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Kajian Penggunaan Antibiotik pada Pasien Meningitis dan Ensefalitis Bakteri di Bangsal Rawat Inap Rumah Sakit Rujukan Utama Diyan Ajeng Rossetyowati; Ika Puspitasari; Tri Murti Andayani; Titik Nuryastuti
Pharmacon: Jurnal Farmasi Indonesia Vol 18, No 2 (2021)
Publisher : Universitas Muhammadiyah Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.23917/pharmacon.v18i2.16861

Abstract

Inadequate antibiotic therapy for meningitis and bacterial encephalitis is one of the factors that can jeopardize patient safety and turn into a public health issue in a number of nations, including Indonesia. This phenomena has the potential to raise health-care expenses, which should be avoided in the era of the JKN program's implementation. The goal of this research was to describe the profile of antibiotic use and cost in hospitalized meningitis and bacterial encephalitis patients. This cross-sectional observational study took place from January to December 2019. As study materials, patient medical records and billing data were employed. To enhance the data obtained, confirmation with medical and pharmaceutical personnel is required. Antibiotic use and expenditures were described using descriptive analysis. A total of 71 patients, both children and adults, met the study's inclusion criteria. Antibiotics were given to all of the patients, and the results revealed that third generation cephalosporins (49.375%) were the most commonly recommended antibiotic class, either alone or in combination. Antibiotic use receives 46.94% of total medication funding. According to the length of stay category, the majority of patients (45.99 %) were hospitalized for 8-14 days consecutively with antibiotic medication. Antibiotics, which are typically administered to patients with meningitis and bacterial encephalitis, had no effect on the length of stay in the hospital. Antibiotic prescriptions must be carefully reviewed at top referrel hospital, taking into account the local germ map.
Antituberculosis Activity of Brotowali (Tinospora crispa) Extract and Fractions against Mycobacterium tuberculosis using Microplate Alamar Blue Assay Method Retno Wahyuningrum; Ritmaleni Ritmaleni; Tatang Irianti; Subagus Wahyuono; Takushi Kaneko; Titik Nuryastuti
Majalah Obat Tradisional Vol 22, No 2 (2017)
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (343.582 KB) | DOI: 10.22146/tradmedj.27925

Abstract

Tuberculosis (TB), in which caused by pathogenic bacteria, Mycobacterium tuberculosis, has become the major causes of death among all of infectious diseases. The increasing incidence of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) has created a need to discover a new antituberculosis drug candidate. The aim of this study was to screen extract and fractions of Tinospora crispa for activity against Mycobacterium tuberculosis H37Rv using the Microplate Alamar Blue Assay (MABA) method. T. crispa extract was prepared by maceration in ethanol (96%) and antituberculosis activity was carried out using MABA method. The result of this study showed that ethanolic extract of T. crispa exhibit antituberculosis activity with minimum inhibition concentration of 12.5 mg/ml.
The Inhibition Activity of Tannin on the Formation of Mono-Species and Polymicrobial Biofilm Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans Hasyrul Hamzah; Triana Hertiani; Sylvia Utami Tunjung Pratiwi; Titik Nuryastuti
Majalah Obat Tradisional Vol 24, No 2 (2019)
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (14.442 KB) | DOI: 10.22146/mot.44532

