chiew, 2010). This situation can be the same for the demand for halal
pharmaceutical product.
Subject also showed positive response towards question on syllabus of antibiotic.
Mostly agreed syllabus of antibiotic should be introduced in all level of pharmacy
student. They also think reference books on medication status are needed in teaching.
This shows students from all university regardless the religions are aware and having
good perception on halal medication issues. However there is small portion of
respondent who objected the inclusion of antibiotic topic in every semester. This is
61
the same as the attitude of some pharmacist who do not interested to further their
study on traditional/ complementary medicine (Jamal et al., 2011).
Research finding shows significant difference between university, race and religion
on students’ perception on halal medication issues. This is consistent with a study
done by Golnaz. R. et al. Based on Golnaz R. study, there are still a lot of non-
Muslim especially in Malaysia which is a multiracial country who are not really
concerned on halal status of food consumed. Most of non- muslim also views the
halal concept as a religious perspective (Golnaz et al., 2010). This statement is
similar with my research where some of non- Muslim respondents said effectiveness
is more important than status of antibiotic or religious view.
For the second objective of study, there are 64 leaflets of antibiotic product that are
taken from Hospital Tuanku Jaafar, Seremban and Hospital Pulau Pinang. The
assessment is difficult to do since there is limited information available on product
leaflet.
The assessment of the status of antibiotic is done with referring to a database called
freepatentonline.net and books like Remington and Martindale. Raw materials that
are originated from unknown animal with unknown killing method are classified as
mashbooh. This means the status is uncertain relative to the uncertainty of the source
of material.
62
Products that classified as prohibited product due to manufacturing process involved
alcohol (ethanol) and raw material used in formulation originated from animal. Raw
materials that are produced by synthetic method or bioengineering method
considered as halal.
Products that are categorised as haram or prohibited to Muslim is due to involvement
of alcohol which referring to ethanol in their preparation process. For example
Cilastatin Sodium and Sorbitan Monooleate is categorised as haram since the
manufacturing process uses Ethanol.
For the mashbooh product, the manufacturing process involving use of substances
originated from animal such as fat, protein, amino acid, hormones and enzymes. This
is because the uncertainty of the slaughtering method used to kill the animal. If the
method is parallel to Islamic way, then the substances is considered halal. However
since I cannot determine the exact method used, I categorised the raw material as
mashbooh (doubtful status). Linezolid is assessed as mashbooh because the
involvement of amino acid in its preparation. It is the same as Imipenem. Ampicillin
is synthetically manufactured but it involved use of enzyme where the source of
enzyme is undetermined. Antibiotic product that categorised as mashbooh is
Amikacin Sulfate, Bactrim, Cefotaxime and Ceftazidime.
63
Raw materials that were produced by synthetic process or bioengineering process are
permissible for Muslim. Meropenem, and Azithromycin (Zithromax) are permissible
for Muslim. Sulperazone (Sulbactam), Rifampicin, Gentamicin (Garasent) and many
other cannot be assessed because list of excipients not available. The status can be
different depending on the dosage form and excipients used in the formulation of
product. For example Azithromycin itself is halal but different in excipient used may
produce Azithromycin with different status. Zithromax available in three forms:
powder for oral suspension, film –coated tablet and injection. Zithromax
(azithromycin) in injection form is halal but the other two forms are haram
depending on excipients used in formulation.
JAKIM for example should collaborate with Ministry Of Health to have access to the
ingredients used in formulation of pharmaceutical product. Last year on April 2011,
a committee involving standards Malaysia, JAKIM, The Ministry of Health (MOH)
and The Halal Industry Development Corporation (HDC) have launched halal
pharmaceutical standard. This standard is useful as a guideline for pharmaceutical
product manufacturer to be halal compliance in their production line starting with
preparation, processing, handling, packaging, storage until distribution of finished
product (“Malaysia introduces new Halal pharmaceuticals standard,” 2011). This can
be an inducer for development of more halal pharmaceutical product in the future.
There should be more pharmaceutical industry that is willing to manufacture halal
product as Chemical Company of Malaysia Berhad (CCM) which is a biggest halal
64
pharmaceutical manufacturer (“Malaysia Public listed company – Chemical
Company of Malaysia, Pharmaceuticals, Fertilizers Company,” n.d.)
The involvement of manufacturer to produce halal pharmaceutical brand will assist
in public or consumer recognition of halal product. For example we can easily say
the CCM products are halal since they are following halal pharmaceutical standard
and it is the leading of halal pharmaceutical in Malaysia (CCM website, 2012;
Abdul Shatar L. A., 2010)
5.2. Limitation
1. Time and feedback from respondents
Duration provided to finish this final year project is two semesters. However that
period is not enough to finish this research. Quite long time required to construct the
questionnaire and another long time more required for distribution of questionnaire. I
initially distributed the questionnaire through social networking site like emailing to
respondents through Facebook and Yahoo email. However the feedback from
respondents was really bad since they have no time to spend on completing the
questionnaire online. Plus some of respondents do not have internet connection
which further limits the feedback. Besides that, some universities were doing hospital
attachment during that time. Therefore they were busy with their academic program.
65
After 3 weeks waiting for online feedback, I decided to proceed with distribution of
questionnaire through co- supervisors from each university. However this method
also took quite some time to recollect back the questionnaire. It took about 1 month
for the posting of questionnaire to co- supervisors, distribution of questionnaires to
final year students and the collection of questionnaire by postage.
Total time used for distribution of questionnaire is 3 months, starting from second
week of September until first week of December. Thus, limited time left to key in all
data in the Statistical Package for the Social Sciences (SPSS), the analysis of data
and thesis writing.
2. Assessment of status and perception
Limitation for assessment of antibiotic status is lack of available information.
Manufacturer of pharmaceutical product did not reveal their formulation in product
leaflet due to confidentiality purposes. The assessment done by using of some
references that is available during period of study.
The problem faced during assessment of students’ perception on status and usage of
antibiotic is missing data from IIUM. This is because of problem on the printed
questionnaire where questions on Part 5 are not printed and it is not distributed to
respondents. Thus data from IIUM on that part is inadequate. Only 4 subjects out of
66
42 IIUM students have question on part 5 printed on their questionnaire form. All 4
of them have good perception towards use of halal antibiotic in Muslim patient.
3. Knowledge and perception
The finding of this research is highly related to the questionnaire used. Level of
knowledge and perception (good or poor) is based on researcher’s perception on
basic knowledge and perception that a pharmacy student should have. Questionnaire
used may not cover parts of knowledge of some student. Thus the level of knowledge
of that student ranked as poor. Besides that, this finding is not applicable or valid in
foreign country since different country has different trade name of antibiotic. The
finding also does not reflect the level of knowledge and perception of all pharmacy
students in Malaysia since the number of sample taken is too small to compare to all
Malaysia’s pharmacy student.
67
CHAPTER 6
CONCLUSION
General knowledge on antibiotic falls in good category regardless the university,
religion, race and previous education but knowledge for specific antibiotic and side
effects is poor. The knowledge on halal status of antibiotic and raw material is also
poor. Even though Muslim respondents are supposed to know the status better
compared to non-Muslim respondents. Majority of total subjects (almost 90%) have
agreed that pharmacist should provide information on halal status of medication, and
dispense halal medications to Muslim patients and also to highlighted halal
medication issue in the pharmacy academic curriculum.
Subjects’ knowledge on antibiotic and their perception and knowledge on usage of
halal antibiotic is good and this proved that the proposed hypotheses for this
research “Most of pharmacy student have sufficient knowledge on antibiotics and
adequate knowledge and perception on halal medication issues specifically on
antibiotic” is acceptable.
About one third of the antibiotic products categorized as halal, impermissible or
prohibited and mushbooh respectively. However not all status of antibiotics can be
identified since lack of information on excipents and the information on origin of raw
material cannot be determined. In the same time the available data on medication
68
formulation is limited. Thus it is hard to do the assessment of status. Cooperation
from drug manufacturers and support from government may improve achievement
toward halal medications in Malaysia. It would be easier if there is a formal
institution which has permission to have all formulations form manufacturer of
pharmaceutical product and responsible to assess the halal status of pharmaceutical
product that are available in the market for the sake of Muslim patient and customer.
69
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78
APPENDICES
APPENDIX A
FUTURE PHARMACIST KNOWLEDGE ON ANTIBIOTIC AND THEIR

