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"Kondisi multipatologi pada pasien geriatri dapat mengakibatkan polifarmasi, interaksi obat, dan peresepan yang tidak sesuai. Penghambat pompa proton adalah salah satu obat yang sering diresepkan pada pasien geriatri. Evaluasi penggunaan obat diperlukan untuk meningkatkan ketepatan dan keefektifan peresepan penghambat pompa proton terutama pada pasien geriatri. Penelitian ini merupakan studi retrospektif deskriptif. Sampel yang digunakan adalah data rekam medik pasien geriatri yang dirawat di ruang rawat inap geriatri RSCM dalam periode Januari hingga Juni 2015. Penelitian ini menganalisa besar penggunaan penghambat pompa proton menggunakan sistem Anatomical Therapeutic Chemical Defined Daily Dose (ATC/DDD) dan perbandingannya dengan penelitian lain. Hasil penelitian menunjukkan 60,2% pasien menggunakan penghambat pompa proton yang 96,4% diantaranya adalah omeprazol. Rute pemberian yang paling dominan adalah intra vena (89,3%). Besar penggunaan penghambat pompa proton 33,79 DDD/100 bed-days. Dibandingkan dengan prevalensi GERD sebagai indikasi obat ini, nilai DDD/100 bed-days penghambat pompa proton lebih tinggi. Hal ini memperlihatkan penggunaan penghambat pompa proton yang berlebihan pada pasien geriatri.

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Multipathologic conditions in geriatric patients can lead to polypharmacy, drug interactions, and irrational prescribing. Proton pump inhibitors are one of the most prescribed drug in geriatric patients. Evaluation of the use of the drug is needed to improve the provision and effectiveness of proton pump inhibitors prescription, especially in geriatric patients. This study is a retrospective descriptive study. The samples were taken from geriatric patient medical records during the period of January to June 2015 in inpatient geriatric ward RSCM. This study analyzes quantitatively the use of proton pump inhibitors using the Anatomical Therapeutic Chemical/Defined Daily Dose system (ATC / DDD) and compare it with other studies. The results showed that 60.2% of patients used proton pump inhibitors, 96.4% of which was omeprazole. The most dominant route of administration was IV (89.3%). The total use of proton pump inhibitors is 33.79 DDD / 100 bed-days. Compared with the prevalence of GERD as an indication of this drug , the value of proton pump inhibitors DDD / 100 bed ?days is higher. This shows the utilization of a proton pump inhibitor was excessive in geriatric patients."

"Pasien geriatri rentan mengidap berbagai penyakit (multipatologi) sehingga memungkinkan terjadi polifarmasi. Saat ini, trend penggunaan statin di beberapa negara mengalami peningkatan. Statin digunakan sebagai pencegahan primer dan sekunder penyakit jantung koroner yang prevalensinya terbanyak pada pasien geriatri. Di RSCM belum ada kajian kuantitatif penggunaan statin, sehingga perlu dilakukan kajian penggunaan statin pada pasien geriatri guna mengetahui besar penggunaan statin di RSCM. Studi ini adalah penelitian cross sectional menggunakan kajian defined daily dose (DDD) pada pasien geriatri (>60 tahun) rawat inap di RSCM pada periode Januari-Juni 2015. Hasil yang didapatkan adalah 24 pasien menggunakan statin; 22 pasien (91.6%) menggunakan simvastatin dan 2 pasien (8.4%) menggunakan atorvastatin. Diperoleh hasil DDD total statin 4.12 DDD/100 bed-days, dengan DDD simvastatin dan atorvastatin berrturut-turut 3.68 dan 0.28 DDD/100 bed-days. Profil penggunaan obat statin pada pasien geriatri rawat inap di RSCM tergolong rendah dibandingkan dengan negara lain, seperti India dengan DDD total statin 55.6 DDD/100 bed-days dan 4.32 DDD/100 bed-days

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Geriatric patients are susceptible to multipathologic condition and susceptible to polypharmacy. Nowadays, trend of statin utilization in some countries has been raising. Statin is used for primary and secondary prevention of coronary heart disease, which has the highest prevalence in elderly. There is no quantitative study about statin utilization in RSCM, so a study of statin utilization in geriatric patient in RSCM is needed. This is a cross sectional study evaluating the quantitative use of statin in geriatric patients (>60 years old) admitted in medicine ward of RSCM from January-June 2015 using the defined daily dose (DDD) system. The results shows that 24 patients used statin: 22 patients (91.6%) were prescribed simvastatin and 2 patients (8.4%) were prescribed atorvastatin. The total statin DDD is 4.12 DDD/100 bed-days with the DDD of simvastatin and atorvastatin is 3.68 and 0.28 DDD/100 bed-days, respectively. The statin utilization in hospitalized geriatric patients in RSCM was lower compared to other country, such as India with total satin DDD is 55.6 DDD/100 bed-days and 4.32 DDD/100 bed-days."

