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Nina Mariana
"[ABSTRAK
Latar Belakang : Penggunaan efavirenz dan rifampisin secara bersamaan menjadi suatu tantangan dalam penanganan HIV/AIDS-Tuberkulosis. Rifampisin sebagai penginduksi enzim pemetabolisme efavirenz dapat menurunkan kadar plasma efavirenz, dan dapat menyebabkan gagal terapi HIV.
Tujuan: Penelitian ini dilakukan untuk mengetahui pengaruh rifampisin terhadap kadar plasma efavirenz dan viral load viral load pasien HIV/AIDS-Tuberkulosis yang telah mendapat terapi antiretrovirus 3-6 bulan. Metode : Penelitian ini mengukur kadar efavirenz dan viral load pasien HIV/AIDS yang mendapat antiretroviral berbasis efavirenz dosis 600 mg/hari setelah 3-6 bulanterapi dan pasien HIV/AIDS-Tuberkulosis dengan terapi antiretroviral yang sama dan terapi antituberkulosis berbasis rifampisin di RSPI Prof. DR Sulianti Saroso, hasilnya akan dibandingkan. Hasil : Subjek penelitian berjumlah 45 pasien, terdiri dari 27 pasien kelompok HIV/AIDS dan 18 pasien kelompok HIV/AIDS-Tuberkulosis. Pada pemeriksaan kadar plasma efavirenz didapat median (min-maks) kelompok HIV/AIDS 0,680 mg/L (0,24-5,67 mg/L), median (min-maks) kadar plasma kelompok HIV/AIDS-Tuberkulosis 0,685 mg/L (0,12-2,23 mg/L), berarti tidak terdapat perbedaan kadar plasma efavirenz yang bermakna secara statistik antara kedua kelompok (MannWhitney, p=0,480). Proporsi pasien dengan viral load ≥ 40 kopi/ml pada kelompok HIV/AIDS sebesar 51,9%, sedangkan pada kelompok HIV/AIDS-Tuberkulosis sebesar 72,2% (ChiSquare, p=0,291), tidak terdapat perbedaan proporsi pasien yang viral load < 40 kopi/ml maupun ≥ 40 kopi/ml antar kelompok. Tidak terdapat perbedaan secara statistik (Chi Square, p=0,470) antara proporsi pasien yang mempunyai kadar subterapetik dalam kelompok, dengan hasil viral load < 40 kopi/ml (45,2%) maupun ≥ 40 kopi/ml (54,8%). Kesimpulan: Kadar plasma efavirenz maupun viral load pasien HIV/AIDS-Tuberkulosis yang mendapat antiretroviral bersama antituberkulosis berbasis rifampisin tidak berbeda bermakna dengan pasien HIV/AIDS setelah 3-6 bulan terapi antiretroviral.

ABSTRACT
Background: Concomitant use of efavirenz and rifampicin is a challenge in the treatment of HIV/AIDS-Tuberculosis infection. Rifampicin may decrease plasma concentration of efavirenz through induction of its metabolism, and could lead to HIV treatment failure Objective: To determine the effect of rifampicin-containing tuberculosis regimen on efavirenz plasma concentrations and viral load in HIV/AIDS-Tuberculosis infection patients who received efavirenz-based antiretroviral therapy. Methods: plasma efavirenz concentrations and HIV viral load were measured in HIV/AIDS patients treated with 600 mg efavirenz-based antiretroviral for 3 to 6 months and in HIV/AIDS-Tuberculosis infection patients treated with similar antiretroviral regimen plus rifampicin-containing antituberculosis in Prof. DR. Sulianti Saroso, Hospital Jakarta, Indonesia, The results were compared Results: Forty five patients (27 with HIV/AIDS and 18 with HIV/AIDSTuberculosis infections) were recruited during the period of March to May 2015. The median (min-max) efavirenz plasma concentration obtained from HIV/AIDS group [0,680 mg/L(0,24 to 5,67 mg/L] and that obtained from HIV/AIDSTuberculosis group[0.685 mg/L (0.12 -2.23 mg/L)] was not significantly different (Mann-Whitney U test, p = 0.480) .The proportion of patients with viral load ≥ 40 copies/ml after 3-6 months of ARV treatment in the HIV/AIDS group (51.9%), and the HIV/AIDS-Tuberculosis group (72.2%) was not significantly different (Chi Square test, p = 0.291). There was no significant difference (Chi Square, p=0,470) between the proportions of patients with subtherapeuticefavirenz plasma concentration in the groups with viral load < 40 copies/mL (45,2%) and ≥ 40 copies/mL (54,8%) Conclusions: Plasma efavirenz concentrations and viral load measurements in HIV/AIDS-Tuberculosis patients in antiretroviral and rifampicin-containing antituberculosis regimen were not significantly different with those in HIV/AIDS patients in 3 to 6 months antiretroviral therapy., Background: Concomitant use of efavirenz and rifampicin is a challenge in the treatment of HIV/AIDS-Tuberculosis infection. Rifampicin may decrease plasma concentration of efavirenz through induction of its metabolism, and could lead to HIV treatment failure Objective: To determine the effect of rifampicin-containing tuberculosis regimen on efavirenz plasma concentrations and viral load in HIV/AIDS-Tuberculosis infection patients who received efavirenz-based antiretroviral therapy. Methods: plasma efavirenz concentrations and HIV viral load were measured in HIV/AIDS patients treated with 600 mg efavirenz-based antiretroviral for 3 to 6 months and in HIV/AIDS-Tuberculosis infection patients treated with similar antiretroviral regimen plus rifampicin-containing antituberculosis in Prof. DR. Sulianti Saroso, Hospital Jakarta, Indonesia, The results were compared Results: Forty five patients (27 with HIV/AIDS and 18 with HIV/AIDSTuberculosis infections) were recruited during the period of March to May 2015. The median (min-max) efavirenz plasma concentration obtained from HIV/AIDS group [0,680 mg/L(0,24 to 5,67 mg/L] and that obtained from HIV/AIDSTuberculosis group[0.685 mg/L (0.12 -2.23 mg/L)] was not significantly different (Mann-Whitney U test, p = 0.480) .The proportion of patients with viral load ≥ 40 copies/ml after 3-6 months of ARV treatment in the HIV/AIDS group (51.9%), and the HIV/AIDS-Tuberculosis group (72.2%) was not significantly different (Chi Square test, p = 0.291). There was no significant difference (Chi Square, p=0,470) between the proportions of patients with subtherapeuticefavirenz plasma concentration in the groups with viral load < 40 copies/mL (45,2%) and ≥ 40 copies/mL (54,8%) Conclusions: Plasma efavirenz concentrations and viral load measurements in HIV/AIDS-Tuberculosis patients in antiretroviral and rifampicin-containing antituberculosis regimen were not significantly different with those in HIV/AIDS patients in 3 to 6 months antiretroviral therapy.]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Siti Mirdhatillah
"[ABSTRAK
Penghambat pompa proton (PPP) adalah salah satu contoh obat yang digunakan secara luas di dunia. Efikasi dan profil keamanan yang baik dari PPP berperan dalam terjadinya peresepan berlebihan di fasilitas pelayanan kesehatan. Data terkini menunjukan bahwa PPP berhubungan dengan peningkatan risiko pneumonia nosokomial. Penggunaan PPP intravena yang tidak tepat telah berkontribusi dalam meningkatkan total biaya kesehatan serta mengurangi ketersediaan obat.
Penelitian retrospektif observasional ini bertujuan untuk menganalisa total konsumsi PPP, total penggunaan sediaan PPP intravena, ketepatan penggunaan sediaan PPP intravena, ketepatan frekuensi penggunaan PPP, dan kejadian pneumonia nosokomial yang berhubungan dengan obat ini. Data diambil dari rekam medik pasien yang masuk ruang rawat inap Ilmu Penyakit Dalam RSCM selama periode Oktober hingga Desember 2014.
Pada penelitian ini, dari 210 pasien yang dievaluasi, terdapat 166 pasien (79%) menggunakan PPP, frekuensi ini lebih tinggi dari yang ditemukan pada rumah sakit di US (40-70%) dan di China (42%). Total konsumsi tercatat sebesar 194.31 defined daily dose (DDD)/ 100 bed-days, jauh lebih tinggi dibandingkan yang ditemukan di Irlandia dan India (56.73 dan 128 DDD/ 100 bed-days). Sediaan intravena diberikan pada 87.35% pasien dan hanya 34.48% pasien memiliki indikasi yang tepat. Frekuensi penggunaan diberikan tanpa diturunkan pada beberapa pasien. Persentase pneumonia nosokomial tujuh hingga delapan kali lipat lebih tinggi pada kelompok PPP dibandingkan kelompok non-PPP. Namun, peranan beberapa faktor risiko terhadap terjadinya pneumonia nosokomial tidak dapat disingkirkan.

ABSTRACT
Proton pump inhibitors (PPIs) are among the most widely used drugs in the world. The favorable efficacy and safety profile of these drugs has led to their over prescriptions in health care facilities. Recent data, however, has shown that the use of PPIs was associated with the increased risk of nosocomial pneumonia. Inappropriate use of intravenous PPIs has contributed to the increasing of total health cost and also decreasing the source of drugs.
This retrospective, observational study was aimed to analyze the total consumption of PPIs, the total use of intravenous PPIs preparations, the appropriateness use of intravenous PPIs preparations, the appropriateness of the frequency of PPIs adminstration, and the occurance of nosocomial pneumonia related to PPIs use. Data were obtained from medical records of patients who came to Internal Medicine Ward RSCM during the period of October to Desember 2014.
