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INDONESIA
Jurnal Farmasi Klinik Indonesia
Published by Universitas Padjadjaran
ISSN : 23375701     EISSN : 2337 5701     DOI : -
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Indonesian Journal of Clinical Pharmacy (IJCP) is a scientific publication on all aspect of clinical pharmacy. It published 4 times a year by Clinical Pharmacy Master Program Universitas Padjadjaran to provide a forum for clinicians, pharmacists, and other healthcare professionals to share best practice, encouraging networking and a more collaborative approach in patient care. Indonesian Journal of Clinical Pharmacy is intended to feature quality research articles in clinical pharmacy to become scientific guide in fields related to clinical pharmacy. It is a peer-reviewed journal and publishes original research articles, review articles, case reports, commentaries, and brief research communications on all aspects of Clinical Pharmacy. It is also a media for publicizing meetings and news relating to advances in Clinical Pharmacy in the regions.
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Ketepatan Penggunaan Metotreksat pada Pasien Reumatoid Artritis di Rumah Sakit Emanuel Klampok berdasarkan Kriteria Eksplisit Puspitasari, Rizki; Purwonugroho, Tunggul A.; Baroroh, Hanif N.
Indonesian Journal of Clinical Pharmacy Vol 3, No 3 (2014)
Publisher : Indonesian Journal of Clinical Pharmacy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (192.675 KB) | DOI: 10.15416/ijcp.2014.3.3.88

Abstract

Metotreksat (MTX) adalah agen antiinflamasi dan imunosupresan yang menjadi lini pertama terapi reumatoid artritis (RA). Penelitian ini bertujuan mengevaluasi penggunaan MTX pada pasien RA di Rumah Sakit Emanuel Klampok berdasarkan kriteria indikasi, indikator proses, komplikasi, dan indikator hasil. Analisis data dilakukan secara deskriptif evaluatif menggunakan data rekam medik13 pasien rawat inap dan 27 pasien rawat jalan. Hasil penelitian menunjukkan ketepatan indikasi 100%. Pasien dengan faktor risiko gangguan GI, hepatotoksik, dan toksisitas bone marrow berturut-turut 35 pasien, 19 pasien, dan 15 pasien. Pemberian MTX dengan dosis tepat sejumlah 32 pasien, dosis tidak tepat dengan ClCr 61–80 mL/menit sejumlah 3 pasien, ClCr 51–60 mL/menit sejumlah 2 pasien, ClCr 10–50 mL/menit sejumlah 1 pasien, dan SGPT >3 nilai normal sejumlah 2 pasien. Interaksi MTX dengan NSAID sejumlah 35 pasien dan dengan agen hepatotoksik sejumlah 19 pasien. Komplikasi terjadi pada 7 pasien berupa gangguan GI dan 1 pasien berupa sirosis. Indikator hasil berupa berkurangnya keluhan klinis seperti nyeri dan kakuterjadi pada 10 pasien dan pasien yang membaik sejumlah 2 pasien. Indikasi penggunaan MTX telah sesuai dengan kriteria sedangkan indikator proses, komplikasi, dan indikator hasil masih belum sesuai.Kata kunci: Metotreksat, reumatoid artritis, Rumah Sakit Emanuel KlampokAccuracy of Methotrexate Use in Rheumatoid Arthritis Patients in Emanuel Klampok Hospital based on Explicit CriteriaMethotrexate (MTX) is the first line therapy for rheumatoid arthritis (RA) as an antiinflammatory and immunosuppressant agent. The purpose of this study was to evaluate the use of MTX in patients with RA at Emanuel Klampok Hospital based on criteria that include indication, process indicators, complication, and outcome indicators. The medical record from 13 inpatients and 27 outpatients who used MTX were compared with the criteria. The results of this study suggested that all of the patients had appropriately indications to use MTX. Patients with risk factors that lead to GI disorders, hepatotoxicity, and bone marrow toxicity were 35 patients, 19 patients, and 15 patients, respectively. There were 32 patients used MTX with the correct dosage, meanwhile incorrect dosage was showed in 3 patients with ClCr 61–80 mL/minute, 2 patients with ClCr 51–60 mL/minute, 1 patient with ClCr 10–50 mL/minute, and 2 patients with SGPT >3 normal value. The interaction with NSAID was detected in 35 patients and the interaction with hepatotoxicity agents in 19 patients. Complication occurred in 7 patients with effects that occur were GI disorders and 1 patient with chirrosis. There were 10 patients with clinical complaints reduced and 2 patients with the better condition. This study suggested that in Emanuel Klampok Hospital, MTX was appropriately use regarding to indication, however, it still not appropriate regarding to process indicators, complication, and outcome indicators.Key words: Emanuel Klampok Hospital, methotrexate, rheumatoid arthritis
Deteksi Gen Resistensi Ampisilin (bla) pada Escherichia coli Isolat Klinik dengan Metode Polymerase Chain Reaction Milanda, Tiana; Saragih, Bonar C.; Kusuma, Sri A. F.
Indonesian Journal of Clinical Pharmacy Vol 3, No 3 (2014)
Publisher : Indonesian Journal of Clinical Pharmacy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (205.271 KB) | DOI: 10.15416/ijcp.2014.3.3.98