"Antiemetik pada pasien geriatri digunakan sebagai terapi untuk mengatasi mual dan muntah yang disebabkan beberapa penyakit, seperti gangguan pencernaan, gangguan keseimbangan, dan kanker. Berdasarkan kriteria Beers, terdapat beberapa antiemetik yang berpotensi tidak tepat pada pasien geriatri sehingga tidak direkomendasikan. Penelitian ini bertujuan untuk mengevaluasi penggunaan antiemetik di unit rawat inap geriatri Rumah Sakit Cipto Mangunkusumo (RSCM) yang diukur menggunakan metode Defined Daily Dose (DDD). Penelitian ini merupakan penelitian retrospektif observational dengan desain cross sectional dan menggunakan sampel pasien geriatri yang mendapatkan terapi antiemetik selama periode Januari-Juni 2015. Hasil penelitian ini menunjukkan bahwa besar penggunaan antiemetik di RSCM adalah 6,08 DDD/100 bed-days, dengan besar penggunaan ondansetron adalah 4,26 DDD/100 bed-days dan besar penggunaan domperidon adalah 1,82 DDD/100 bed-days. Persentase penggunaan antiemetik ondansetron adalah 79,3% dan antiemetik domperidon adalah 20,7%. Rute pemberian antiemetik lebih sering diberikan secara parenteral daripada oral. Penelitian lebih lanjut diperlukan untuk mengevaluasi ketepatan indikasi dan dosis penggunaan antiemetik.

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Antiemetics in geriatric patients is used as a therapy to treat nausea and vomiting caused by diseases such as gastrointestinal disorders, balance disorders, and cancer. Based on the Beers criteria, there are several antiemetics which potentially improper in geriatric patients so it is not recommended. This study aimed to evaluate the use of antiemetics in inpatient geriatric unit of Cipto Mangunkusumo Hospital (RSCM) as measured using Defined Daily Dose (DDD). This study was a retrospective observational study with cross sectional design and the samples were geriatric patients who received antiemetic therapy during the period of January to June 2015. The results of this study showed that the total use of antiemetic in RSCM was 6,08 DDD/100 bed-days, with the use of ondansetron was 4.26 DDD/100 bed-days and the use of domperidone was 1.82 DDD/100 bed-days. The percentage of the use of ondansetron and domperidone was 79.3% and 20.7% respectively. Route of administration of antiemetic through parenteral was more frequent than oral. Further research is needed to evaluate the accuracy of indications and dosage use of antiemetics."

"Pendahuluan: Penelitian di beberapa negara menunjukkan tingkat penggunaan obat off-label yang tinggi pada pasien pediatrik. Penggunaan obat off-label sendiri berpotensi meningkatkan kejadian efek samping obat. Penelitian ini bertujuan untuk mengevaluasi penggunaan obat off-label kategori usia pada pasien bangsal anak RSUPN Dr. Cipto Mangunkusumo (RSCM) yang belum pernah diteliti sebelumnya. Metode: Desain penelitian adalah observasional analitik cross sectional. Sampel merupakan data sekunder dari rekam medis pasien pediatrik yang dirawat di Bangsal Anak RSCM yang dipilih secara consecutive sampling. Kriteria inklusi adalah rekam medik pasien anak 0-18 tahun yang dirawat di Bangsal Anak RSCM periode Januari – Desember 2018, dan kriteria eksklusi berupa data pengobatan yang sulit dibaca, tidak lengkap, serta peresepan elektrolit, suplemen, dan obat luar. Obat yang diberikan dicatat dan ditabulasi. Status peresepan off-label ditentukan berdasarkan usia ketika obat diresepkan dan dicocokkan dengan ketentuan yang tertera pada label atau referensi yang relevan. Beda proporsi penggunaan obat off-label antar kelompok dianalisis menggunakan uji Chi-Square. Hasil: Dari 456 sampel peresepan, 12,5% (CI95 = [9,46%; 15,54%]) di antaranya diberikan secara off-label kategori usia. Berdasarkan klasifikasi ATC, golongan obat terbanyak yang diberikan secara off-label adalah agen antineoplastik dan imunomodulasi (61,2%) dan sistem muskuloskeletal (20,0%). Tidak didapatkan hubungan bermakna antara jenis kelamin dengan penggunaan obat off-label (p = 0,571; PR= 1,19; CI95 = [0,732; 1,942]) serta antara kategori usia bayi, anak, dan remaja dengan penggunaan off-label (p = 0,392). Kesimpulan: Tingkat penggunaan obat off-label kategori usia di bangsal anak 12,5%. Dalam penelitian ini, jenis kelamin dan kelompok usia tidak berpengaruh terhadap prevalensi penggunaan obat off-label.