PERCEPTION AND KNOWLEDGE ON HALAL MEDICATION ISSUES
SPECIFICALLY ON ANTIBIOTIC
Dear respondent,
I am a fourth year student of Bachelor of Pharmacy , UiTM Puncak Alam. I

am currently conducting a research to fulfil the requirement of final year project in a
research course (PHR 555 and PHR 556). So, in related to that, I currently
conducting a research study which will include final year pharmacy student from five
universities: UiTM, UKM, UM, USM and UIAM. The main objective for this study
is to determine level of knowledge of final year pharmacy students on antibiotic and
to evaluate their knowledge and perception on halal medication issues specifically on
antibiotic. Hence your participation in this study by answering the questionnaire is
greatly welcomed and highly appreciated. All the information is keep confidential
and will not be revealed and it will only be used for research and educational
purpose.
Saya adalah pelajar tahun empat dari Sarjana Muda Farmasi UiTM Puncak
Alam sedang menjalankan satu kajian bagi memenuhi keperluan projek tahun akhir
untuk kursus penyelidikan (PHR 555 and PHR 556). Sehubungan dengan itu, saya
menjalankan satu kajian yang mana akan melibatkan pelajar- pelajar farmasi dari
tahun akhir daripada lima buah universiti: UiTM, UKM, UM, USM and UIAM.
Objektif bagi kajian ini adalah untuk mengkaji tahap pengetahuan pelajar- pelajar
farmasi tahun akhir berkaitan dengan antibiotik dan tahap pengetahuan dan
persepsi mereka terhadap isu ubat- ubatan halal terutamanya antibiotik.
Sehubungan dengan itu, kesudian tuan/ puan untuk mengisi borang kaji selidik ini
amatlah dialu- alukan dan sangatlah dihargai. Segala maklumat adalah sulit dan
tidak akan didedahkan dan ia hanya akan digunakan untuk tujuan penyelidikan dan
pembelajaran sahaja.
Hereby I:
1. understand that my participation is voluntary and that I
am free to withdraw at any time, without giving reason yes/no
2. agree to take part in the above study yes/no
I admit that all the information given is true and I allow the information to be shared with whoever related
to the research study (academician) for the purpose of education. I also allow the data to be analysing for
conclusion of the research.
Saya dengan ini:
1. Memahami bahawa penglibatan dalam kajian ini adalah secara ya/tidak
sukarela dan berhak menarik diri pada bila- bila masa tanpa
mengemukakan alasan
2. Bersetuju untuk melibatkan diri di dalam kajian ini ya/tidak
Saya mengaku bahawa segala maklumat yang diberikan adalah benar dan saya membenarkan ia dikongsi
dengan orang- orang yang berkaitan (ahli akademik) untuk tujuan pembelajaran. Saya juga membenarkan
data ini dianalisa sebagai kesimpulan untuk kajian ini.
--------------------------------------------- -------------------- -----------------------