In this study, out of 210 patients evaluated, 166 patients (79%) used PPIs, the frequency is higher than those in hospitals in the US (40 to 70%) and in China (42%). The total consumption of PPIs was 194.31 defined daily dose (DDD)/ 100 bed-days, which is much higher compared to those in Ireland and India (56.73 and 128 DDD/ 100 bed-days). Intravenous preparations were admistered to 87.35% of patients, among which only 34.48% had been given for appropriate indications. There are no reduced of frequent used in some patients. The frequency of nosocomial pneumonia was seven to eight times higher among patients treated with PPIs compared to those without PPIs. However, the role of some risk factors that may contribute the occurance of nosocomial pneumonia cannot be ruled out.;Proton pump inhibitors (PPIs) are among the most widely used drugs in the world. The favorable efficacy and safety profile of these drugs has led to their over prescriptions in health care facilities. Recent data, however, has shown that the use of PPIs was associated with the increased risk of nosocomial pneumonia. Inappropriate use of intravenous PPIs has contributed to the increasing of total health cost and also decreasing the source of drugs.
This retrospective, observational study was aimed to analyze the total consumption of PPIs, the total use of intravenous PPIs preparations, the appropriateness use of intravenous PPIs preparations, the appropriateness of the frequency of PPIs adminstration, and the occurance of nosocomial pneumonia related to PPIs use. Data were obtained from medical records of patients who came to Internal Medicine Ward RSCM during the period of October to Desember 2014.
In this study, out of 210 patients evaluated, 166 patients (79%) used PPIs, the frequency is higher than those in hospitals in the US (40 to 70%) and in China (42%). The total consumption of PPIs was 194.31 defined daily dose (DDD)/ 100 bed-days, which is much higher compared to those in Ireland and India (56.73 and 128 DDD/ 100 bed-days). Intravenous preparations were admistered to 87.35% of patients, among which only 34.48% had been given for appropriate indications. There are no reduced of frequent used in some patients. The frequency of nosocomial pneumonia was seven to eight times higher among patients treated with PPIs compared to those without PPIs. However, the role of some risk factors that may contribute the occurance of nosocomial pneumonia cannot be ruled out., Proton pump inhibitors (PPIs) are among the most widely used drugs in the world. The favorable efficacy and safety profile of these drugs has led to their over prescriptions in health care facilities. Recent data, however, has shown that the use of PPIs was associated with the increased risk of nosocomial pneumonia. Inappropriate use of intravenous PPIs has contributed to the increasing of total health cost and also decreasing the source of drugs.
This retrospective, observational study was aimed to analyze the total consumption of PPIs, the total use of intravenous PPIs preparations, the appropriateness use of intravenous PPIs preparations, the appropriateness of the frequency of PPIs adminstration, and the occurance of nosocomial pneumonia related to PPIs use. Data were obtained from medical records of patients who came to Internal Medicine Ward RSCM during the period of October to Desember 2014.
In this study, out of 210 patients evaluated, 166 patients (79%) used PPIs, the frequency is higher than those in hospitals in the US (40 to 70%) and in China (42%). The total consumption of PPIs was 194.31 defined daily dose (DDD)/ 100 bed-days, which is much higher compared to those in Ireland and India (56.73 and 128 DDD/ 100 bed-days). Intravenous preparations were admistered to 87.35% of patients, among which only 34.48% had been given for appropriate indications. There are no reduced of frequent used in some patients. The frequency of nosocomial pneumonia was seven to eight times higher among patients treated with PPIs compared to those without PPIs. However, the role of some risk factors that may contribute the occurance of nosocomial pneumonia cannot be ruled out.]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Purba, Abdul Khairul Rizki
"[ABSTRAK
Latar belakang:
Penggunaan antibiotik empirik pada tata laksana penyakit infeksi, misalnya pneumonia
komunitas, sebaiknya mempertimbangkan bukti kemanfaatan klinis dan hasil
sensitivitas antibiotik pada suatu institusi pelayanan kesehatan. Penggunaan antibiotik
yang tidak tepat dapat menyebabkan kegagalan terapi, resistensi kuman, komplikasi
dan kematian. Biaya yang tinggi juga merupakan keluaran langsung dari penggunaan
antibiotik namun biasanya tidak dilaporkan. Oleh sebab itu, analisis terhadap biaya,
keluaran klinis, dan pola sensitivitas kuman menjadi sangat penting untuk menentukan
antibiotik empirik pada terapi pneumonia komunitas.
Tujuan:
Tujuan penelitian ini adalah menentukan antibiotik yang paling efektif dari aspek biaya
dan keluaran klinis pada tata laksana pneumonia komunitas.
Metode:
Penelitian ini dilakukan secara retrospektif pada pasien pneumonia komunitas di RSU
Dr. Soetomo Surabaya sejak 1 Januari sampai 31 Desember 2013. Analisis cost
effectiveness digunakan untuk evaluasi farmakoekonomi berdasarkan perbaikan klinis
hari ke-5, mortalitas, dan biaya total.