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Introduction: Various studies conducted in many countries showed high level of off-label drug use in pediatric patients. Off-label drug use may increase the occurrence of adverse drug reactions. This study aims to evaluate off-label drug use in Dr. Cipto Mangunkusumo National Central General Hospital (RSCM) which has never been conducted. Methods: Samples were secondary data from medical records of pediatric patients admitted to RSCM Pediatric Ward and collected using consecutive sampling method. Inclusion criteria were medical records of patient of 0-18 years old admitted in the period of January-December 2018, and exclusion criteria were unreadable or incomplete medication record, and electrolyte, supplement, or external medicine. Collected data were recorded and tabulated. Off-label status was determined based on patients’ age when the drug was prescribed and then was matched with the information on the label of the drug or relevant references. Results: Of 456 evaluated prescriptions, 12,5% (CI95 = [9,46%; 15,54%]) were administered off-label according to age category. Based on Anatomical Therapeutic Chemical (ATC) classification, the most frequent drugs prescribed off-label were anti-neoplastic and immunomodulating (61,2%) and musculoskeletal system drugs (20,0%). There was no association between gender and off-label drug use (p = 0,571; PR= 1,19; CI95 = [0.732; 1.942]), and also between infant, children, and adolescent age categories and off-label drug use (p = 0,392). Conclusion: The prevalence of off-label drug use according to age category in the pediatric ward was 12.5%. In this study, gender and also infant, children, and adolescent age categories had no effect on the prevalence of off-label drug use."

"PendahuluanBerbagai studi menunjukkan obat off-label banyak diberikan pada pasien anak. Pemberian obat off-label dapat menimngkatkan risiko efek samping obat. Penelitian ini bertujuan mengevaluasi peresepan obat off-label pada pasien anak di Instalasi Gawat Darurat RSUPN dr. Cipto Mangunkusumo (IGD-RSCM) yang selama ini belum pernah diteliti.MetodeDesain penelitian ini potong lintnag. Sampel peresepan, diambil dari rekam medis pasien anak di IGD-RSCM secara consecutive sampling. Kriteria inklusi adalah peresepan untuk pasien anak usia 0-18 tahun di IGD RSCM pada periode Januari- Desember 2018. Kriteria eksklusi berupa data tidak terbaca atau tidak lengkap, peresepan elektrolit, suplemen, vitamin, dan obat luar. Data jenis kelamin, usia, dan jenis kelompok obat berdasarkan klasifikasi The Anatomical Therapeutic Chemical (ATC) dicatat. Status peresepan off-label ditentukan berdasarkan usia pasien saat obat diresepkan. Proporsi peresepan off-label pada kelompok gender dan usia anak dianalisis dengan uji Chi-Square.HasilDari 446 sampel peresepan yang diuji, 24,7% sampel merupakan peresepan off- label berdasarkan kategori usia.Berdasarkan kelompok ATC, kelompok obat yang paling sering diresepkan adalah obat sistem saraf dengan proposi off-label paling tinggi ditemukan pada kelompok agen antineoplastik dan imunomodulasi (88,2%). Tidak ada perbedaan proporsi peroff-label yang signifikan antara pasien anak laki- laki (21,9%) dan perempuan (27,4%) (p = 0,169, PR= 0,662 IK= 0,593 – 1,005). Tidak ada hubungan signfikan antara kelompok usia (bayi, anak, dan remaja) terhadap proporsi peresepan off-label (p = 0,086).KesimpulanProporsi peresepan obat off-label pasien anak di Instalasi Gawat Darurat RSCM adalah 24,7%. Jenis kelamin dan perbedaan kelompok usia antara bayi, anak, dan remaja tidak berhubungan dengan besar proporsi peresepan off-label.

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Introduction

Various studies showed that pediatric patients often received off-label drugs. Off- label drug administration can increase the risk of adverse drug reactions. This study aims to evaluate the off-label prescriptions in pediatric patients at the Emergency Department of dr. Cipto Mangunkusumo Hospital (IGD-RSCM) which has never been studied.