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Biofilm acts as the mediator for infection nowadays. Approximately, more than 80% infection incidents are biofilm-formation related. Biofilm as bacteria's defense system is more difficult to eradicate by antibiotic; therefore, pathogen bacteria on their biofilm forms can make serious problems for human health. The invention of a new candidate for polymicrobial biofilm can be an essential challenge to be studied, in order to prevent infections related to biofilm. Tannin is a polyphenol compound with anti-bacterial and anti-fungal potential. This study aims to acknowledge the effectiveness of tannin in inhibition and degradation of C. albicans, P. aeruginosa, E. coli, S. aureus, and polymicrobial biofilm. The assay for biofilm inhibition and degradation were determined with microtiter broth method. The effectivity of tannin antibiofilm against polymicrobial biofilm were analyzed by calculating minimum biofilm inhibitory concentration (MBIC50) and minimum biofilm eradication concentration (MBEC50) values. The mechanism of action of tannin against polymicrobial biofilm was tested using scanning electron microscopy (SEM). The data were analyzed using the Statistical Package for the Social Sciences (SPSS) with a 95% confidence level. Tannin 1% gave inhibition activity of mono-species biofilm formation S. aureus in the middle phase and maturation of 79.04±0.01, 61.48±0.03, E. coli 74.56±0.01, 67.91±0.02, P. aeruginosa 67.32±0.05, 35.13± 0.01, C. albicans 60.62±0.01, 47.16±0.01. The results also provide evidence that tannin activity can degrade and damage the matrix of extracellular polymeric substance (EPS) polymicrobial biofilms. Hence, tannins can be a potential candidate for new antibiofilm for polymicrobial biofilm.
Use of Xpert MTB/RIF for diagnosis of pediatric tuberculosis in Indonesia Rina Triasih; Amalia Setyati; Dwikisworo Setyowireni; Titik Nuryastuti; Rachma Dewi Isnaini Putri; Emi Rusdiyati
Paediatrica Indonesiana Vol 60 No 4 (2020): July 2020
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi60.4.2020.198-204

Abstract

Background The Xpert MTB/RIF assay demonstrated a better diagnostic value than sputum smear for TB in adults and children. Objective To evaluate the use of Xpert MTB/RIF for TB diagnosis in children. Methods We conducted a prospective study in Yogyakarta, Indonesia, involving 19 primary health centers (PHCs) and one provincial hospital. Children aged 0-14 years with suspected TB who visited the study sites were screened. Subjects underwent history-taking, physical examination, tuberculin skin test, chest X-ray, as well as sputum induction for Xpert MTB/RIF assay, sputum smear, and TB culture. The diagnosis of TB was made by doctors based on the results of investigations, as follows: certain TB (bacteriological confirmation), probable TB, and possible TB. Results Of 80 subjects, 21 (26%) were diagnosed with TB disease (4 certain TB and 17 probable TB). Sputum induction was successfully performed in 79 children. None of the children had positive sputum smears. Mycobacterium tuberculosis was detected by Xpert MTB/RIF in 4 children, accounting for 5% of all children with suspected TB, or 19% among children with TB disease. The 4 Xpert MTB/RIF-positive subjects had severe TB disease and were rifampicin-sensitive. Conclusion Xpert MTB/RIF may improve case finding among children with severe TB disease with negative sputum smear.
Evaluasi Drug Related Problems (DRPs) Antibiotik pada Pasien Sepsis di Rumah Sakit di Yogyakarta SAMUEL BUDI; ZULLIES IKAWATI; IWAN DWIPRAHASTO; TITIK NURYASTUTI
JURNAL ILMU KEFARMASIAN INDONESIA Vol 15 No 1 (2017): JIFI
Publisher : Fakultas Farmasi Universitas Pancasila

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (287.055 KB)

Abstract

Sepsis is a manifestation of the most severe acute infections that can lead to the various organ failure generally ends with death in 30-50% of cases. The number of sepsis deaths in developed countries can be reduced to 11-15%, but in developing countries it was reported above 45%. Proper and adequate use of empirical antibiotics may decrease the risk of death in sepsis and may at least shorten patient duration of care in the hospital. Aim to this study was determine the pattern of antibiotic use, the incidence of Drug Related Problems (DRPs) and clinical outcomes in septic patients in hospital X at Yogyakarta. An observational study was carried out during the period of January-December 2015 in hospital X at Yogyakarta. Data were collected retrospectively among patients with sepsis, age > 15 years old, hospitalized during the the study period. From 632 cases, 162 patients were diagnosed as sepsis and met the inclusion criteria of the study. The antibiotics used were cephalosporin (42.58%), quinolone (17.46%), carbapenem (10.77%), aminoglycoside (9.33%), imidazole (8.85%) and macrolide (4.88%). Poor clinical outcomes associated with DRPs (64.29%) were greater than those that showed good clinical outcomes (35.71%). The incidence of DRPs in sepsis treatment is still high (60.49%), and is generally associated with antibiotic needs, the inappropriate selection of antibiotics, inadequate dosage and the presence of antibiotic interactions.
Analisis Faktor Resiko Sepsis Neonatal terhadap Clinical Outcome di Neonatal Intensive Care Unit (NICU) Rizal Fauzi; Titik Nuryastuti; Ika Puspitasari
Indonesian Journal of Hospital Administration Vol 3, No 2 (2020)
Publisher : Universitas Alma Ata

