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"ABSTRACTObjectives: To examine the influence of pharmacists demographic characteristics on dispensing antibiotics purchased with and without a prescription in the community pharmacies.Methods: This cross-sectional study was conducted in 24 randomly-selected community pharmacies located in Abu Dhabi, United Arab Emiratesbetween March and September 2009. Data were collected through a closed-structured questionnaire and analyzed using the Statistical Package for Social Sciences Version 17. Descriptive statistics, odds ratios, significance and 95% CI and logistic regression analyses were then used to analyze the resulting data.Results: Participating pharmacists conducted a total of 1645 antibiotic transactions (1211 [73.6%] dispensed with prescriptions versus and 434 [26.4%] without). Gender and socioeconomic status of the patients hada significant effect in acquiring antibiotics without prescription (p=0.012, p=0.001). Clarithromycin (91.5%), cefuroxime (91.3%), and co-amoxiclav(66.4%) were dispensed with prescription. Ceftriaxone (53.3%), amoxicillin (47.8%) and co-amoxiclav (33.6%) were dispensed without prescription. Dispensing of antibiotics with prescription were frequently given a 5,7, or 10 day regimen, while those without prescription were frequently given 3-7 days duration. Co-amoxiclav for sore throat was commonly dispensed without prescription. Ceftriaxone for sexually transmitted diseases was dispensed at a similar rate, both with and without prescription.Conclusions: Dispensing antibiotic without prescription is illegal and alarming. Patient interviews and interventions to improve the current prescribing pattern for both prescribers and pharmacists are highlywarranted."

"Latar belakang. Berbagai studi sebelumnya menunjukkan bahwa insidens kolonisasi dan infeksi C.difficile semakin meningkat, terutama pada pasien rawat inap yang mendapat terapi antibiotika. Namun belum ada penelitian yang mendapatkan data kedua insidens tersebut di Indonesia, terutama di RSCM. Tujuan. Untuk mengetahui insidens kolonisasi dan infeksi C.difficile pasien rawat inap yang mendapat terapi antibiotika di RSCM. Metode. Dilakukan studi kohort prospektif berbasis surveilans pada 96 pasien rawat inap yang mendapat terapi antibiotika di RSCM pada periode penelitian. Dilakukan pemeriksaan feses dengan uji kromatografi cepat C.DIFF QUIK CHEK COMPLETETM pada awal dan akhir penelitian. Dilakukan follow-up selama 5-7 hari perawatan pada semua pasien. Insidens kolonisasi strain non-toksigenik adalah pasien yang memiliki hasil pemeriksaan fesesnya konversi GDH/Toksin -/- saat awal perawatan menjadi GDH/Toksin +/-. Insidens kolonisasi strain toksigenik adalah pasien yang memiliki konversi GDH/Toksin -/- saat awal perawatan menjadi GDH/Toksin +/+. Insidens infeksi adalah pasien yang memiliki konversi GDH/Toksin -/- saat awal perawatan menjadi GDH/Toksin +/+ yang disertai satu atau lebih gejala yang berhubungan dengan infeksi C.difficile. Hasil. Dari 96 subjek penelitian, 13 subjek mengalami kolonisasi non-toksigenik; 8 subjek mengalami kolonisasi toksigenik; 9 subjek mengalami infeksi. Terdapat 11 subjek yang mengalami gejala klinis, namun hasil pemeriksaan fesesnya tidak ditemukan toksin yang positif (2 subjek hanya mengalami kolinisasi non-toksigenik dan 9 subjek tidak mengalami kolonisasi atau infeksi) sehingga dianggap bukan merupakan infeksi C.difficile. Kesimpulan. Insidens kolonisasi C.difficile adalah 22%, dimana kolonisasi strain non-toksigenik adalah 14% (IK95% 13-16) dan strain toksi.

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Background. Previous studies showed that there have been a significant increasing of the incidence of C.difficile colonization and infection, particularly among hospital inpatients prescribed antibiotics. However, there is no such data available in Indonesia, mainly at Cipto Mangunkusumo Hospital.

Objective. To determine the incidence of Clostridium difficile colonization and infection among hospital inpatients prescribed antibiotics at Cipto Mangunkusumo Hospital.