Hasil:
Sebanyak 434 pasien dirawat di RSU Dr. Soetomo dan menerima antibiotik empirik.
Sebanyak 200 pasien dikelompokkan menjadi 4 grup: seftriakson(35%), seftazidim
(26%), levofloksasin (14,5%), dan kombinasi seftazidim dan levofloksasin (24,5%).
Perbaikan klinis hari ke-5 tertinggi adalah kelompok yang diberi seftazidim sekitar
67,3%. Seftriakson merupakan antibiotik empirik yang paling efektif dengan ACER
505.585,3 untuk perbaikan klinis hari ke-5 namun hasil sensitivitas kuman
menunjukkan bahwa seftazidim masih lebih sensitif dari pada seftriakson (61,1% vs
38,5%) dengan nilai ACER seftazidim sebesar 763.322. Kombinasi seftazidim dan
levofloksasin digunakan untuk pasien dengan klinis yang buruk (PSI: 84,1+28,6) dan
berdampak pada tingginya biaya pengobatan (ACER 23685450.5).
Kesimpulan:
Seftazidim dapat dipertimbangkan sebagai antibiotik empirik yang efektif dan efisien
dalam tata laksana pneumonia komunitas yang dirawat di rumah sakit. Kombinasi seftazidim dan levofloksasin juga dapat dipertimbangkan untuk pasien pneumonia komunitas yang berat.ABSTRACT Introduction:
Empirical antibiotic use in the management of infectious disease such as community
pneumonia should be considered based on evidence of clinical effectiveness and
institutional antibiotic sensitivity results. Inappropriate antibiotic leads to failure in
treatment, microbial resistance, complications and mortality. In addition, high cost is
one of the direct impact of this condition that is usually under-reported. Thus, analysis
of cost and clinical outcome, besides antibiotic sensitivity pattern, should be performed
to find effective empirical antibiotic in the treatment in community acquired
pneumonia (CAP).
Aim:
The objective of the study was to determine the most effective antibiotic in cost and
clinical outcome in CAP.
Methodology:
This study has been conducted retrospectively in patient with CAP in Dr. Soetomo
Hospital Surabaya from 1 January to 31 December 2013. Cost effectiveness analysis
was used to evaluate pharmacoeconomic outcomes based on clinical improvement in
day 5, mortality, and total cost.
Results:
There were 434 hospitalized patients with pneumonia that received empirical
antibiotic. Two hundred patients were selected based on inclusion and exclusion
criteria of this study. Subjects were categorized into 4 groups: ceftriaxone (35%),
ceftazidim (26%), levofloxacin (14.5%), and combination ceftazidim and levofloxacin
(24.5%). Clinical improvement in day 5 and clinical remission was assessed with
highest number in ceftazidim group, roughly 67.3% and 76,9% respectively.
Furthermore, ceftriaxone was the most effective one with ACER 505585.3 for day 5
outcome. However, the ceftazidim sensitivity was higher than ceftriaxone (61,1% vs
38,5%), while ceftazidime was in the one second position with ACER 763322. The
combination ceftazidim and levofloxacin particularly used in worse clinical symptom
(PSI: 84,1+28,6) and lead to the highest cost with ACER 23685450.5.
Conclusion:
Ceftazidim should be considered as effective and efficient empirical antibiotic in the
management of hospitalized CAP. However, combination ceftazidim and levofloxacin is also could be effective to improve clinical sign for particular patient even with severe CAP. , Introduction:
Empirical antibiotic use in the management of infectious disease such as community
pneumonia should be considered based on evidence of clinical effectiveness and
institutional antibiotic sensitivity results. Inappropriate antibiotic leads to failure in
treatment, microbial resistance, complications and mortality. In addition, high cost is
one of the direct impact of this condition that is usually under-reported. Thus, analysis
of cost and clinical outcome, besides antibiotic sensitivity pattern, should be performed
to find effective empirical antibiotic in the treatment in community acquired
pneumonia (CAP).
Aim:
The objective of the study was to determine the most effective antibiotic in cost and
clinical outcome in CAP.
Methodology:
This study has been conducted retrospectively in patient with CAP in Dr. Soetomo
Hospital Surabaya from 1 January to 31 December 2013. Cost effectiveness analysis
was used to evaluate pharmacoeconomic outcomes based on clinical improvement in
day 5, mortality, and total cost.
Results:
There were 434 hospitalized patients with pneumonia that received empirical
antibiotic. Two hundred patients were selected based on inclusion and exclusion
criteria of this study. Subjects were categorized into 4 groups: ceftriaxone (35%),
ceftazidim (26%), levofloxacin (14.5%), and combination ceftazidim and levofloxacin
(24.5%). Clinical improvement in day 5 and clinical remission was assessed with
highest number in ceftazidim group, roughly 67.3% and 76,9% respectively.