Methods

This is a cross sectional study. Prescription samples were taken from the medical records at IGD-RSCM by consecutive sampling. The inclusion criteria were prescriptions for children aged 0-18 years treated at IGD-RSCM during January- December 2018. The exclusion criteria were unreadable, incomplete prescribing data, electrolytes, supplements, vitamins, and external medications. Data of gender, age, and drug class based on The Anatomical Therapeutic Chemical (ATC) classification were recorded. Off-label prescribing status was determined based on the patient's age at the time of prescription. Proportions of Off-label prescriptions in each gender and pediatric age groups were analyzed using the Chi-Square test. Results

Of the 446 prescriptions analyzed , 24.7% were prescribed off-labelly by age category. Based on the ATC, nervous system drugs was the most frequently prescribed medication. The highest proportion of off-label drugs prescription was the antineoplastic and immunomodulating agent (88.2%). There was no significant difference in the off-label prescription proportion between boys (21.9%) and girls (27.4%) (p=0.169, PR=0.662 CI=0.593-1.005). There was no significant association between age groups (infants, children and adolescents) and the proportion of off-label prescriptions (p= 0.086).

Conclusion

The proportion of pediatric off-label prescription at the IGD-RSCM was 24.7%. Gender and pediatric age group differences were not associated with the level of off-label prescriptions proportions."

"PendahuluanPasien anak, termasuk di Pediatric Intensive Care Unit (PICU), tergolong rentan menerima peresepan obat off-label, yang berpotensi menimbulkan kejadian efek samping obat. Penelitian ini bertujuan mengevaluasi penggunaan obat off-label pada pasien anak di PICU RSCM, yang belum pernah diteliti.MetodeSampel merupakan peresepan yang diambil dari rekam medis secara consecutive sampling. Perhitungan jumlah sampel menggunakan proporsi tunggal dan beda dua proporsi. Kriteria inklusi adalah pasien anak <18 tahun yang dirawat di PICU RSCM tahun 2018. Kriteria eksklusi adalah pasien dengan data pengobatan yang sulit dibaca atau tidak lengkap, obat luar, elektrolit, dan suplemen. Data ditabulasi berdasarkan nama obat, jenis kelamin, usia, status off-label obat berdasarkan usia pasien, dan klasifikasi Anatomical Therapeutic Chemical (ATC). Uji Chi-Square dipakai untuk mengetahui beda proporsi penggunaan obat off-label antar kelompok.HasilDari 400 peresepan yang dievaluasi, 23,8% tergolong off-label kategori usia. Berdasarkan klasifikasi ATC, peresepan di PICU didominasi oleh obat kardiovaskular (25,25%). Obat muskuloskeletal paling sering diresepkan secara off-label (84,6%). Tidak ada perbedaan signifikan proporsi penggunaan obat off-label pada kelompok laki-laki (21%) dan perempuan (26,5%) (p = 0,196,). Proporsi off-label pada kelompok usia bayi (0-2 tahun) 33,8%, anak (2-12 tahun) 18,6%, dan remaja (12-18 tahun) 14,3%. Peresepan off-label pada bayi lebih tinggi secara signifikan dibandingkan anak (p = 0,002) dan remaja (p = 0,001)KesimpulanSebanyak 23,8% peresepan pada pasien PICU diberikan secara off-label berdasarkan usia, dan yang tersering adalah obat muskuloskeletal. Perbedaan proporsi obat off-label antar jenis kelamin tidak signifikan, sedangkan antar kelompok usia signifikan.

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Introduction

Pediatric patients, including Pediatric Intensive Care Unit (PICU) patients, are prone to off-label drug prescriptions, which potentially lead to adverse drug reactions. This study aimed to assess the use of off-label drugs on PICU patients at RSCM, which has never been studied before.

Methods

Samples were prescriptions taken from medical records connsecutively. Sample size were calculated using single proportion and difference between two proportions. The inclusion criteria were <18 years old PICU patients at RSCM admitted in 2018. The exclusion criteria were patients with unclear or incomplete data, external drugs, electrolytes, and supplements. Data were tabulated by drug name, sex, age, off-label drug status based on patient age, and Anatomical Therapeutic Chemical (ATC) classification. Difference in proportions between groups were tested using Chi-Square.