Abstract

Escherichia coli merupakan bakteri batang Gram negatif yang dapat menjadi patogen jika jumlahnya meningkat atau berada di luar saluran pencernaan. E. coli yang patogen akan menghasilkan enterotoksin yang menyebabkan diare atau infeksi pada saluran kemih. Ampisilin merupakan salah satu antibiotik pilihan untuk mengatasi penyakit infeksi tersebut. Akhir-akhir ini ampisilin tidak lagi digunakan sebagai obat pilihan karena banyaknya kasus resistensi E. coli terhadap antibiotik tersebut. Penelitian ini bertujuanuntuk mendeteksi keberadaan gen yang bertanggung jawab terhadap resistensi antibiotik ampisilin pada E. coli isolat klinik. Sampel yang digunakan adalah hasil isolasi urin midstream pasien dengan gejala sistitis di Rumah Sakit Hasan Sadikin (RSHS) Bandung. Uji resistensi antibiotik menggunakan metode Polymerase Chain Reaction (PCR), baik PCR-koloni maupun PCR-DNA. Berdasarkan hasil uji resistensi terhadap ampisilin, E. coli hasil isolasi telah resisten terhadap ampisilin. Elektroforesis hasil PCR-koloni dan PCR-DNA menunjukkan bahwa resistensi terhadap ampisilin disebabkan oleh gen bla berukuran 199 pb. Diperlukan pemilihan antibiotik yang selektif dan rasional untuk mencegah resistensi ampisilin pada pasien dengan gejala sistitis.Kata kunci: bla, Escherichia coli, gen resistensi ampisilin, polymerase chain reactionDetection of Ampicillin Resistance Genes (bla) in Clinical Isolates ofEscherichia coli with Polymerase Chain Reaction MethodEscherichia coli is a rod negative Gram which could be pathogenic, if its value increases or located in outer gastrointestinal tract. Pathogenic E. coli will produce enterotoxin which will cause diarrhea or infection in urine tract. Ampicilin was one of particular antibiotics to overcome infection. Ampicilinnowadays is no longer used as first choice medicine, because of its resistance case. The aim of this research was to detect the presence of gene which is responsible to ampicilin resistant E. coli. We used isolated midstream urine from cystitis object in Hasan Sadikin Hospital as samples. Polymerase Chain Reaction (PCR) method (colony-PCR and DNA-PCR) were performed to invenstigate the antibiotic resistency. Based on the result of antibiotic susceptibility testing to ampicillin, E. coli samples were resistant to ampicilin. Electropherogram products of colony-PCR and DNA-PCR showed that the resistance case of ampicilin caused by bla gene (199 bp). Our result suggested that bla gene may be use to detect the ampicilin resistance. Furthermore, selective and rational antibiotic treatment is required toprevent ampicillin resistance in patients with symptoms of cystitis.Key words: Ampicillin resistance gene, bla, Escherichia coli, polymerase chain reaction
Pengoptimalan Peran Apoteker dalam Pemantauan dan Evaluasi Insiden Keselamatan Pasien Kusharwanti, Wara; Dewi, Sekar C.; Setiawati, Margarita K.
Indonesian Journal of Clinical Pharmacy Vol 3, No 3 (2014)
Publisher : Indonesian Journal of Clinical Pharmacy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (346.782 KB) | DOI: 10.15416/ijcp.2014.3.3.67