Furthermore, ceftriaxone was the most effective one with ACER 505585.3 for day 5
outcome. However, the ceftazidim sensitivity was higher than ceftriaxone (61,1% vs
38,5%), while ceftazidime was in the one second position with ACER 763322. The
combination ceftazidim and levofloxacin particularly used in worse clinical symptom
(PSI: 84,1+28,6) and lead to the highest cost with ACER 23685450.5.
Conclusion:
Ceftazidim should be considered as effective and efficient empirical antibiotic in the
management of hospitalized CAP. However, combination ceftazidim and levofloxacin is also could be effective to improve clinical sign for particular patient even with severe CAP. ]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Jason Sriwijaya
"Dihidroartemisinin-piperakuin (DHA-PPQ) telah digunakan secara global sebagai terapi kombinasi standar pada pengobatan malaria vivaks di Indonesia. Efikasi dan keamanan obat ini banyak dilaporkan, namun data efek samping obat terhadap jantung masih sangat terbatas. Salah satu efek samping yang patut diwaspadai adalah pemanjangan repolarisasi ventrikel yang dapat menyebabkan berkembangnya aritmia ventrikuler yang dikenal sebagai Torsade de Pointes (TdP).
Pengukuran interval QT telah dijadikan standar untuk mengukur waktu repolarisasi ventrikel. Interval QT juga mewakili waktu yang dibutuhkan untuk depolarisasi dan repolarisasi ventrikel sehingga tidak selalu bisa dijadikan indikator akurat pada kelainan repolarisasi. Saat ini pengukuran interval QT digunakan sebagai standar utama penilaian efek samping obat terhadap jantung, namun menurut pemikiran sebagian ahli, pengukuran interval JT lebih akurat untuk mengukur waktu repolarisasi ventrikel, karena tidak terpengaruh oleh variabilitas durasi kompleks QRS. Interval QT dan JT dipengaruhi oleh frekuensi denyut jantung, maka dalam penelitian ini digunakan dua formula yang sudah dikoreksi terhadap frekuensi denyut jantung, yaitu formula Bazett (QTcB, JTcB) dan Fridericia (QTcF, JTcF).
Penelitian before-after ini bertujuan untuk mengetahui perbedaan nilai rerata interval QTc dan JTc penderita malaria vivaks sebelum dan sesudah pemberian DHA-PPQ. Penelitian ini dilakukan pada penderita malaria vivaks yang juga diberikan primakuin (PQ) untuk mencegah kekambuhan, sehingga juga dilakukan pengukuran interval QTc dan JTc sebelum dan sesudah pemberian PQ.
Subyek yang masuk dalam kriteria seleksi pada pemberian DHA-PPQ berjumlah 24 subyek, sedangkan pada pemberian PQ sebanyak 14 subyek. Pengukuran interval QT dan JT dilakukan pada data rekaman EKG penelitian utama ?Safety, tolerability, and efficacy of artesunat-pyonaridine or dihydroartemisinin-piperaquine in combination with primaquine as radical cure for P. Vivax in Indonesian Soldiers? tahun 2010.
Hasil penelitian menunjukkan terdapat pemanjangan rerata interval QTcF dibandingkan baseline yang bermakna secara statistik di D3 setelah pemberian DHA-PPQ. Pemanjangan sebesar 14,42 milidetik terjadi di D3 predose dan 20,53 milidetik di D3 postdose, sedangkan rerata pemanjangan interval JTcF yang bermakna setelah pemberian DHA-PPQ, didapatkan sebesar 13,43 milidetik di D3 postdose.
Hasil penelitian pada pemberian PQ terdapat perbedaan nilai rerata interval QTcB dibandingkan baseline sebesar 19,42 milidetik. Nilai median interval QTcB di D42 predose dan D42 postdose, masing-masing sebesar 402,69 milidetik dan 399,73 milidetik, sedangkan nilai median QTcB D29 predose sebagai baseline 380,31 milidetik, dan perbedaan tersebut bermakna secara statistik. Untuk rerata pemanjangan interval JTcF dibandingkan baseline diperoleh sebesar 16,50 milidetik di D42 postdose dan secara statistik bermakna.

Dihydroartemisinin-piperaquin (DHA-PPQ) has been used globally as standard combination therapies for vivax malaria treatment in Indonesia. There are accumulating reports of efficacy and safety for these drugs. However, data on cardiotoxicity are limited. One of the side effects that must be put into caution is the prolongation of ventricular repolarization which can lead to the development of ventricular arrhythmia known as Torsade de Pointes (TdP).
QT interval has been the standard measurement of ventricular repolarization. However, it includes both depolarization and repolarization time, and may not always be an accurate indicator for repolarization abnormalities. Recently, many experts suggest that JT interval could be a more accurate measurement of ventricular repolarization since the variability of QRS complex duration does not affect it. QT and JT intervals are affected by heart rate, so both of them have to be corrected for the heart rate using two formulas, i.e.: Bazett (QTcB, JTcB) and Fridericia (QTcF, JTcF) formulas.