Methods. A surveillance-based prospective cohort study was conducted on 96 inpatients prescribed antibiotics at Cipto Mangunkusumo Hospital during the study period. All patient was followed-up for 5-7 days hospitalization. We obtained rectal swabs or stool samples on admission and day 5-7 of hospitalization and performed a rapid chromatography test C.DIFF QUIK CHEK COMPLETETM to determine colonization or infection. Incidence of non-toxigenic colonization was defined as a conversion of baseline result GDH/toxin -/- into GDH/toxin +/- as the second result. Incidence of toxigenic colonization was defined as as a conversion of baseline result GDH/toxin -/- into GDH/toxin +/+ as the second result. Incidence of infection was defined as a conversion of baseline result GDH/toxin -/- into GDH/toxin +/+ as the second result, accompanied by one or more C.difficile infection-associated clinical symptoms.

Results. A total of 96 subjects were included in the study; 13, 8 and 9 had a non-toxigenic colonization, toxigenic colonization, and infection, respectively. 11 subjects with clinical symptoms could not be determined whether they had a C.difficile infection because of the “toxin-negative” findings from their stool examination (2 subjects had non-toxigenic colonization and 9 subjects had neither colonization nor infection).

Conclusion. The incidence of C.difficile colonization was 22%, which 14% (95% CI 13-16) was the incidence of non-toxigenic colonization and 8% (95% CI 7-10) was the incidence of toxigenic colonization. The incidence of C.difficile infection was 9% (95% CI 8-11)."

"Latar Belakang: Sampai saat ini belum ada konsensus sepakat mengenai durasi pemberian antibiotik untuk kasus fraktur terbuka grade I-II. Penelitian ini bertujuan untuk menentukan apakah risiko infeksi akan lebih besar jika antibiotik profilaksis diberikan intravena dihentikan 24 jam pasca operasi dibandingkan dengan diteruskan sampai 72 jam pasca operasi.Metode: Desain yang digunakan dalam penelitian ini yaitu uji klinis terkontrol tersamar tunggal. Penelitian akan dilakukan multi center pada RSUPN Dr. Cipto Mangunkusumo Jakarta, RS Siaga Medika Banyumas dan RSUD Kabupaten Tangerang. Penelitian dilakukan mulai Bulan Juli 2022 sampai dengan Maret 2023. Populasi target dari penelitian ini adalah pasien dewasa yang menjalani operasi reposisi terbuka dan fiksasi interna untuk kasus fraktur terbuka tulang panjang.Hasil : Dalam penelitian ini didapatkan bahwa sebagian subjek yang mengalami fraktur terbuka tulang panjang berjenis kelamin laki-laki, yakni 16 orang (51,6%) di kelompok pemberian antibiotik selama 24 jam, dan 15 orang (48.4%) di kelompok pemberian antibiotik selama 72 jam. Pada penelitian in didapatkan lokasi fraktur sebagian besar terjadi pada ekstremitas bawah yakni sebanyak 17 orang (51.5%) di kelompok pemberian antibiotik selama 24 jam, dan 16 (48.5%) di kelompok pemberian antibiotik selama 72 jam. Pada penelitian ini didapatkan tidak didapatkan hubungan yang bermakna antara lama pemberian antibiotik 24 jam dan 72 jam dengan terjadinya infeksi pada fraktur terbuka (p>0.05).Kesimpulan: Angka infeksi pasca operasi reposisi terbuka dan fiksasi interna fraktur terbuka tulang panjang derajat 1 dan 2 kurang dari 5 persen. Penghentian antibiotik profilaksis 24 jam pasca operasi reposisi terbuka dan fiksasi interna fraktur terbuka tulang panjang derajat 1 dan 2 memiliki angka infeksi yang sama dibandingkan dengan dilanjutkan sampai 72 jam pasca operasi.

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Introduction: There is no agreed consensus regarding the duration of antibiotic administration for grade I-II open fracture cases. The aim of this study was to determine whether the risk of infection would be greater if prophylactic antibiotics given intravenously were discontinued 24 hours postoperatively compared to continuing until 72 hours postoperatively.

Method: The design used in this study was a single-blind controlled clinical trial. The research will be carried out in a multi-center at RSUPN Dr. Cipto Mangunkusumo Jakarta, Siaga Medika Hospital in Banyumas and Tangerang District Hospital. The study was conducted from July 2022 to March 2023. The target population for this study were adult patients who underwent open repositioning surgery and internal fixation for cases of open long bone fractures.

