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Abstrak :
Pneumonia merupakan salah satu penyakit menular yang sering terlihat pada pasien penyakit ginjal kronis (PGK). Antibiotik yang digunakan dalam terapi farmakologis pneumonia sering kali memerlukan pengaturan dosis akibat penurunan fungsi ginjal. Studi cross-sectional ini dilakukan untuk mengetahui ketepatan dosis antibiotik dan pengaruhnya pada luaran terapi dan durasi rawat pada pasien pneumonia dengan PGK di RSUP Persahabatan Jakarta. Data pasien diambil secara retrospektif pada periode 2021-2023 menggunakan metode total sampling. Analisis statistik dilakukan dengan metode Chi-squared untuk kesesuaian dosis dan hubungan kesesuaian dosis dengan luaran terapi dan Mann-Whitney untuk kesesuaian dosis dengan durasi rawat. Diperoleh 111 sampel penelitian yang mayoritias merupakan laki-laki dengan median usia 59 tahun dengan penyakit ginjal stadium akhir. Sefoperazon merupakan antibiotik yang paling banyak digunakan, diikuti oleh levofloksasin dan sefotaksim. Mayoritas pasien (51,4%) menerima peresepan antibiotik dengan pengaturan dosis yang tidak tepat. Ditemukan bahwa nilai laju filtrasi glomerulus (LFG) (p < 0,001; RR = 1,048) dan hemodialisis (p = 0,003; RR = 0,571) memengaruhi kesesuaian dosis. Tidak ditemukan hubungan yang signifikan antara kesesuaian dosis dengan luaran terapi; faktor lain yang memengaruhi luaran terapi meliputi nilai Charlson comorbidity index (CCI) (p = 0,007; RR = 1,829), jenis terapi (p = 0,023; RR = 1,183) dan sepsis (p < 0,001; RR = 0,368). Kesesuaian dosis memengaruhi durasi rawat secara signifikan (p < 0,001) dan faktor lain yang memengaruhi durasi rawat adalah hemodialisis (p = 0,019). Temuan ini menunjukkan masih adanya ketidaksesuaian pengaturan dosis yang perlu diperbaiki dengan melibatkan apoteker dan tenaga kesehatan lain dalam pengaturan dosis antibiotik. ......Pneumonia is one of the most prevalent infectious diseases in patients with chronic kidney disease (CKD). Antibiotics used in pneumonia often require dose adjustments. A cross-sectional study was conducted to determine antibiotic dose appropriateness and its impact on patients’ outcomes and length of stay (LOS) at the Persahabatan National Respiratory Hospital Jakarta. Patients’ data were retrospectively reviewed between 2021 and 2023 using the total sampling method. Statistical analyses were performed with the Chi-squared analyses for dose appropriateness and outcomes and the Mann-Whitney test for LOS. A total of 111 samples were included in the study, with the majority being males with a median age of 59 and end-stage renal disease. Cefoperazone was prescribed more than any other antibiotics, followed by levofloxacin and cefotaxime. Most patients (51,4%) received antibiotics with inappropriate dose adjustment. Low estimated glomerular filtration rate (eGFR) (p < 0,001; RR = 1,048) and haemodialysis (p = 0,003; RR = 0,571) were independently associated with inappropriate dose adjustment. No statistically significant association was found between dose appropriateness and clinical outcome; other associated factors include a high Charlson comorbidity index (CCI) score (p = 0,007; RR = 1,829), type of therapy (p = 0,023; RR = 1,183), and sepsis (p < 0,001; RR = 0,368). Inappropriate dose adjustments were associated with a longer LOS (p < 0,001). Other associated factors include haemodialysis (p = 0,019). These findings indicate substantial dose adjustment inappropriateness that requires immediate attention and collaboration by pharmacists and other healthcare professionals to ensure appropriate adjustment.

Abstrak :
Diabetes Mellitus Tipe 2 (DMT2) adalah penyakit kronis yang ditandai dengan tingginya kadar gula dalam darah. Indonesia menempati peringkat ketiga kasus DMT2 di Asia Tenggara. Pengobatan yang tidak optimal dapat meningkatkan prevalensi kematian akibat komplikasi. Oleh karena itu, penelitian ini dilakukan untuk menganalisis secara deskriptif perbandingan karakteristik pasien DMT2 yang menerima terapi dipeptidyl peptidase 4 inhibitor (DPP4i) dan/atau sodium glucose cotransporter-2 inhibitors (SGLT2i) dan mengidentifikasi kesesuaian dosis pada pasien dengan gangguan hati, gangguan ginjal, dan geriatri. Penelitian ini adalah studi observasional cross-sectional dengan 132 subjek menggunakan metode total sampling. Data diperoleh retrospektif dari rekam medis. Hasilnya menunjukkan mayoritas penerima terapi DPP4i dan/atau SGLT2i berusia dewasa di bawah 60 tahun, dengan pria lebih banyak daripada wanita. Penyakit kardiovaskular merupakan penyakit penyerta terbanyak, dan obat penurun gula darah dan agen pengubah lipid adalah obat lain yang paling sering dikonsumsi. Tidak terdapat perbedaan signifikan antara karakteristik pasien dengan jenis obat (p > 0,05). Ditemukan perbedaan signifikan antara penyakit penyerta dengan jenis obat (p = 0,003), dan terdapat perbedaan signifikan antara jenis obat lain yang dikonsumsi dengan jenis obat DPP4i dan/atau SGLT2i (p < 0,001) yang dianalisis menggunakan uji Chi Square. Selain itu, kesesuaian dosis pada pasien dengan gangguan hati dan ginjal belum sepenuhnya sesuai. Dalam penelitian ini, diberikan gambaran mengenai karakteristik pasien dan kesesuaian dosis DPP4i dan/atau SGLT2i, obat antidiabetes yang masih tergolong baru, terutama di Rumah Sakit Universitas Indonesia. Evaluasi lebih lanjut diperlukan agar pengobatan dapat optimal dalam mengurangi komplikasi dan mortalitas pasien DMT2. ......Type 2 diabetes mellitus (T2DM) can lead to complications resulting in mortality. Indonesia ranks third in the prevalence of T2DM cases in the Southeast Asian region. Ineffective treatment of T2DM patients can increase the prevalence of complications-related deaths. Therefore, this research aims to descriptively analyze the characteristics of T2DM patients receiving dipeptidyl peptidase 4 inhibitors (DPP4i) and/or sodium glucose cotransporter-2 inhibitors (SGLT2i) therapy, as well as identify dosage appropriateness in patients with liver and kidney disorders, and geriatric patients. The study also involves identifying dosage regimens for DPP4i and SGLT2i. This study is an analytical descriptive observational research with a cross-sectional study design. A total of 132 research subjects receiving DPP4i and/or SGLT2i therapy during the period from January 2021 to December 2022 were included in this study using total sampling method. Data were retrospectively obtained from medical records of T2DM patients. The results of the study showed that the majority of patients receiving DPP4i and/or SGLT2i therapy were adults under 60 years of age, with a higher proportion of male patients than female patients. The average duration of treatment was ≤ 3 months, the number of comorbidities was ≥ 8 diseases, and the average number of other medications consumed was ≤ 5 types of medications. There was no significant difference between patient characteristics and types of medications (p > 0.05) analyzed using the Chi-Square test. Additionally, the most common comorbidity among patients receiving DPP4i and/or SGLT2i therapy was cardiovascular disease. A significant difference was found between the types of medications used and comorbidities (p = 0.003) analyzed using the Chi-Square test. Antidiabetic agents and lipid-modifying agents were the most commonly consumed medications, and there was a significant difference between the types of medications used and comorbidities (p < 0.001) analyzed using the Chi-Square test. During health examinations, several parameters were not adequately controlled prior to initiating therapy in patients. Furthermore, dosing adequacy for patients with liver and kidney disorders was not fully met, while in geriatric patients, dosing was appropriate. In the dosage regimens, there were still patients receiving DPP4i and SGLT2i therapy that were not appropriately dosed from the total patient population. This study provides an overview of patient characteristics and dosing adequacy of DPP4i and SGLT2i, relatively new antidiabetic medications, particularly in the University of Indonesia Hospital. Further evaluation is needed to optimize treatment in reducing complications and mortality, especially in patients with T2DM.

Abstrak :
Penyakit ginjal kronis (PGK) berkaitan dengan perburukan dan kematian akibat COVID-19. Pasien COVID-19 dengan PGK yang menjalani rawat inap banyak diberikan antivirus dan/atau antibiotik yang memerlukan penyesuaian dosis. Penyesuaian dosis dianalisis berdasarkan laju filtrasi glomerulus (LFG) pasien yang diestimasi dengan metode CKD-EPI. Studi cross-sectional ini bertujuan untuk mengevaluasi penyesuaian dosis antivirus dan/atau antibiotik pada pasien COVID-19 dengan PGK terhadap luaran terapi dan durasi rawat inap di RSUD Pasar Minggu Jakarta periode Januari hingga Desember 2021. Penelitian ini menggunakan teknik total sampling.  Hasil menemukan 70 pasien (51,1%) dari 137 pasien menerima dosis antivirus dan/atau antibiotik yang tidak sesuai anjuran pedoman. Hasil uji Chi-square menunjukkan bahwa pasien dengan dosis sesuai memiliki kecenderungan sebesar 2,236 kali lebih tinggi untuk mencapai luaran terapi perbaikan dibandingkan pasien dengan dosis tidak sesuai (p = 0,032). Faktor lain yang memengaruhi luaran terapi adalah usia (p = 0,000) dan derajat keparahan COVID-19 (p = 0,000). Hasil uji Mann-Whitney U menunjukkan tidak ada hubungan antara kesesuaian dosis dan durasi rawat inap (p = 0,303). Faktor lain yang memengaruhi durasi rawat inap pasien COVID-19 dengan PGK adalah derajat keparahan COVID (p = 0,020), stage PGK (p = 0,020), komorbid selain PGK (p = 0,062), dan luaran terapi (p = 0,001). ......Chronic kidney disease (CKD) is associated with worsening and death from COVID-19. COVID-19 patients with CKD who are hospitalized are often given antivirals and/or antibiotics that require dose adjustments. Dose adjustment can be analyzed based on the patient's glomerular filtration rate (GFR) estimated by the CKD-EPI method. This cross-sectional study aims to evaluate the dose adjustment of antiviral and/or antibiotic and analyze its relation with therapeutic outcomes and length of stay of COVID-19 patients with CKD at Pasar Minggu Hospital, Jakarta from January to December 2021. This study used a total sampling technique. Results found that 70 patients (51.1%) of 137 patients received inappropriate doses. Results of Chi-square test showed that patients with appropriate doses had a tendency of 2,236 times higher to achieve improved therapeutic outcomes than patients with inappropriate doses (p = 0.032). Other factors that influenced therapeutic outcomes were age (p = 0.000) and severity of COVID-19 (p = 0.000). Results of Mann-Whitney U test showed no relationship between dose adjustments and length of stay (p = 0.303). Other factors that influenced length of stay were the severity of COVID (p = 0.020), CKD stage (p = 0.020), comorbidities other than CKD (p = 0.062), and therapeutic outcomes (p = 0.001).