Results

Of the 400 prescriptions evaluated, 23.8% were off-label by age. Based on the ATC classification, PICU prescription was dominated by cardiovascular drugs (25.25%). Musculoskeletal drugs were most often prescribed off-label (84.6%). There was no significant difference in off-label prescription between males (21%) and females (26.5%) (p = 0.196). The proportion of off-label in the infant age group (0-2 years) was 33.8%, in children (2-12 years) 18.6%, and in adolescents (12-18 years) 14.3%. Infants were given off-label drugs significantly higher than children (p = 0.002) and adolescents (p = 0.001)

Conclusion

Off-label prescription in PICU patients is 23.8%. Musculoskeletal drugs are most often prescribed off-label. The difference in the proportion of off-label drugs between sexes was not significant, whereas between age groups was significant"

"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.

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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."

"Latar belakang: Stroke selalu menempati urutan pertama jumlah penderita rawat inap di pusat-pusat pelayanan neurologi di Indonesia. Keragaman faktor risiko dan penyakit penyerta menyebabkan farmakoterapi pasien stroke menjadi kompleks, bervariasi, dan dapat menimbulkan masalah terkait obat seperti ketepatan indikasi, polifarmasi, interaksi, dan efek samping obat. Tujuan: Penelitian observasional retrospektif ini dilakukan untuk mengevaluasi penggunaan obat pada pasien stroke rawat inap di RSUP Prof. Dr. R.D. Kandou Manado pada periode bulan Juli-Desember 2013 dalam hal ketepatan indikasi, dosis, lama penggunaan, efek samping, dan kemungkinan interaksi obat. Metode: Semua pasien stroke rawat inap pada periode bulan Juli-Desember 2013 yang rekam mediknya dapat ditelusuri dievaluasi pengobatannya. Ketepatan indikasi, dosis, lama penggunaan, efek samping, dan kemungkinan interaksi obat dinilai berdasarkan standar pelayanan medik RSUP Prof. Dr. R.D. Kandou, berbagai literatur dan buku teks. Hasil: Dari 127 pengobatan kasus stroke yang dapat dievaluasi, terdapat 762 penggunaan obat yang 61,5% di antaranya tepat indikasi, 35,2% kurang tepat indikasi, dan 3,30% tidak tepat indikasi. Dari penggunaan obat yang tepat indikasi, 89,6% di antaranya tepat dosis, 10,2% dosis subterapi, 0,20% dosis berlebih, 59,5% tepat lama penggunaan, 9,60% tidak tepat lama penggunaan dan 30,9% tidak dapat dinilai lama penggunaannya. Didapatkan 68,3% penggunaan ranitidin dengan indikasi kurang tepat. Frekuensi terbanyak (28,3%) jumlah jenis obat yang dipakai ialah 5 jenis. Interaksi antar obat potensial didapatkan pada 33 kasus (4,30%) dan kemungkinan kejadian efek samping obat didapatkan dua kasus (2,62%). Didapatkan 21,6% kasus stroke iskemik yang tidak mendapat terapi aspirin. Kesimpulan: Ketepatan indikasipenggunaan obatpada pasien stroke rawat inap di RSUP Prof.Dr.R.D. Kandou Manado masih perlu ditingkatkan. Ketidak tepatan indikasi ini berkaitan dengan penggunaan obat yang bukti ilmiahnya masih kurang atauindikasinyakurangtepat.

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Background: Stroke is the most common disorder in patients hospitalized in Indonesia neurology centers. Various risk factors and comorbidities in patients with stroke may lead to a complex drug therapy that result in drug-related problems such as the inappropriateness of indications, polypharmacy, interactions, and adverse reactions. Aim: This retrospective observational study was performed to evaluate drug therapy in stroke patients hospitalized at the Prof. Dr. R.D. Kandou Manado Hospital within the period of July-December 2013 in terms of the appropriateness of the indications, dosages, duration of use, potential drug interactions and adverse drug reactions. Methods: Drug therapy in stroke patients hospitalized within the period of JulyDecember 2013 and had traceable medical records were evaluated. The appropriateness of the indications, dosages, duration of use, potential drug interactions and adverse drug reactions were determined based on the Prof. Dr. R. D. Kandou Manado Hospital medical services standard, literature and text books. Results: Of the 127 evaluable stroke cases, there were 762 drug utilization, with 61.5%, 35.2%, and 3.30% of them given for appropriate, less appropriate, and not appropriate indications, respectively. Among drugs given for appropriate indications, 89.6%, 10.2.%, and 0.20% were given at appropriate, under, and over doses, respectively, while 59.5%, 9.60%, and 30.9% were given with appropriate, less appropriate, and undetermined duration of therapy, respectively. Less appropriate indication for using ranitidine was 68.3%. The number of drug most oftenly given to the patients was 5 (28.3%). The percentage of potential drug interactions and possible adverse drug reactions were 4.30% and 2.62%, respectively. Among patients with ischaemic stroke, 21.6% were not treated with aspirin. Conclusion: The appropriateness of indication of drug therapy in stroke patients hospitalized at the Prof. Dr. R. D. Kandou Manado Hospital needs to be improved. Inappropriate drug therapy was related to the use of drugs lacking the scientific evidence, or given without clear indications."