Result: In this study, it was found that some of the subjects who had open fractures of the long bones were male, namely 16 people (51.6%) in the group given antibiotics for 24 hours, and 15 people (48.4%) in the group given antibiotics for 72 hours . In this study, it was found that most of the fracture locations occurred in the lower extremities, namely 17 people (51.5%) in the group given antibiotics for 24 hours, and 16 (48.5%) in the group given antibiotics for 72 hours. In this study, there was no significant relationship between the duration of 24 and 72 hours of antibiotic administration and the occurrence of infection in open fractures (p>0.05).

Conclusion: Prophylactic antibiotics for up to 24 hours postoperative open repositioning and internal fixation in open fractures of long bones degrees 1 and 2 had no significantly different infection rates when compared to prophylactic antibiotics continued for up to 72 hours postoperatively."

"Kombinasi antibiotik b-laktam dengan penghambat b-laktamasa terbukti telah dapat mengatasi resistensi yang disebabkan oleh produksi b-laktamasa. Konsentrasi Hambatan Minimal (KHM) beberapa antibiotik b-laktam terhadap isolat penghasil b-laktamasa akan dievaluasi. A.anitratus, E.koli, K.pneumoniae, Proteus sp, Pseudomonas sp, S.aureus, S.epidermidis, S.pneumoniae, S.viridans, dan b-hemolitik Streptokokkus, dipaparkan terhadap Ampisilin/Sulbaktam (AMS), Seftriaksone (CRO), dan Sefotaksime (CTX) menggunakan teknik Etest. Produksi b-laktamasa diidentifikasi menggunakan cakram Cefinase. Enampuluh empat persen isolat memiliki kemampuan menghasilkan b-laktamasa. Semua E.koli dan K.pneumoniae yang diuji merupakan penghasil b-laktamasa, namun tidak satupun Proteus sp, Pseudomonas sp, dan S.epidermidis yang diuji menghasilkan b-laktamasa. Dalam kelompok penghasil b-laktamasa, sulbaktam mampu menurunkan resistensi terhadap CFP dari 25% menjadi 5%. Sekitar 20% dari isolat penghasil b-laktamasa yang resisten terhadap CFP, ternyata peka terhadap CSL. Kepekaan S.viridans terhadap AMS, AMC, CFP, dan CSL ternyata lebih dari 80%, tetapi kurang dari 50% terhadap CRO dan CTX. S.pneumoniae ternyata kurang peka terhadap antibiotik yang diuji. Kepekaan S.aureus terhadap antibiotik uji adalah 60 sampai 70%, sedangkan Streptokokus b-haemolitikus memperlihatkan respons yang baik. Hanya 30% atau kurang K.pneumoniae dan E.koli yang peka terhadap AMS dan AMC. A.anitratus memperlihatkan kepekaan yang baik hanya terhadap AMS (78%) dan CSL (89%). Enampuluh empat persen isolat yang diamati ternyata menghasilkan b-laktamasa. Penghambat b-laktamasa dapat menurunkan resistensi organisma penghasil b-laktamasa terhadap antibiotik b-laktam dari 25 menjadi 5 persen. (Med J Indones 2004; 13: 140-5)