This study used ?before and after? design and was aimed to find out whether there was a significant difference of QTc and JTc interval of vivax malaria patients pre and post DHA-PPQ dose. Since our patients were also given primaquine (PQ) the differences of QTc and JTc interval of vivax malaria patients pre and post PQ were also explored.
The ECG record of 24 DHA-PPQ and 14 PQ treated subjects taken from ?Safety, tolerability, and efficacy of artesunat-pyonaridine or dihydroartemisinin-piperaquine in combination with Primaquine as radical cure for P. Vivax in Indonesian Soldiers? study in the 2010 year, were analyzed.
The results showed significant QTcF prolongations of 14.42 ms predose and 20.53 ms postdose on D3 DHA-PPQ treatment compared to the baseline value, D1, whereas prolongations of JT interval were 13.43 ms found on D3 postdose.
The results after given PQ showed mean difference of QTcB compared to the baseline value was 19.42 ms and the values of QTcB interval median were 402.69 ms and 399.73 ms for D42 predose and D42 postdose, respectively, compared to the baseline value 380.31 ms for D29 predose, and which was statistically significant. The result for JTcF interval after given PQ, showed mean difference of prolongations compared to the baseline value was 16.50 ms, statistically significant."
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Gestina Aliska
"ABSTRAK
Latar belakang
Kematian akibat sepsis dan syok septik pada pasien rawatan Intensive Care Unit (ICU) yaitu 20-30%. Pemberian antibiotik empirik yang tepat merupakan salah satu langkah awal yang sangat penting. Amikasin merupakan salah satu antibiotik terpilih untuk tata laksana sepsis di ICU RSUPN dr. Cipto Mangunkusumo (RSCM). Saat ini belum pernah dilakukan penelitian mengenai ketercapaian kadar terapi amikasin dengan menggunakan dosis standar amikasin pada pasien sepsis dewasa di ICU RSCM, sehingga studi ini menjadi penelitian pertama di Indonesia.
Penelitian ini bertujuan untuk mengetahui ketercapaian kadar amikasin optimal pada pasien ICU RSCM.
Metode
Data dikumpulkan secara potong lintang melalui observasi terhadap hasil pemeriksaan kadar plasma amikasin, pengukuran minimum inhibitory concentration (MIC) dan perhitungan rasio Cmax/MIC pada pasien sepsis di ICU RSCM periode Mei-September tahun 2015.
Hasil penelitian
Proporsi pasien sepsis dengan kadar amikasin optimal ialah sebesar 57% (4/7). Kadar puncak amikasin yang dapat dicapai dengan dosis 1000 mg sekali sehari tanpa menghiraukan berat badan ialah median 86,4 (43,5-238) µg/mL. Pada penelitian ini ditemukan 87% pasien dengan kadar puncak amikasin di atas 64 µg/mL, meskipun amikasin 1000 mg tersebut lebih rendah dari dosis yang dianjurkan untuk sepsis (25 mg/kgBB). Sebagian besar (78,3 %) subyek pada kenyataannya menerima dosis 15-25 mg/kgBB, dengan pemberian 1000 mg amikasin tanpa memperhatikan berat badan. Bakteri yang banyak ditemukan dari hasil kultur pasien sepsis di ICU RSCM, yaitu K. pneumoniae, A. baumanii, P. aeruginosa dan E. coli. Rentang nilai MIC untuk patogen tersebut berturut-turut yaitu 0,75 - >256 µg/mL, 0,75 - >256 µg/mL, 1,5 - >256 µg/mL dan 0,75 - 16) µg/mL. Sebanyak 84% isolat K. pneumoniae masih sensitif terhadap amikasin, diikuti oleh 63% untuk A. baumanii, 47% P. aeruginosa dan 100% untuk E. coli.
Kesimpulan
Optimalitas amikasin terhadap bakteri Gram negatif penyebab sepsis bergantung kadar puncak dan MIC bakteri. Kadar puncak plasma amikasin yang dicapai dengan dosis 1000 mg sekali sehari sangat bervariasi. Pemberian amikasin dengan dosis per kgBB dapat dipertimbangkan. Kepekaan beberapa bakteri Gram negatif terhadap amikasin mulai menurun dengan rentang MIC yang cukup lebar. Pengukuran ketercapaian kadar optimal dalam terapi definitif dapat dilakukan untuk meningkatkan keberhasilan terapi.ABSTRACT
Background
The mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.
The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.
Methods
This was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.
Results
The proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.
Conclusions
Amikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment.;Background
The mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.
The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.
Methods
This was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.
Results
The proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.
Conclusions
Amikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment.;Background
The mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.
The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.
Methods
This was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.
Results
The proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.
Conclusions
Amikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment."