"[ABSTRAKPenghambat 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.

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ABSTRACTProton 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.]"

"ABSTRAKLatar belakang: Sepsis merupakan masalah kesehatan penting yang dapat menyebabkan insidens kematian sampai 50% pada pasien dengan sepsis berat. Antibiotik aminoglikosidaterutama amikasin semakin banyak digunakan untuk mengobati infeksi kuman Gram negatif pada pasien sepsis di ICU, meskipun penggunaan obat tersebut pada dosisterapi dapat meningkatkan risiko kerusakan ginjal sekitar 10-25%. Pemantauan kadar lembah amikasin serta biomarker dini diperlukan untuk mencegah kerusakan ginjal pada pasien sepsis yang dirawat di ICU. Penelitian ini dilakukan untuk mengetahui hubungan kadar lembah amikasin pada pasien ICU dewasa yang dirawat di Rumah Sakit Cipto Mangunkusumo yang diberikan amikasin 1000 mg/hari denganpeningkatan kadar KIM-1 normalisasi dalam urin yang merupakan biomarker dini nefrotoksisitas.Metode:Penelitian ini merupakan penelitian pendahuluan yang dilakukan pada 12 pasien sepsis dewasa yang dirawat di ICU RSCM dan diberikan amikasin 1000 mg/hari pada bulan Mei-September 2015. Kadar lembah amikasin dosis ketiga dihubungkan dengan peningkatan kadar KIM-1 normalisasi yang diukur melalui urin 24 jam setelah pemberian amikasin dosis pertama/kedua dan dosis ketiga.Hasil:Dari 12 subyek penelitian, didapatkan 3 subyek penelitian dengan kadar lembah amikasin di atas 10 g/mL, sedangkan 9 subyek penelitian kadar lembahnya ada dalam batas aman (di bawah 10 g/mL). Delapan dari 12 subyek penelitian (66,7%) mengalami peningkatan kadar KIM-1 normalisasi dalam urin hari ketiga dibandingkan hari pertama. Tidak ada hubungan antara kadar lembah amikasin dengan peningkatan kadar KIM-1 normalisasi dalam urin (p=0,16; r=0,43).Kesimpulan:Pasien sepsis yang mendapat amikasin 1000 mg/hari di ICU RSCM selama 3 hari memperlihatkan kadar lembah amikasin plasma dalam batas aman untuk ginjal.

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ABSTRACT

Background: Sepsis is a common caused of mortality which may account for up to 50% death rate in patients with severe sepsis. Aminoglycoside antibiotics, especially amikacin, are the most commonly used antibiotics in the septic patients with Gram-negative bacterial infections, despite these drugs may induce nephrotoxicity in 10-25%

patients. Hence, it is essential to monitor amikacin trough plasma concentration and to detect nephrotoxicity as early as possible. The aim of this study is to find out the correlation between amikacin trough plasma concentration with normalized KIM-1 concentration in the urine as a sensitive and specific biomarker.

Methods:

This is a pilot study conducted in 12 septic patients treated with amikacin 1000 mg/day from May, 2015 to September, 2015. The correlation between amikacin

trough plasma concentrations measured at the third doses with the elevation of urine normalized KIM-1 concentrations measured at the first/second and the third doses were evaluated.

Results:

We observed 3 patients with amikacin trough plasma concentration above the safe level (>10 g/mL), while 9 patients had amikacin concentrations within the safe

plasma level (<10 g/mL). Furthermore, we observed 8 out of 12 patients with higher normalized KIM-1 concentrations measured at third doses compared to normalized KIM-1 concentrations measured at first/second doses. There was no correlation between amikacin trough concentration with elevated urine normalized KIM-1

concentration (p=0,16; r=0,43).

Conclusion:

Septic patients treated with amikacin 1000 mg/day hospitalized in ICU RSCM for 3 days have amikacin safe trough plasma concentration."