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Combination of b-lactam antibiotic with b-lactamase inhibitor has been proven to overcome resistance caused by b-lactamase production. An evaluation to the MIC of some b-lactam antibiotics to b-lactamase producing isolates will be reported. A.anitratus, E.coli, K.pneumoniae, Proteus sp, Pseudomonas sp, S.aureus, S.epidermidis, S.pneumoniae, S.viridans, and b-hemolytic Streptococcus, were challenged to Ampicillin/Sulbactam (AMS), Amoxicillin/Clavulanic acid (AMC), Cefoperazone (CFP), Cefoperazone/ Sulbactam (CSL), Ceftriaxone (CRO), dan Cefotaxime (CTX) using ETest techniques. b-lactamase production was identified using Cefinase disk. Sixtyfour percent of isolates were capable of producing b-lactamase. All E.coli and K.pneumoniae tested were b-lactamase producer, none of Proteus sp, Pseudomonas sp, and S.epidermidis tested produced b-lactamase. In b-lactamase producing group, Sulbactam was able to reduce resistance to CFP from 25% to 5%. About 20% of b-lactamase producing isolates which were resistant to CFP, were susceptible to CSL. Susceptibility of S.viridans to AMS, AMC, CFP, and CSL was higher than 80%, but less than 50% to CRO and CTX. S.pneumoniae was less susceptible to tested antibiotics, 50 to 60% susceptibility was shown to AMC, CFP, and CSL. S.aureus was 60 to 70% susceptible, while b-haemolytic Streptococcus showed good response to the tested antibiotics. Only 30% or less of K.pneumoniae and E.coli was susceptible to AMS and AMC. A.anitratus showed good susceptibility only to AMS (78%) and CSL (89%). Sixtyfour percent of isolate studied produced b-lactamase. b-lactamase inhibitor could reduce resistance of b-lactamase producing organism to b-lactam antibiotic from 25 to 5 percent. (Med J Indones 2004; 13: 140-5)"

"Tujuan penelitian ini ialah untuk membandingkan penggunaan antibiotik sebelum dan sesudah penerapan Formularium Rumah sakit (FRS) di Rumah Sakit MMC (RS MMC). Seluruh penggunaan antibiotik yang termasuk dalam klasifikasi J01 Anatomical Therapeutic Chemical (ATC) dicatat dari data pelayanan farmasi rawat-inap dan rawat-jalan. Paramater kuantitatif penggunaan antibiotik pasien rawat inap adalah Defined Daily Doses/100 hari rawat (DDDs/shr) dan DDDs/1000 pasien/hari (DDDs/rph) untuk pasien rawat-jalan. Parameter kualitas penggunaan obat adalah jumlah nama obat yg berdasarkan urutan DDDs membentuk segmen 90% dari total penggunaan obat (DU90%) dan kepatuhan peresepan antibiotik terhadap formularium dalam segmen DU90% berdasarkan nama dagang dan nama generik. Kuantitas dan kualitas penggunaan antibiotik dibandingkan sebelum dan sesudah penerapan FRS (tahun 2000 terhadap tahun 1999). Analisa perbandingan kuantitas penggunaan antibiotik dilakukan dengan. uji peringkat tanda Wilcoxon. Penggunaan antibiotik untuk pasien rawat-inap menurun nyata sebesar 23,1%, dari 124,96 DDDs/shr di tahun 1999 menjadi 96,13 DDDs/shr (p= 0,03). Penurunan penggunaan antibiotik di rawat-jalan 4,9%, dari 3,49 DDDs/rph di tahun 1999 menjadi 3,32 DDDs/rph di tahun 2000 (p=0,58). Siprofloksasin adalah antibiotik yang terbanyak diresepkan di rawat-inap pada tahun 1999 dan 2000, sedangkan di rawat-jalan amoksisilin pada tahun 1999 dan siprofloksasin pada tahun 2000. Kepatuhan peresepan antibiotik terhadap FRS untuk pasien rawat-inap dan rawat-jalan berturut-turut berdasarkan nama generik 100% dan 100%, berdasarkan nama dagang 90,5% dan 94,3%. Profil penggunaan antibiotik dalam segmen DU90% untuk pasien rawat-inap dan rawat-jalan dapat dikatakan tidak menunjukkan perbaikan baik berdasarkan nama dagang maupun nama generik. Sebagai kesimpulan ialah bahwa penerapan FRS di RS MMC hanya menunjukkan penurunan bermakna pada penggunaan antibiotik untuk pasien rawat-inap. (Med J Indones 2004; 13: 173-9)