Name of participant date signature
79
--------------------------------------------- -------------------- ------------------------
Name of witness/investigator date signature
FUTURE PHARMACIST KNOWLEDGE ON ANTIBIOTICS AND
PERCEPTION ON HALAL MEDICATION
This survey is conducted to evaluate the knowledge on antibiotic products

among final year pharmacy students in five different universities in Malaysia and to
measure their perception on halal haram medication issues specifically on antibiotic
products.
PART 1: Demographic
1. University : UiTM UKM USM UIAM UM
2. Gender : Male Female
3. Age : _________
4. Race : Malay Chinese India Kadazan Iban
Others
5. Religions : Islam Christian Buddhist Others
6. cGPA : 1.0-2.0 2.1-3.0 3.1-4.0
7. Previous education: Matriculation Foundation Diploma
PART 2: General knowledge on antibiotic

Please tick √ one appropriate answer the following questions:
Statement ( Questions ) YES NO UNSURE
1. Most of antibiotics effective against 1 or 2 bacteria
2. All oral antibiotics should be taken during empty stomach.
3. Many antibiotics are also antiviral
4. Antibiotic is drug of choice for common cold.
5. Antibiotics should only be prescribed by doctors
6. You don’t have to continue taking antibiotics once
infections are gone.
7. Antibiotic resistance associated with frequent used of
antibiotic
8. In most cases antibiotic should be taken more than 2 weeks
to prevent relapse.
9. If diarrhea occurs stop antibiotic use immediately.
10. Dose of antibiotics used depends on the site and severity
of the infection.
80
PART 3: General knowledge of specific antibiotic and the side effects.
TRUE FALSE UNSURE

1. Chloramphenicol is effective against MRSA
2. Tetracycline is drug of choice for a 7 years old child
with conjunctivitis.
3. Patients who is penicillin-allergic, should avoided
receiving imipenem
4. Aztreonam has a similar spectrum (coverage of
organism) as Ampicillin.
5. Parenteral penicillin more appropriate than oral form
for critically ill patient
6. Majority patients do not develop serious side effects
of antibiotics
7. Nausea and diarrhea are common side effects of
antibiotics.
8. Cephalexin and Erythromycin can cause
pseudomembranous colitis.
9. Erythromycin can cause discoloration of teeth in
children below 8 years old.
10. Vancomycin can cause Redman syndrome
PART 4: Knowledge on halalness of antibiotic and halal concept.

For non-muslim who do not know about concept of halal, please skip this part.
YES NO UNSUR
E
1. Pamecil® (Ampicillin capsule) is lawful for Muslim
2. Augmentin® tablet ( Amoxicillin + Clavulanic Acid) is
haram for Muslim
3. Muslim patient may take Meronem® IV injection/ infusion
(Meropenem)
4. Magnesium stearate is a halal pharmaceutical ingredient
5. Methylhydroxypropyl methycellulose is masbooh
Masbooh = status of substance is doubtful or questionable.
6. Sodium Metabisulphite prohibited for Muslim
7. Muslim may take masbooh antibiotic for life saving
purposes even if alternative is available
8. The use of antibiotic should be stopped if it is haram, if no
alternative is available
9. Product that use parts of animals (skin, bone) that is
slaughtered not in the name of Allah is permitted for
Muslim
10. Concept of halal/haram/mushbooh is applicable to non-
ingested products (cream, nasal spray)
81
PART 5: perceptions and opinion on usage and status of antibiotic
Please tick suitable answer. 1(strongly disagree), 2(disagree), 3(mixed), 4 (agree),
5(strongly agree)
1 2 3 4 5
1. Only halal antibiotic should be prescribed to Muslim patients
2. Muslim may take haram antibiotic for severe illness even if it’s
effectiveness is doubtful.
3. Pharmacists (both Muslims and non Muslims) should respect
patient’s religion, thus they should aware about the issue of
halal/haram in medicines.
4. Pharmacist should inform prescriber regarding status of non halal
antibiotic prescribed to Muslim patient.
5. All muslim healthcare practitioners should have deep knowledge
on the halal concept.
6. Non-Muslim pharmacist/health care professionals should also be
exposed with the concept of halal and haram
7. Syllabus on antibiotic should be introduced to all level of
pharmacy students
8. Antibiotics syllabus give a positive impact on pharmacy students
9. Pharmacy courses should be included a syllabus on halal and
haram status of medications.
10. Reference books on halal medication are needed in teaching and
learning.
What would you suggest to improve the efficiency of antibiotic teaching program?
As a future pharmacist, how can you ensure Muslim patients in hospital are provided
with halal medication?
____________________________________________________________________
~  Thank you for your cooperation  ~
82
APPENDIX B
Application letter to USM
Tarikh: 2 Oct, 2012

Kepada:
Dekan,
Pusat Pengajian Sains Farmasi,
University Sains Malaysia (USM),
11800, Penang, Malaysia
Yg Berbhg Prof,
Per: Memohon Kebenaran Mengedar Borang Kaji Selidik ‘Future pharmacist

knowledge on antibiotic and their perception and knowledge on halal
medication issues’
Behubung perkara di atas,