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21927/ijhaa.2020.3(2).86-93

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 AbstrakSepsis neonatal merupakan sindrom klinik yang terjadi secara sistemik dari penyakit infeksi yang terjadi pada 4 minggu pertama kehidupan. Sepsis neonatal merupakan urutan ketiga penyebab kematian neonatal, setelah kelahiran prematur dan komplikasi terkait intrapartum (atau asfiksia). Kejadian sepsis neonatal dapat diamati pada bayi yang dilahirkan dengan asfiksia, prematuritas, berat badan lahir rendah, dan faktor-faktor lainnya seperti jenis persalinan, perawatan antenatal yang diterima, pemberian makanan campuran untuk bayi baru lahir, dan perawatan tali pusat diyakini berkontribusi pada insidensi sepsis neonatal. Tujuan dari penelitian ini adalah untuk mengetahui hubungan antar faktor resiko terjadinya sepsis neonatal yang dirawat di Neonatal Intensive Care Unit (NICU) RSUP Dr. Sardjito Yogyakarta dengan clinical outcome pasien. Penelitian ini merupakan observasional deskriptif dengan desain cohort retrospective. Data dari rekam medis pasien terdiagnosis sepsis neonatal di Neonatal Intensive Care Unit (NICU) RSUP DR.Sardjito Yogyakarta pada periode 1 Januari – 31 Desember 2015. Data yang memenuhi kriteria inklusi dikumpulkan dan dicatat, kemudian data dianalisis dengan menggunakan analisis bivariat untuk melihat hubungan variabel penelitian dengan clinical oucome. Analisis yang digunakan adalah uji statistik Chi-Square-fisher. Hasil penelitian ini diketahui sepsis neonatus banyak dialami pasien dengan jenis kelamin laki-laki 58,73%; berat badan lahir ≤ 2.500 gram 73,02%; lama perawatan lebih dari 15 hari 55,56%. Hasil uji analisis bivariat uji Chi square-fisher secara statistik tidak terdapat hubungan antara jenis kelamin dengan clinical outcome (p = 0,695), berat badan lahir dengan clinical outcome (p=0,070), lama rawat inap dengan clinical outcome (p=0,305), infeksi penyerta dengan clinical outcome (p=0,223) dan asfiksia dengan clinical outcome (p=0,559) Kata Kunci: Sepsis neonatal; NICU; Clinical outcome
Evaluasi Penggunaan Antibiotik Empiris dan Analisis Biaya Demam Tifoid di Sebuah RS Swasta Kota Semarang Hananun Zharfa Hanifah; Ika Puspita Sari; Titik Nuryastuti
Jurnal Sains Farmasi & Klinis Vol 5, No 1 (2018): J Sains Farm Klin 5(1), April 2018
Publisher : Fakultas Farmasi Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (448.338 KB) | DOI: 10.25077/jsfk.5.1.1-6.2018