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The objective of this study is to compare the use of antibiotics at the Metropolitan Medical Center Hospital in Jakarta, Indonesia (MMCH), before and after the implementation of a hospital formulary. All antibiotic data under J01 Anatomical Therapeutic Chemical (ATC) classification were collected from pharmacy inpatient and outpatient records. Quantitative antibiotic use was expressed in Defined Daily Doses/100 bed-days (DDDs/hbd) for inpatients and DDDs/1000 patients/day (DDDs/tpd) for outpatients. The general quality of drug use was assessed in number of drugs that account for 90% of the use (DU90%) and the adherence to hospital formulary by substance and brand name within the DU90% segment. Quantitative and qualitative antibiotic use were compared before and after implementation of the formulary (1999 to 2000). The Wilcoxon rank sign test was used to compare overall antibiotic use. Inpatient antibiotic usage decreased significantly by 23.1%, 124.96 DDDs/hbd in 1999 to 96.13 DDDs/hbd during 2000 (p= 0.03) and outpatient antibiotic usage decreased insignificantly by 4.9%, 3.49 DDDs/tpd during 1999 to 3.32 DDDs/tpd during 2000 (p=0.58).The most commonly antibiotic use was ciprofloxacin in inpatient setting during the study and in out-patient setting was amoxicillin in 1999 and ciprofloxacin in 2000. The adherence to the formulary by substance and by brand name in inpatient department was 100% and 90.5% and in outpatient department was 100% and 94.3% during the study. DU 90% by substance name and by brand name was considerably not improved in both settings. The conclusion is that the effectiveness of one year formulary implementation at MMCH was only revealed in inpatient setting. (Med J Indones 2004; 13: 173-9) "

"Swamedikasi antibiotik dapat meningkatkan terjadinya resistensi antibiotik dan resiko penggunaan antibiotik yang tidak tepat. Hal ini dikarenakan kurangnya pengetahuan pasien terhadap bahaya penggunaan antibiotik tanpa resep. Penelitian ini bertujuan untuk menganalisis pengaruh pemasangan banner terhadap pengetahuan pengunjung mengenai bahaya swamedikasi antibiotik. Penelitian ini dilakukan dengan metode eksperimen semu menggunakan rancangan separate sample pretest-posttest. Kuesioner yang telah tervalidasi digunakan untuk mengumpulkan data sosiodemografi, riwayat penggunaan antibiotik, pengetahuan pengunjung sebelum dan setelah 1 bulan pemasangan banner. Penelitian dilakukan pada bulan November 2012-Mei 2013 di 22 apotek kota Depok. Sampel penelitian merupakan responden yang berkunjung ke apotek tersebut dan memenuhi kriteria inklusi dan eksklusi. Pemilihan sampel dilakukan dengan metode consecutive sampling. Jumlah responden yang diperoleh saat pretest dan posttest sebanyak 133 orang dan 44 orang. Hasil penelitian menunjukkan bahwa mayoritas pengunjung mempunyai tingkat pengetahuan yang sedang, baik pada saat pretest (nilai rata-rata 9,59) dan posttest (nilai rata-rata 10,09). Pemasangan banner antibiotik tidak memberikan berpengaruh terhadap pengetahuan pengunjung apotek (p>0,05).

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Self-medication with antibiotics can increase the antibiotic resistance and the risk of inappropriate use. This practice is happened because the lack of patient knowledge about the danger of antibiotic use without prescription. Education providing with banner setting in the pharmacies could be undertaken to increase the patient knowledge. The aim of this study was to analysis the influence of banner setting in the pharmacies toward visitor knowledge about the danger of sel-medication with antibitics.

This study was quasi experiment with separate sample pretest-postest design. A validated questionnaire was used to obtain socio-demographic data, history of antibiotic use, visitor knowledge before and after 1 month banner setting. This study was conducted from November 2012 to february 2013 in 22 Depok pharmacies. The sample of this study was the respondent who visited to pharmacies and meet the inclusion and exclusion criteria. A consecutive sampling method was used in this study, which involved 133 respondents in the pre-test and 44 respondents in the post-test.

The result showed that the majority of visitors had a moderate level of knowledge, both in pre-test (mean= 9.59) and post-test (mean = 10.09 ). The banner setting of antibiotics weren’t given the influence to pharmacy visitors knowledge (p<0.05)."

"Tujuan penelitian ini adalah melakukan analisis pengendalian persediaan antibiotik pada tahun 2011 di RSIA Budi Kemuliaan. Desain penelitian yang digunakan Cross Sectional dengan pendekatan kualitatif untuk menganalisis unsur-unsur yang berpengaruh pada efektifitas pengendalian dan pendekatan kuantitatif digunakan untuk melakukan analisis ABC antibiotik pada tahun 2011. Hasil yang didapat dari penelitian ini untuk analisis ABC nilai indeks kritis, kelompok A terdiri dari 8 item obat atau 6,25 % dari seluruh item antibiotik, kelompok B 58 item atau 45,31% dan kelompok C 48,44% atau 62 item antibiotik Untuk evaluasi Formularium, 28 item antibiotik dalam kelompok C dapat dihilangkan. Efektifitas pengendalian belum tercapai, dikarenakan kebijakan yang ada belum cukup dan belum dibakukan menjadi pedoman yang disosialisasikan serta dievaluasi secara rutin dan belum dibakukannya prosedur-prosedur yang berkaitan dengan pengendalian persediaan, serta sistem informasi yang tersedia belum menunjang proses pencatatan dan pelaporan.