Saya adalah sebagai penyelia pelajar dan maklumat seperti di bawah:
Nama: Nurul Fhariha Bt Kamarudin
No. Matrik: 2009431346
No. Kad Pengenalan: 901209-03-6038
Emel: nurfhar_0912@yahoo.com
2. Saya ingin memohon kebenaran dari pihak tuan/puan untuk mengedar borang
soal selidik (seperti lampiran) kepada pelajar- pelajar tahun akhir program
Ijazah Sarjana Muda Farmasi.
3. Untuk makluman, kajian di atas adalah sebahagian daripada keperluan

pengijazahan Sarjana Muda Farmasi. Keizinan dan bantuan dari pihak
tuan/puan amatlah dihargai.
Sekian, terima kasih
Yang Benar,
Prof Dr Noorizan Binti Abdul Aziz

Jabatan Farmasi Klinikal/ Farmasi Amalan,
Fakulti Farmasi, University Teknologi Mara (UiTM),
Kampus Puncak Alam, 42300 Puncak Alam,
Selangor Darul Ehsan.
Tel: 033258483/4647
83
Application letter to UKM
Tarikh: 2 Oct, 2012

Kepada:
Dekan,
Fakulti Farmasi,
University Kebangsaan Malaysia (UKM),
Jalan Raja Muda Aziz,
50300 Kuala Lumpur.
Yg Berbhg Dr,


No. Matrik: 2009431346

Yang Benar,

Tel: 033258483/4647
84
Application letter TO IIUM
Tarikh: 2 Oct, 2012

Kepada:
Dekan,
Fakulti Farmasi,
Universiti Islam Antarabangsa Malaysia (UIAM),
Jalan Sultan Ahmad Shah,
Bandar Indera Mahkota,
25200 Kuantan,
Pahang Darul Makmur.
Yg Berbhg Prof,


No. Matrik: 2009431346

Yang Benar,

Tel: 033258483/4647
85
APPENDIX C
Approval letter from USM
86
Approval letter from UKM
87
Approval letter from IIUM
88
Appreciation letter to USM
90
Appreciation letter to USM
91
Appreciation letter to IIUM
92
APPENDIX E
Table of antibiotic
No Classification General Mechanism Examples of drugs Spectrum Of Indications

Of Actions (Generic Names) Activity
1 Penicillin  Penicillin acts Penicillin: Bactericidal against  Pneumonia
by inhibit cell  Benzylpenicillin gram positive  Streptococcus
wall synthesis (penicillin G) bacteria, gram infection of RTI
by inhibiting the (Sandoz®) negative cocci,  Otitis media
formation of  Benzathine some other gram  Meningococcal
peptidoglycan benzylpenicilllin negative bacteria, meningitis
layer.  penicillin V spirochetes and Pharyngitis
 Penicillin act by (Ospen®) actinomyces  Rheumatic fever
inhibiting the  Bacteria
final cross Narrow spectrum of endocarditis
linking stage of penicillinase resistant Gram (+):  Meningitis
Peptidoglycan penicillin: Streptococcus
 Bacteremia
production. Penicillinase
 STD’s
 It bind to the  Nafcillin Producing
Staphylococcus  UTI’s
Peptidoglycan  Flucloxacin  Epiglotitis
and inactivates (Flucloxil ®) Strep. Pneumonia
And Strep.  Osteomyelitis
activity of  Dicloxacillin
Pyogenes
transpeptidase  Cloxacillin
on the inner (Monoclox®)
surface of the Gram (-):
 Oxacillin
bacteria. Not useful against
(Oxacillin ®)
 The cell wall gram – bacteria
becomes less
strong.
 Thus the Broad spectrum,
bacteria leaks Gram (+):
Aminopenicillin:
out its contents Streptococcus
Staphylococcus
and perish.  Ampicillin
Enterococcus
(Ampillin®)
Gram (-):
 Amoxicillin Escherichia coli
(Amoxil®) Klebsiella
 Amoxicillin and pneumoniae
Clavulanate Proteus vulgaris
(Augmentin ®) Haemophilus
Influenzae
Neisseria
gonorrhoeae
Extended spectrum Gram (+):

anti pseudomonas: Less effective
against Gram+ve
 Ticarcillin penicillinase-
(Ticarcillin®) producing
 Piperacillin organisms
 Mezlocillin E. Feacalis,
 Piperacillin and B. Fragilis.
Tazobactam
(Tazocin®)
93
Gram (-):
extended spectrum
on gram negative
bacteria
Pseudomonas
Aeruginosa,
Spirochetes,
Actinimyces,
Enterobacteriaceae,
2 Cephalosporin  Mimic D-Ala- 1st Generation: Gram (+):  Pneumonia
D-Ala site and Streptococcus  strep throat
competitively  Cefadroxil Staphylococcus  various staph
inhibit (Duricef®) Enterococcus infections
Penicillin-  Cefalexin including those of
Binding (Keflex®) the skin
Proteins (PBP)  Cefalotin Gram (-):  tonsillitis
to cross-link (Keflin®) Penicillinase-  bronchitis
peptidoglycan.  Cefapirin producing,  gonorrhea
 Disrupt (Cefadryl®) methicillin-
 septicemia
synthesis of  susceptible
Cefazolin  meningitis
peptidoglycan staphylococci and
(Kefzol®)  peritonitis
layer of  streptococci cover
Cefradine
N. gonorrhea, M.  urinary tract
bacterial cell (Velosef®)
catarrhalis, H. infections
walls.
 surgical
 Inhibit cell wall influenza, E. coli,
Klebsiella, Proteus prophylaxis
structural
integrity. mirabilis
 Bactericidal
(lysis and death
of the cell)
 Less susceptible 2nd Generation: Gram (+):
to Streptococcus
Penicillinases.  Cefaclor Staphylococcus
Enterococcus
(Distaclor®)
 Cefonicid
(Monocid®)
Gram (-):
 Cefprozil
Proteus mirabilis,
(Cefzil®) some Escherichia
 Cefuroxime coli, Klebsiella
(Zinacef®) pneumoniae,
Haemophilus
influenzae,
Enterobacter
aerogenes and
some Neisseria
Gram (+):
3rd Generation: Streptococcus
 Cefdinir Staphylococcus
(Omnicef®) Enterococcus
 Cefixime (Decreased activity)
(Suprax®)
 Cefotaxime
(Claforan) Gram (-):
 Cefpodoxime pneumococci,
(Vantin®) meningococci, H.
 Ceftibuten influenzae, and
(Cedax®) susceptible E. coli,
 Ceftizoxime Klebsiella, and
(Cefizox®) penicillin-resistant
 Ceftriaxone N. gonorrhoeae
(Rocephin®)
94
 Cefoperazone
(Cefobid®)
 Ceftazidime
(Fortum®)
4th Generation: Gram (+):