Abstract

The treatment of typhoid, which is caused by S. typhi, requires wise use of antibiotics. The use of irrational antibiotics can increase mortality, morbidity, disease spread and health costs. This study aims to understand the appropriateness of antibiotics use in a private hospital Semarang, the relationship between antibiotics rationality and costs. An observational retrospective study that used a cross sectional method, whereby data was collected from medical records and financial recap that fulfil the inclusion criteria. Data were used to perform descriptive analysis, analysis of antibiotics rationality using the Gyssens method, and to study the relationship between rationality and healthcare costs. Data on rationality and costs were analysed using the Mann Whitney test. Result showed 180 cases were evaluated during this study: 98 antibiotic regimens from medication in hospitalized and 82 antibiotic regimens from medication through take-home medicines. A number of 20,4% of the cases from medication in hospitalized and 7,3% of the cases from medication through take-home medicines were considered rational. There is a relationship between antibiotics rationality and antibiotic costs (p<0,05)
EVALUASI KESESUAIAN ANTIBIOTIK DEFINITIF TERHADAP CLINICAL OUTCOME PADA PASIEN ANAK DENGAN MENINGITIS BAKTERIAL DI BANGSAL RAWAT INAP RUMAS SAKIT UMUM PUSAT Wihda Yanuar; Ika Puspitasari; Titik Nuryastuti
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 6, No 3
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (993.87 KB) | DOI: 10.22146/jmpf.346

Abstract

Meningitis bacterial merupakan infeksi sistem saraf pusat (SSP), terutama menyerang anak pada usia <2 tahun, dengan puncak angka kejadian pada usia 6-18 bulan. Penyakit ini diperkirakan mencapai  1,2 juta kasus tiap tahunnya dengan mortalitas pasien berkisar antara 2%-30% diseluruh dunia. Kasus meningitis bakteri di Indonesia mencapai 158/100,000 kasus pertahun, dengan etiologi Haemophilus influenza tipe b (H. influenza) 16/100.000 dan bakteri lain 67/100.000. Pasien dengan meningitis bakteri yang bertahan hidup beresiko mengalami komplikasi. Komplikasi utama meningitis bakterial terjadi karena adanya kerusakan pada otak. Pasien yang bertahan hidup dari meningitis dapat mengalami gangguan saraf. Oleh karena itu, pasien meningitis bakterial khususnya pada anak perlu mendapatkan terapi  yang optimal. Penelitian ini bertujuan untuk mengetahui kesesuaian penggunaan antibiotik definitif terhadap cinical outcome pasien anak dengan meningitis bakterial di bangsal rawat inap RSUP Dr. Sardjito Yogyakarta serta gambaran antibiogramnya. Penelitian ini dilakukan dengan rancangan deskriptif observasional dengan pengumpulan data secara retrospektif terhadap rekam medis pasien yang memenuhi kriteria inklusi dan eksklusi. Penyusunan antibiogram dilakukan berdasarkan perhitungan persentase sensitivitas antibiotik. Hasil penelitian menunjukkan bahwa penggunaan antibiotik definitif 63,33% sesuai dengan hasil uji kultur dan sensitivitas antibiotik. Clinical outcomepenggunaan antibiotik definitif sesuai dengan hasil uji kultur dan sensitivitas 100% (19 pasien) membaik. Antibiogram pada pasien anak dengan meningitis bakterial di RSUP Dr. Sardjito adalah: pola bakteri Gram positif sebesar 63,33% dan bakteri Gram negatif 36,67%, dimana antibiotik yang memliki sensitivitas tinggi terhadap bakteri Gram positif adalah vankomisin 89% dan siprofloksasin 83% sedangkan untuk bakteri Gram negatif adalah meropenem 100%  dan amikasin 83%.
IDENTIFIKASI INFEKSI MULTIDRUG-RESISTANT ORGANISMS (MDRO) PADA PASIEN YANG DIRAWAT DI BANGSAL NEONATAL INTENSIVE CARE UNIT (NICU) RUMAH SAKIT Daru Estiningsih; Ika Puspitasari; Titik Nuryastuti
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 6, No 3
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jmpf.351