Fakultas Kedokteran Universitas Indonesia, 2016
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UI - Tugas Akhir  Universitas Indonesia Library
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Cindy Tiaranita
"ABSTRAK
Latar Belakang: Gagal jantung merupakan salah satu masalah kesehatan global dengan angka yang meningkat setiap tahunnya. Pengobatan gagal jantung melibatkan berbagai golongan obat, salah satunya adalah digoksin sebagai komponen terapi tertua pada gagal jantung. Penggunaan digoksin masih kontroversial karena selain batas terapeutik sempit, terdapat berbagai faktor yang dapat meningkatkan risiko terjadinya intoksikasi.
Tujuan: Menganalisis kejadian intoksikasi, rehospitalisasi, dan kesintasan dalam setahun pada pasien gagal jantung yang mendapat digoksin.
Metode: Studi analitik observasional dengan desain potong lintang dilakukan di Rumah Sakit Pusat Jantung dan Pembuluh Darah Harapan Kita pada bulan Januari 2017 hingga Desember 2018. Pasien gagal jantung yang mendapatkan terapi digoksin dan diperiksa kadar digoksin serum diikutsertakan dalam penelitian. Intoksikasi didefinisikan sebagai peningkatan kadar digoksin serum ≥ 2 ng/ml disertai dengan perubahan EKG tipikal intoksikasi dan minimal satu gejala non-kardiak. Dilakukan analisis terhadap faktor-faktor risiko pada pasien dan gejala intoksikasi menggunakan uji X2, sedangkan angka kesintasan dan rehospitalisasi dalam setahun dianalisis dengan rumus Kaplan Meyer.
Hasil: Sebanyak 195 subyek penelitian yang terdiri dari 22 (11,3%) subyek dengan kadar digoksin subterapeutik, 43 (22,1%) subyek dengan kadar terapeutik, 70 (35,9%) subyek dengan kadar supraterapeutik dan 60 (30,8%) subyek dengan kadar toksik diikutsertakan dalam studi ini. Didapatkan sebanyak 32 (16,4%) subyek mengalami intoksikasi. Insufisiensi renal merupakan faktor risiko yang sangat memengaruhi kejadian intoksikasi digoksin, dengan risiko sebesar 2,5 kali (p=0,016; RR=2,484). Angka rehospitalisasi pada pasien gagal jantung yang mendapat dan tidak mendapat digoksin adalah sebesar 11,8% dan 29,2% (p=0,085). Angka kesintasan dalam setahun pada pasien gagal jantung yang mendapat digoksin di RS JPDHK tahun 2017-2018 adalah 300 hari (259 hari pada yang mengalami intoksikasi, dan 307 hari pada yang tidak mengalami intoksikasi).
Kesimpulan: Proporsi intoksikasi digoksin pasien gagal jantung pada penelitian ini adalah 16,4%. Insufisiensi renal merupakan faktor risiko yang memengaruhi kejadian intoksikasi digoksin. Terdapat kecendrungan pengurangan rehospitalisasi pada pasien yang mendapat digoksin.

ABSTRACT
Background: Heart failure is one of the most prevalent global health problems with increasing number every year. Treatment of heart failure involves various classes of drugs, one of which is digoxin as the oldest therapy for heart failure. The use of digoxin is still controversial because of a narrow therapeutic limit, there are various factors that can increases the risk of intoxication.
Objective: To analyze digoxin intoxication, rate of rehospitalization as well as one-year survival in patients with heart failure who were prescribed digoxin.
Methods: An observational analytic study with a cross-sectional design was conducted at the Harapan Kita National Cardiovascular Center from January 2017 to December 2018. Heart failure patients who received digoxin therapy and had been examined for serum digoxin levels were included in the study. Intoxication was defined as having increased serum digoxin level exceeding 2 ng/ml along with electrocardiogram changes and a minimum of one non-cardiac symptomsRisk factors of intoxication were analyzed by Chi-square test, and one year survival was analyzed with Kaplan Meyer method.
Results: A total of 195 study subjects consisting of 22 (11,3%) subjects with subtherapeutic digoxin levels, 43 (22,1%) were therapeutic, and 70 (35,9%) supratherapeutic and 60 (30,8%) toxic digoxin level were included in the study. There were 32 (16.4%) subjects having digoxin intoxication in this study. Renal insufficiency was revield as significant influencing factor of digoxin intoxication with 2.5 fold increasing risk. Overall, one-year survival of heart failure patients receiving digoxin was 300 days (259 days in non-intoxication group and 307 days in intoxication group). One-year rehospitalization was 11,8% in patients who received digoxin, and 29,2% in those without digoxin (p=0.085).