 Cefepime S. aureus
(Maxipime®)
Gram(-):
Pseudomonas
aeruginosa,
Enterobacter,
Serratia, C. freundii
3 Quinolone and  Quinolone 1st gen: Quinolones : Gram (+):  Uncomplicated
fluoroquinolones blocks the S. aureus gonorrhea
bacteria DNA  Cinoxacin Streptococci  conjunctivitis
replication (Cinobac ®)  Infection of
pathway thus  Nalidixic acid Gram(-): reaspirator tract,
inhibit bacteria E. Coli, Proteus, middle ear,
replication. Klebsiella, kidney, urinary
 It acts by Enterobacteria, tract and genital
binding to Salmonella, infection
enzyme DNA Shigella spp.
gyrase and
topoisomerase  Gonorrhea
11 which are 2nd gen: Gram (+):  conjunctivitis
responsible in Fluoroquinolones: Limited gram  Infection of
unwinding of positive coverage reaspirator tract
DNA for  Norfloxacin Corynebacterium,  UTI
complementary (Utinor ®) Propinquum,
 thyphoid fever
base pairing.  Perfloxacin Staph. Aureus
 urethritis
Therefore  Ciprofloxacin  Legionnaires
bacteria is (Ciprox ®) Enoxacin fails to
cover S. Aureus disease
unable to  Enoxacin  skin and soft
replicate or  Ofloxacin
Gram(-): tissues infection
even synthesis (Floxin®)
protein. Enterobacteria,  chronic bronchitis
 Levofloxacin pneumonia
E. Coli,
(Levaquin®)
Klebsiella,

N. Gonorrhoea,
Proteus,
3rd gen:
S. Epidermis.
Fluoroquinolone:
Salmonella,
Shigella,
 Lemofloxacin Pseudomonia,
Streptococci spp.
4th gen:
Fluoroquinolones:
 Gatifloxacin active vs. Group A

(Zymar ®) Streptococcus:
 Moxifloxacin including penicillin-
(Vogamox®) resistant forms,
S. aureus,
S. pneumo
including MRSA,
H. influenza,
M.Catarrhalis
including penicillin
resistant strain.
Less activity
against
Pseudomonas and
95
addition of
anaerobic activity
4 Other B-lactams:
Monobactam  Inhibit  Aztreonam Gram(-):  Nosocomial
mucopeptide (Azactam ®) Pseudomonas infections
synthesis in the aeruginosa.  Patient allergic to
bacterial cell Citrobacter, penicillin and
wall in which Enterobacter, cephalosporin.
blocking E. coli,  Bone and joint
peptidoglycan Haemophilus, infections
crosslinking. Klebsiella, Proteus,  Gonorrhea
 Has a very high and Serratia  Intra-abdominal
affinity for species. infections
penicillin-  Lower respiratory
binding protein tract infections
3 (PBP-3) and  Meningitis
mild affinity for  Septicaemia
PBP-1a, thus it
 Cystitis
binds very
 Skin and soft
poorly to
tissue infections
penicillin-
 Urinary tract
binding proteins
of gram- infections
positive and
anaerobic
bacteria.
  Nosocomial
 Bactericidal Imipenem+ Gram(+):
infections
Carbapenem  Has single beta- Cilastatin Enterococcus
(Bacqure®) species  Urinary tract
lactam ring and
not fused to  Meropenem Listeria infections
other ring. (Meronem®) Nocardia
 Susceptible to  Ertapenem
extended- (Invanz®) Gram(-):
spectrum of  Doripenem Pseudomonas
beta-lactamases. (Doribax®) maltophilia and
P.cepacia
 Inhibit cell wall
synthesis of Anaerobes
bacteria.
Aerobes:
 Very stable in
the presence of Depend on drugs
beta-lactamase used.
(both
penicillinase
and
cephalosporinas
e) produced by
some bacteria
 Strong inhibitor
of beta-
lactamases from
some Gram-
negative
bacteria that is
resistant to most
beta-lactam
antibiotics.
 Bactericidal
 Some
mechanisms
may differ
96
depend on
drugs.
5 Aminoglycosides  Aminoglycoside  Amikacin Gram(+):  Uncomplicated
is an inhibitor (Apalin®) Staphylococcus UTI
of protein  Gentamicin  Bacterimia
synthesis. (Garamycin ®) Gram(-):  Septicaemia
 It binds to 30S  Tobramycin E. Coli,  Burn
ribosomal (Tobrex®) Klebsiella,  Streptococcal,
subunit of  Netilmicin Proteus, endococcal
bacteria then  Kanamycin Salmonella, encocarditis
disturbs the  Neomycin Pasteurella,  surgical
elongation of  Paromycin Brucella, propylaxis
peptide chain. Haemophilus,  Hepatic
 Aminoglycoside Shiegella
encephalopathy
also terminate  ophthalmic
the initiation of infection
bacteria protein  skin infection
synthesis thus
impairing
translation
accuracy of
mRNA.
6 Macrolides  Inhibit protein  Azithromycin Gram(+): AZITHROMYCIN
synthesis by (Zithromax®) staphylococci  respiratory tract
binding  Clarithromycin streptococci infections
reversibly to (Clarimycin®) aerobes and  Listeriosis
50S ribosomal  Erythromycin anaerobes  Skin and skin
subunits at or (EES 400®) mycoplasmas, structure
very near the atypical infections
site that binds mycobacteria,  whooping cough
chloramphenico Mycobacterium  Diphtheria
l in which will avium, M.  Erythrasma
prevent catarrhalis, , M.  Intestinal
peptidyltransfer pneumonia
amebiasis
ase from adding non-tuberculous
 Acute pelvic
the peptidyl mycobacteria,
inflammatory
attached to disease
tRNA to the Gram(-):
 Nongonococcal
next amino treponemes
urethritis
acid. some rickettsiae
 Primary syphilis
 Some drugs and some strains of
Pasteurella,  Legionnaires'
inhibit the
translocation Haemophilus , Disease
step where in a Neisseria species
Bacteroides CLARITHROMYCIN
newly
synthesized fragilis  Pharyngitis/
peptidyl tRNA Legionella, Tonsillitis
molecule moves Hemophilus  Acute maxillary
from the influenzae, sinusitis
acceptor site on Chlamydia  Acute bacterial
the ribosome to trachomatis and exacerbation of
the peptidyl Chlamydophila chronic bronchitis
donor site. pneumoniae.  Community-
 Bacteriostatic Acquired
Pneumonia
 Uncomplicated
skin and skin
structure
infections
 Acute otitis media
ERYTHROMYCIN
 Acute bacterial
exacerbations of
chronic
97
obstructive
pulmonary disease
 Community-
acquired
pneumonia of mild
severity
 Streptococcal
pharyngitis/
Tonsillitis
 Uncomplicated
skin and skin
structure
infections
 Non-gonococcal
urethritis and
cervicitis
 Disseminated
Mycobacterium
avium complex
disease
7 Sulfonaminde  Sulphonamide  Mafenide Gram(+):  Second and third