Abstract

Multidrug-resistant (MDR) adalah suatu keadaan dimana bakteri resisten terhadap minimal satu  jenis antibiotik dari ≥3 golongan antibiotik. MDR ini dapat disebabkan karena beberapa hal antara lain pemakaian antibiotik yang tidak tepat dosis, tidak tepat diagnostik dan tidak tepat bakteri penyebab. Multidrug-resistant organisms (MDRO) adalah mikroorganisme, terutama bakteri yang mengalami MDR. Saat ini resistensi antibiotik merupakan masalah global, data pada tahun 2009, Indonesia menduduki peringkat ke 8 dari 27 negara dengan predikat multidrug-resistant tertinggi di dunia . Penelitian ini bertujuan mengidentifikasi pola MDRO dan infeksi MDRO pada pasien yang dirawat di bangsal NICU RSUP dr. Soeradji Tirtonegoro Klaten selama periode Desember 2013 sampai dengan Desember 2014. Desain penelitian ini adalah deskriftif dengan data yang dikumpulkan secara retrospektif. Empat puluh enam pasien yang menjadi subyek penelitian karakteristiknya homogen dalam hal usia, lama perawatan dan luaran kliniknya, Semua pasien dilakukan kultur dan tes sensitivitas terhadap antibiotik.   Hasil : bakteri yang menginfeksi pasien NICU RSUP dr. Soeradji Tirtonegoro adalah Pseudomonas sp, Klebsiella sp, Serratia sp, Enterobacter sp, Acinetobacter dan Edwardsiella sp (diurutkan dari proporsi tertinggi ke terendah). Ditemukan bahwa 98% dari keseluruhan isolat bakteri tersebut termasuk kategori MDRO. Jenis infeksi bakterial yang ditemukan adalah sepsis, pneumonia dan komplikasi sepsis dengan pneumonia. Antibiotik yang masih poten untuk semua bakteri ini adalah cotrimoxazole, ciprofloxasin, chloramphenicol, levofloxasin, amikasin and meropenem (diurutkan dari antibiotik dengan sensitivitas terendah).
Pattern of Antibiotic in Community-Acquired Pneumonia (CAP) Comparison in Type A and B Hospital Ika Puspita Sari; Titik Nuryastuti; Rizka Humardewayanti Asdie; Anton Pratama; Endang Estriningsih
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 7, No 4
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jmpf.33261