Conclusion: The proportion of digoxin intoxication in heart failure patient is 16,4%. Renal insufficiency was reviled as significant influencing factor of intoxication. There was a tendency of reduced hospitalization in those who received digoxin."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Tugas Akhir  Universitas Indonesia Library
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Triasti Khusfiani
"Pendahuluan: PGK merupakan penyakit yang sering memiliki beberapa komorbid sehingga perlu menggunakan berbagai terapi kombinasi obat. Oleh sebab itu, polifarmasi sering dilakukan dan salah satu konsekuensinya adalah terjadinya potensi interaksi obat (PIO). PIO dianggap sebagai masalah pengobatan yang dapat dicegah, namun dalam praktik klinis dapat mengakibatkan efek samping obat (ESO) atau reaksi obat yang merugikan. Hal tersebut tentu akan mempengaruhi klinis dan keberhasilan pengobatan serta keamanan penggunaan obat pada pasien PGK. Penelitian ini bertujuan untuk mengetahui pola peresepan pasien PGK dan pengaruhnya terhadap potensi interaksi dan efek samping obat yang dicurigai akibat interaksi obat.
Metode: Penelitian ini merupakan penelitian non eksperimental dan pengambilan data dilakukan secara potong lintang pada pasien PGK rawat jalan stadium 3-5 pre-dialisis di rumah sakit Cipto Mangunkusumo (RSCM) dalam periode Januari 2019 sampai dengan Desember 2020. Data diambil dari electronic health record dan pusat rekam medis RSCM. Rujukan potensi interaksi obat menggunakan software Micromedex.
Hasil: Terdapat 106 pasien yang memenuhi persyaratan dan diambil menjadi subjek penelitian. Hasil penelitian menunjukkan bahwa pada pasien PGK rawat jalan stadium 3- 5 pre-dialisis di RSCM tahun 2019-2020, terdapat 111 jenis obat yang diresepkan dan obat yang paling sering diresepkan adalah bisoprolol (36,5%). Proporsi pasien yang mendapatkan pengobatan dengan potensi interaksi obat adalah 76% (81 pasien), sedangkan proporsi pasien yang mengalami ESO yang dicurigai akibat interaksi obat adalah 28% (23 pasien) dari 81 pasien dengan PIO. ESO tersebut berupa hiperglikemi (17 pasien), hipertensi (1 pasien), hiperkalemi (1 pasien) dan hipotensi (1 pasien). Terdapat hubungan yang bermakna secara statistik antara variabel perancu yaitu, jumlah obat > 10, komorbid jantung dan DM dengan ESO yang dicurigai akibat interaksi obat (p<0.05). Hasil multivariat mendapatkan hanya komorbid jantung (gagal jantung dan penyakit jantung koroner) yang memiliki hubungan yang bermakna secara statistik dengan ESO yang dicurigai akibat interaksi obat (p = 0,03).
Kesimpulan: Pada penelitian ini, sebanyak 76% pasien mendapatkan pengobatan dengan PIO. Sedangkan 28% pasien dari 81 pasien dengan PIO mengalami ESO yang dicurigai akibat interaksi obat. ESO yang paling banyak dialami adalah hiperglikemi. Komorbid jantung merupakan faktor risiko terjadinya ESO yang dicurigai akibat interaksi obat.

Introduction: CKD often has several comorbidities so it is necessary to use various drug combination therapies. Therefore, it can lead to polypharmacy and one of its consequences is the occurrence of potential drug-drug interactions (DDI). DDI is considered a problem that can be prevented, but in clinical practice it can result in adverse drug reactions (ADR). This will certainly affect the clinical and treatment success as well as the safety of the drug use in CKD patients. This study was aimed to determine the prescribing pattern and its effect on potential DDI and ADR that are suspected due to DDI.
Methods: This was a non-experimental cross-sectional study, conducted on CKD outpatients stage 3-5 pre-dialysis at Cipto Mangunkusumo Hospital in the period January 2019 to December 2020. Data were taken from electronic health records and the hospital’s medical record. The Micromedex software was used as a reference for potential drug interactions.
Results: There were 106 patients who met the requirements and were taken as research subjects. The results showed that in CKD out-patients stage 3-5 pre-dialysis at RSCM in 2019-2020, there were 111 types of drugs prescribed and the most frequently prescribed drug was bisoprolol (36.5%). The proportion of patients who received treatment with a potential DDI was 76% (81 patients), while the proportion of patients who experienced ADR suspected due to DDI was 28% (23 patients) from 81 patients with suspected DDI. The ADRs were hyperglycemia (17 patients), hypertension (1 patient), hyperkalemia (1 patient) and hypotension (1 patient). There was a statistically significant association between the confounding variables, namely, number of drugs, cardiovascular disease and DM with ADR suspected due to DDI (p<0.05). Multivariate analysis found that only cardiovascular disease (congestive heart failure and coronary artery disease) had a statistically significant relationship with ADR suspected due to DDI (p = 0.03).
Conclusion: In this study, 76% of patients received treatment with potential DDI. Meanwhile, 23% from 81 patients patients with DDI experienced ADR suspected due to drug interactions. The most often occuring ADR is hyperglycemia. It was found that cardivascular comorbidity is a risk factor for having an ADR suspected cause by DDI.
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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021
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UI - Tugas Akhir  Universitas Indonesia Library