and inhibits (Sulfamylone®) Staphylococcus degree burns to
Trimetophrime dihydrofolic  Silver aureus prevent
acid, DHF sulfadiazine septicaemia.
formation from (Silvadene ®) Gram(-):  for use in burned
para-amino  Sulfacetamide E. Coli, ears and nose
benzoic acid, (Sultrim®) Klebsiella,  Ocular infection
PABA. Thus  Sulfadiazine P. Vulgaris,  UTI
interfering with (Sulfadiazine ®) S. Aureus,  GI infection
synthesis and  Sulfamethoxazole Taxoplasma  respiratory tract
growth of  Sulfasalazine , N. Meningitis, infection
bacteria folic  Sulfamethizole H. Influenza  Pneumocystis
acid. Folic acid
 Trimetoprome Carinii
is required for and
growth of
sulfamethoxazole
bacteria cells.
(Bactrim®)
 Trimethoprim is
a strong
inhibitor of
DHFR. It
inhibits enzyme
folic acid
pathway. It
blocks
conversions and
recycling of
dihydrofolic
acid to
tetrahydrofolic
acid: DHF 
THF  DHF.
8 Tetracycline  Binding to the Gram (+):  Rickettsial

30S bacterial  Beatacycline ® Bacillus anthracis  chlamydial &
ribosomal  Doxycycline Nocardia mycoplasmal
subunit in (Domycin®) infections
mRNA Gram (-):  Brucellosis, plaque
translation rosacea, Yersinia tularaemia
complex pestis  malabsorption
 Preventing chlamydia, syndrome
access of
98
aminoacyl Rickettsiae,  UTI
tRNA to the P. multocida.  Severe acne
acceptor (A)  Chronic bronchitis
site on the  cholera
mRNA-  Venereal diseases.
ribosome
complex
 Inhibit bacterial
protein
synthesis
 Bacteriostatic
Chloramphenicol  Binding  Beaphenicol ® Gram(+):