Abstract

Pneumonia is a threat to all States. CAP treatment in hospitals typically uses empirical antibiotic therapy with IDSA/ATS guidelines. This research aimed to compare empirical antibiotic therapy of CAP patients in types A and B hospital and to analyze the variations that occur and compare the outcome of the therapy. The research was conducted retrospectively by collecting data from the medical records of patients diagnosed with CAP. The inclusion criteria in this research were male and female adult patients aged ≥18 years who had complete medical record data. Patients who underwent inpatient care in the in-patient wards (non ICU) of type A and B hospital received empirical antibiotic therapy. Data from type A hospital (RS A) were taken within the period of January 2014-December 2016, while data from type B hospital (RS B) were taken in January 2013-December 2016. The number of patients with CAP in hospital A is 72, whereas in hospital B, it is 34. Patients with malignancy and immunocompromise were excluded from this research. In this research, germs found in hospital A were mapped, while no gynecologic examination/culture was performed in hospital B. The outcome of the treatment was an improvement in response 5-7 days after empirical antibiotics was given, as reported by a physician and/or by an improvement in the x-ray thorax results. Patient demographic data and antibiotic therapy pattern were analyzed descriptively. Outcome of patient therapy was analyzed using Chi square statistics with 95% confidence level.The results showed that empirical antibiotic therapy in CAP patients in type A hospital were largely based on IDSA/ATS guidelines, whereas in it is the opposite for type B hospital. Outcomes of patient therapy in A and B hospitals showed patient improvement of about 76%. In type A hospital, the cause of CAP is largely negativeGram bacteria which are still sensitive to cephalosporin/carbapenem (cefpirom, ceftasidim, cefepim, and imipenem) and aminogicosida (amikacin, netilmisin, and tobramisin).
Co-Authors . Mursiti Abu Tholib Aman Ade Christanti Putri Sidabutar Afdina Melya Ganes Febiyanti Aisyah Nur Sapriati Altaufik Ngani Amaia, Devika N. Amalia Setyati Aman, Alia Hanifa Aminy, Sayyidah A. Andi Ameilia Sari Riandika Anggraeni, Nuniek Annisa Aulia Savitri Annisa Somaningtyas Anton Pratama Apriyanto, Muchammad Arief Nurrochmad As, Musdalifa Atikana, Akhirta Atthobari Avanilla Fany Septyasari Bastiaan P. Krom, Bastiaan Bastian P. Krom Cicilia Widhi Astuti Cindy Elvionita Daru Estiningsih Dessy Kurnia Sari Devi Artami Susetiati Dewi Purbaningsih Dhannia Fitratiara Diah Susanti Diyan Ajeng Rossetyowati Diyan Ajeng Rossetyowati Djoko Wahyono Djoko Wahyono Dwi Utami Anjarwati Dwikisworo Setyowireni Edwin W. Daniwijaya Eggi Arguni Elya Antariksana Bachmida Emi Rusdiyati Endang Estriningsih Ervina Damayanti Estiningsih, Daru Estriningsih, Endang Firdhani Satia Primasari Fita Rahmawati Fita Rahmawati Galang Ridha Allatief Hakim, Mohamad Saifudin Hamzah, Hasyrul Hananun Zharfa Hanifah Handi Virawan Hardyanto Soebono Henk J. Busscher Henk J. Busscher, Henk J. Henny C. van der Mei Henny C. van der Mei, Henny C. Hera Nirwati Ika Puspita Sari Ika Puspita Sari Ika Puspita Sari IKA PUSPITA SARI Ika Puspita Sari Ika Puspita Sari Ika Puspita Sari Ika Puspitasari Ika Puspitasari Ika Puspitasari Ika Puspitasari Ilma Tazkiya Iman Iman Ishak SKM., MPH IWAN DWIPRAHASTO Kholidah, Siti Nurhayati Kris Kurniawan Kuwat Triyana LINDA SUKMARINI Linda, Vitia Ajeng Nur Lucky Herawati Luthvia Annisa Marselinus Edwin Widyanto Daniwijaya Maulidia, Faiqoh Nur Maulidiah, Rizka Mawarti, Yuli Meilia Nhadia Amalia Mubasysyir Hasanbasri Mujahidah, Mujahidah Mukhriani, Mukhriani Munifah Wahyuddin Mursiti, Mustofa, Handry Darussalam, Titik Nuryastuti, Mursiti, Mustofa Mustofa Nanang Munif Yasin Ni Luh Putu Vidya Paramita Niken Puspitasari Ning Rintiswati Nunung Yuniarti Nunung Yuniarti Nurkhalika, Rachmi Nurpagino, Bombong Prameshwara, Almarissa Ajeng Praseno Praseno Pratama, Anton Prawarni, Vidyadhari Puspa Prayoga, Muhammad Bagas Pujilestari, Dwi PUSPITA LISDIYANTI Qonita Imma Irfani Rachma Dewi Isnaini Putri Rahmawati, Fita Rakhmat Ari Wibowo Rebriarina Hapsari Retno Wahyuningrum Rina Triasih Ritmaleni, Ritmaleni Rizal Fauzi Rizka Humardewayanti Asdie Rizka Humardewayanti Asdie Rizqi Nurul Khasanah Roel Kuijer Roel Kuijer, Roel SAMUEL BUDI Sapriati, Aisyah Nur Setiawati, Setiawati SHANTI RATNAKOMALA Subagus Wahyuono Supriyati Susi Iravati Sylvia Utami Tunjung Pratiwi Takushi Kaneko Tatang Irianti Tina Amnah Ningsih Titi Ira Pangestuti Tri Murti Andayani Tri Murti Andayani Tri Wibawa Triana Hertiani Tristina Devi Azzahra Untari, Febriana Vera Olfiana Wahyuddin, Munifah Wihda Yanuar Wihda Yanuar Yanuar, Wihda Yeli Trimayanti Yolanda Pitra Kusumadewi Yusrizal Djam’an Saleh ZULLIES IKAWATI