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The aim of this research is to analyze antibiotics stock control in Budi Kemuliaan Hospital in 2011. This was a cross-sectional study using qualitative approach to analyze some factors influencing control effectivity and quantitative approach to analyze ABC antibiotics in 2011. The result of this study, using ABC analysis of critical index point, showed that Group A consisted of 8 drug items or 6.25% of total antibiotics items, Group B consisted of 58 items (45.31%) and Group C consisted of 62 items (48.44%). Twenty eight itemsin Group C could be deleted from Budi Kemuliaan Hospital?s drug formularium lists.The effectivity of stock control had not been achieved yet because the policy regarding stock controlhad not been established adequately andhad not became a guidance to be socialized and evaluated routinely;there were many procedures of drug stock control had not became SOP (Standard Operating Procedure); and the excellence information system that supported good documentation had not been available yet."

"Laparotomi merupakan salah satu prosedur medis yang dilakukan secara manual dan menyebabkan banyak perlukaan, yang berisiko tinggi mengalami infeksi, yang dicegah dengan antibiotik profilaksis. Pemberian antibiotik profilaksis yang dilakukan secara empiris dapat menyebabkan banyak dampak negatif jika dilakukan tanpa pengkajian kerasionalan penggunaannya. Penelitian ini bertujuan untuk memperoleh data penggunaan antibiotik profilaksis dan melakukan evaluasi kerasionalannya dilihat dari ketepatan indikasi, ketepatan obat, dan ketepatan dosis. Penelitian dilakukan dengan pengambilan data penggunaan antibiotik profilaksis laparotomi dari rekam medis pasien yang menerima prosedur laparotomi pada bulan Januari - Desember 2012 secara retrospektif dengan desain cross-sectional. Pengambilan sampel penelitian dilakukan dengan teknik total sampling. Populasi penelitian berjumlah 486 pasien, dan 161 pasien diterima sebagai sampel penelitian, dengan total administrasi antibiotik profilaksis laparotomi sebanyak 230 kali. Hasil penelitian menunjukkan pola penggunaan antibiotik profilaksis yang kebanyakan diberikan adalah antibiotik profilaksis tunggal (57,14%), dan antibiotik yang paling banyak digunakan adalah seftriakson dan sefotaksim (34,78%). Penggunaan antibiotik profilaksis yang memenuhi kriteria tepat indikasi adalah 54,78%, tepat obat 3,48%, dan tepat dosis 88,70%. Namun demikian, dari seluruh sampel penelitian tidak ada yang dapat dikategorikan rasional dilihat dari ketepatan indikasi, obat, dan dosis.

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Laparotomy is a manual medical procedure which causes many wounds, and has a high infection risk. Surgical site infection is usually prevented by administration of prophylaxis antibiotics. Empirical administration of prophylaxis antibiotics without rationality study can cause many negative impacts.

The aim of this study was to collect prophylaxis antibiotics usage data and to evaluate rationality of the administration, observed from the accuracy of indication, medication, and dose. This retrospective cross-sectional study was done by collecting laparotomy prophylaxis antibiotics usage data from medical record of patients who had received laparotomy procedure on January - December 2012 using total sampling. Population of study included 486 patients, and 161 patients were accepted as samples of study, with total 230 times administration of laparotomy prophylaxis antibiotics.

The results showed that most of prophylaxis antibiotics were given as single type antibiotic (57.14%), and the most antibiotics used were ceftriaxone and cefotaxime (34.78%). Patients given prophylaxis antibiotics with rational indication were 54.78%, only 3.48% were given the appropriate medication, and 88.70% were given antibiotics with the right dose. However, among all samples, none was considered rational in terms of indication, medication, and dose accuracy."