reversibly to the  Nicol eye drop Streptococcus  Bacterial
23S rRNA of  Nicol ear drop pneumoniae, meningitis
50S ribosomal Enterococcus  Brain abscess
subunit faecium,  Granuloma
 Competitively Mycoplasma inguinale
inhibit binding  Anthrax
of the amino  Listeriosis
acid-containing  Gas gangrene
end of the
Gram(-):  Whipple's disease
aminoacyl  Severe
tRNA to the Neisseria
meningitidis, gastroenteritis
acceptor site on  Severe melioidosis
the 50S Haemophilus
influenzae  Plague
ribosomal
Proteus mirabilis,  Psittacosis
subunit.
Salmonella typhi,  Tularaemia
 Interaction
between
Pseudomonas  Otitis externa
peptidyltransfer
mallei, P.cepacia,  Eye infections
Vibrio cholera,
ase and its
Francisella
amino acid
tularensis, Yersinia
substrate cannot
pestis, brucella,
occur, thus
Shigella, Rickettsia,
peptide bond
Chlamydia
formation is
inhibited.
 Inhibit protein
chain Anaerobes:
elongation. Bacteroides
 Bacteriostatic. fragilis,
Clostridium,
Fusobacterium,
Veillonella
(British National Formulary edition 57, 2009)
99
APPENDIX F
Application letter to Hospital Tuanku Jaafar Seremban
100
101
18. Ceftazidime Ceftazidime Kotra Pharma Injection Ceftazidime Mashbooh Sodium Carbonate Halal Mashbooh
Injection (M) Sdn Bhd Pentahydrate
19. Ceftriaxone Oframax Ranbaxy Injection Ceftriaxone Halal No Data Available Cannot Be Cannot Be
Injection Laboratories Sodium Assesed Assesed
Ltd.
20. Cefuroxime Zinnat Tablet Glaxo Wellcome Tablet Cefuroxime Halal No Data Available Cannot Be Cannot Be
Operations Assesed Assesed
21. Cefuroxime Xylid Pharmaniaga Tablet Cefuroxime Masbooh No Data Available Cannot Be Cannot Be
Manufacturing Axetil Assess Assess
Berhad
22. Cefuroxime Zinnat Glaxo Suspension Cefuroxime Masbooh Aspartame Masbooh Masbooh
Operations UK 125mg/5ml Axetil
Ltd Xanthan Gum Halal
Acesulfame Halal
Potassium
Povidone K30 Halal
Stearic Acid Halal
Sucrose Halal
Tutti Frutti Flavor Halal
23. Cefuroxime Anikef Duopharma (M) Powder For Cefuroxime Haram Water For Injection Halal Haram
Sdn Bhd Injection Sodium
24. Ciprofloxacin Ificipro Injection Unique Injection Ciprofloxacin Unknown No Data Available Cannot Be Cannot Be
Pharmaceutical Hydrochloride Assesed Assesed
Labs
105
25. Ciprofloxacin Cifran Tablets Ranbaxy (M) Film- Ciprofloxacin Unknown No Data Available Cannot Be Cannot Be
Sdn Bhd Coated Hydrochloride Assess Assess
Tablets
26. Ciprofloxacin Cifran Ranbaxy Film-Coated Ciprofloxacin Halal No Data Available Cannot Be Cannot Be
Tablet Assess Assess
27. Ciprofloxacin Cifran Ranbaxy Injection Ciprofloxacin Halal Sodium Chloride Halal Halal
Water For Injection Halal

28. Ciprofloxacin Ciprobay Bayer Schering Tablet Ciprofloxacin Halal Microcrystalline Halal Mushbooh
Pharma Hcl Cellulose
Monohydrate
Maize Starch Halal
Poly(1-Vinyl-2- Halal
Pyrrolidone) Cross-
Linked
Highly Dispersed Halal

Silicon Dioxide
Magnesium Stearate Mushbooh
Methylhydroxy
Propylcellulose Halal
Macrogol 4000
Mashbooh
Titanium Dioxide
(E171) Halal
29. Ciprofloxacin Ufexil DEMO SA. Solution Ciprofloxacin Halal Lactic Acid Halal Halal
Pharma For
Injection Sodium Chloride Halal
Hydrochloric Acid Halal
106
Water For Injection Halal
30. Ciprofloxacin Cipricin S.M. Pharma Tablet Ciprofloxacin Halal No Data Available Cannot Be Cannot Be
Hydrochloride Assess Assess
31. Clarithromycin Claritrox SM Film- Clarithromycin Halal No Data Available Cannot Be Cannot Be
Pharmaceutical Coated Assess Assess
Sdn Bhd Tablets
32. Clarithromycin Klacid I.V Abbott France Injection Clarithromysin Halal Lactobionic Acid Mashbooh Mashbooh
Sodium Hydroxide Halal

Ph. Eur
33. Clarithromycin Klacid Pediatric Abbott S.P.A Film- Clarithromycin Halal Croscarmellose Halal Haram
Suspension Coated Sodium
Tablet
Starch Pregelatinised Halal
Cellulose
Microcrystalline Halal
Silica Gel
Halal
Povidone
Halal
Stearic Acid
Halal
Magnesium Stearate
Mushbooh
Talc Halal
Hypromellose Halal
Hydroxypropylcellul Halal
107
ose
Propylene Glycol Halal
Sorbitan Monooleate Haram
Titanium Dioxide Halal
Sorbic Acid Halal
Vanillin Halal
Quinoline Yellow Halal

(E104)
34. Clarithromycin Klacid Pediatric Abbott S.P.A Film- Clarithromycin Halal Croscarmellose Halal Haram
Suspension Coated Sodium
Tablet
Starch Pregelatinised Halal
Cellulose
Microcrystalline Halal
Silica Gel Halal
Povidone Halal
Stearic Acid Halal
Magnesium Stearate Mushbooh
Talc Halal
Hypromellose Halal
Hydroxypropylcellul Halal
ose
108
ose Sodium
Aspartame Masbooh
Xanthan Gum Halal
Mannitol Halal
Sodium Benzoate Halal
Colloidal Silicon Halal

Dioxide
Sodium Chloride Halal
Orange Dry Flavor Halal
52. Meropenem Meronem Astrazeneca Powder For Anhydrous Halal Anhydrous Sodium Halal Halal
Intravenous Meropenem Carbonate
Injection/In Trihydrate
fusion
53. Moxifloxacin Avelox Bayer Schering Tablet Moxifloxacin Halal Croscarmellose Unknown Cannot Be
Pharma Hydrochloride Sodium Assess
Lactose Monohydrate Mushbooh
Magnesium Stearate
Mushbooh
Microcrystalline
Cellulose
Halal
Hypromellose
Macrogol 4000 Halal
112
Titanium Dioxide Unknown
(E171)
Halal
Ferric Oxide
(E172) Halal
54. Moxifloxacin Avelox Bayer Schering Vial Moxifloxacin Halal No Data Available Cannot Be Cannot Be
Pharma Hydrochloride Assess Assess
Ofloxacin Oflicin Tablet Noripharma Sdn Tablet Ofloxacin Halal No Data Available Cannot Be Cannot Be
55. Bhd. Assesed Assesed
56. Polymyxin B Polymyxin B For X-Gen Injection Polymyxin Unknown No Data Available Cannot Be Cannot Be
Injection USP Pharmaceutical Assesed Assesed
Inc
57. Rifampicin Rifampicin Upha Pharma Capsule Rifampin Halal No Data Available Cannot Be Cannot Be
Assess Assess
58. Streptomycin Streptin Injection SM Powder Streptomycin Halal No Data Available Cannot Be Cannot Be
Pharmaceutical Sulfate Assess Assess
Sdn. Bhd
59. Streptomycin Streptomycin Karnataka Powder Streptomycin Halal Water For Injection Halal Halal
Sulfate Injection Antibiotics & Sulfate
Pharmaceuticals
Ltd.
60. Sulbactam Sulperazon Pfizer Italia Dry Powder Sulbactam Unknown No Data Available Cannot Be Cannot Be
S.R.L For Sodium Assesed Assesed
Inhection Cefoperazone
Sodium
61. Sultamicin Unasyn Oral Pfizer Film- Oxymethylpenni Masbooh Lactose Masbooh Haram
Coated cilate Sulphone
Tablets Ester Of Corn Starch Halal
Ampicillin
Sodium Starch Unknown
Glycolate
Hydroxypropylcellul Haram
ose
113
Magnesium Stearate Masbooh
Hydroxypropylmethy
lcellulose 2910 Haram
Titanium Oxide Halal
Talc Halal
Macrogol 6000 Masbooh
Purified Water Halal
Carnauba Wax Halal
Denatured Alcohol Haram
62. Sultamicin Unasyn Oral Pfizer Powder For Oxymethylpenni Masbooh Sucrose Halal Masbooh
Oral cilate Sulphone
Suspension Ester Of Artificial Cherry Halal
50 Mg/Ml Ampicillin Flavor
Colloidal Silicon Halal

Dioxide
Dibasic Sodium Masbooh

Phosphate Anhydrous
Monobasic Sodium
Phosphate Anhydrous Masbooh
114
63. Tazosin Tazpen Agila Specialties Granule Piperacillin Halal Tazobactam Sodium Halal Halal
Pvt. Ltd. Sodium
64. Vancomycin Vancomycin Hospira Inc. Injection Vancomycin Masbooh Water For Injection Halal Masbooh
Hydrochloride
Assessment of antibiotic status:

Halal: 13
Haram : 10
Masbooh:12
Cannot Be Assesed: 29
115

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UNIVERSITI TEKNOLOGI MARA

FUTURE PHARMACIST KNOWLEDGE ON ANTIBIOTIC AND THEIR

NURUL FHARIHA BT KAMARUDIN

BACHELOR OF PHARMACY (Hons)

FUTURE PHARMACIST KNOWLEDGE ON ANTIBIOTIC AND

NURUL FHARIHA BT KAMARUDIN

Dissertation submitted in partial fulfillment of the requirements

Kamarudin (2009431346) entitled ‘Future Pharmacist Knowledge on Antibiotic and Their

Perception and Knowledge on Halal Medication Issues Specifically on Antibiotic’ be

from Faculty of Pharmacy, UiTM.

Date (Prof. Dr. Noorizan Bt Abd Aziz)

Universiti Teknologi MARA

Date (Professor Dr. Aishah Adam)

Universiti Teknologi MARA

Knowledge On Antibiotic And Their Perception And Knowledge On Halal Medication

Issues Specifically On Antibiotic”.

who answered my questionnaire.

Thank you so much

Nurul Fhariha binti Kamarudin

Date; 20 Dec. 2012

LIST OF TABLES viii

1.1 Overview of antibiotic 1

1.2 Issues related with antibiotic 2

1.2.1. Mechanism of bacterial resistance 2

1.2.2. Classes of antibiotic 4

1.3 Halal issue 4

1.4 Problem statement 6

1.5 Significance of study 7

1.6 Objective of study 8

2.1. Knowledge on antibiotic 9

2.3 Usage and inappropriate use of antibiotic 11

2.4 Antibiotic resistances 13

2.5 Cost of antibiotic 15

2.6 Medication in Islamic perspective 16

2.7 The concept of halal , haram and masbooh 18

2.8 Is it permissible to use haram medication? 19

2.9 Awareness on status of pharmaceutical product 21

CHAPTER 3 MATERIALS AND METHOD

3.1 Methodology for objective one 22

3.2 Sample size 23

3.3 Subject selection 23

3.6 Research tool (Questionnaire form) 25

3.8 Reliability test 27

3.9 Statistical analysis 28

3.10 Methodology for objective two 28

3.11 Assessment of knowledge and perception 28

4.1. Result for objective one 30

4.1.1. Analysis of demographic data

4.1.2.1. General knowledge on antibiotic 35

4.1.2.2. General knowledge of specific antibiotic and the

4.1.2.3. Knowledge on halalness of antibiotic and halal

4.1.3. Association between demographic data with levels

4.1.3.1. Association between demographic data with

levels of knowledge on antibiotic 42

4.1.3.2. Association between demographic data

levels of knowledge on halalness of antibiotic

and halal concept 45

4.1.3.3. Association between demographic data with

levels of perception on usage and status

4.1.3.4. Summarization of result 50

4.1.4. Analysis of open ended question 54

4.2. Result for objective two

4.2.1. Evaluation of antibiotics’ status 55