Abstract

Apoteker dapat berkontribusi dalam perawatan pasien dengan mengoptimalkan penggunaan obat dan meminimalisasi efek obat yang tidak diharapkan dengan cara mengidentifikasi Medication Related Problems (MRPs), memberikan solusi terhadap MRPs, dan mencegah MRPs melalui pelayanan farmasi klinik. Tujuan penelitian ini adalah mengintegrasikan kegiatan farmasi klinik dengan kegiatan keselamatan pasien untuk mengoptimalkan peran apoteker dalam pemantauan dan evaluasi insiden keselamatan pasien (IKP). Penelitian ini merupakan penelitian kuasi eksperimental dengan pengambilan data secara prospektif yang dilakukan pada bulan Mei–Juli 2012 dengan subjek penelitian pasien rawat inap sebanyak 5173 pasien. Hasil penelitian ini menunjukkan terdapat 150 MRPs yang terjadi pada 142 pasien. MRPs dikelompokkan dalam 5 kategori insiden, yaitu Kondisi Potensial Cedera (2,67%), Kondisi Nyaris Cedera (16,67%), Kondisi Tidak Cedera (58,66%), Kejadian Tidak Diharapkan (22%), dan sentinel (0%). Setiap MRPs ditindaklanjuti dengan rekomendasi yang diukur tingkat penerimaannya, yaitu diterima sesuai rekomendasi (81,64%), diterima dengan modifikasi (5,70%), diterima tanpa dilakukan perubahan (12,56%.). Setelah itu dilakukan pemetaan risk grading matrix. Integrasi kegiatan farmasi klinik dengan kegiatan keselamatan pasien diwujudkan melalui sistem pelaporan yang memuat MRPs, kategori insiden, dampak klinik, rekomendasi pemecahan masalah, dan risk grading matrix.Kata kunci: Apoteker farmasi klinik, keselamatan pasien, risk grading matrix Optimization of Pharmacists Roles in Patient Safety Monitoring andEvaluationPharmacists can contribute to patient care by optimizing the use of drugs and minimizing adverse drugs effect. This can be performed by identifying the presence of Medication Related Problems (MRPs) and providing a solution to prevent the MRPs through clinical pharmacy services. The aim of this study was to integrate clinical pharmacy activities with patient safety activities in order to optimize the roles of pharmacists both in monitoring and evaluation of patient safety incidents. This study was a quasi-experimental study with prospective data collection which was conducted in May–July 2012 with 5173 hospitalized patients as subjects. The results showed that there were 150 MRPs occurred in 142patients. The existing MRPs were grouped in 5 categories of incidents; Potential Injury (2.67%), Almost Injury (16.67%), No Injury (58.66%), Unexpected Incidents (22%), and Sentinel (0%). Each MRPs was followed by recommendations which level of acceptance were measured; accepted according to the recommendations (81.64%), accepted with modifications (5.70%), and accepted without changes (12.56%). Furthermore, risk grading matrix mapping was also performed. Based on these results,integration of clinical pharmacy activities to patient safety activities was performed through report system. This report including MRP, incident categories, clinical impacts, recommendation, and risk grading matrix.Key words: Clinical pharmacists, patient safety, risk grading matrix
Overview Off-label Drug Uses in Pediatric Patients at Ulin’s Hospital, Banjarmasin Kartinah, Nani; Intannia, Difa; Fitri, Nahyanti
Indonesian Journal of Clinical Pharmacy Vol 3, No 3 (2014)
Publisher : Indonesian Journal of Clinical Pharmacy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (349.307 KB) | DOI: 10.15416/ijcp.2014.3.3.77

Abstract

Profile of off-label drug uses in Indonesia particularly in South Borneo is yet unknown. Study of off-label drug uses is necessary because its safety and effectiveness treatment for children are not guaranteed. The purpose of this study was to identify the percentage of pediatric patients who received off-label drug, the most commonly drug that used as an off-label drug, and the percentage of off-label drug based on the criteria, including: age, dose, route of administration, and indication. This research used a prospective study. The study population on this research was patients aged a month to 18 years who is treated at Ulin’s Hospital during March to May 2013. The samples of this research were patients who received antibiotics, analgesics, and antipyretics, anti-inflammatory, antihistamine, anticonvulsant, and antiemmetic drug therapy. There was 86 people (32.58%) of the 264 patients who received an off-label drug, anti-inflammatory drug was the most commonly used as an off-label drug with 38 cases (30.64 %) of the 124 cases of an off-label drug, and based on the criteria, there was 41 cases (33,06 %) off-label of age, 45 cases (36.29%) off-label of dose, no cases off-label of route of administration, and 38 cases (30,65 %) off-label of indication. Further research is needed to determine the safety and efficacy of an off-label drug.Key words: Off-label drug, pediatrics, RSUD Ulin BanjarmasinGambaran Penggunaan Obat Off-label pada Pasien Pediatrik di Rumah Sakit Ulin, BanjarmasinPenggunaan obat off-label pada anak-anak di Indonesia khususnya Kalimantan Selatan tidak diketahui. Penelitian ini diperlukan karena tidak terdapat jaminan keamanan dan efektivitas pengobatan bagi anakanak. Tujuan dari penelitian ini adalah untuk mengidentifikasi pasien anak yang mendapatkan obat offlabel, mengidentifikasi obat yang paling umum digunakan sebagai off-label, dan menentukan persentase obat off-label berdasarkan kriteria usia, dosis, cara pemberian, dan indikasi. Metode penelitian ini menggunakan prospektif studi. Populasi penelitian adalah pasien 1 bulan hingga18 tahun yang dirawat di RSUD Ulin pada bulan Maret hingga Mei 2013. Sampel penelitian adalah semua pasien usia 1 bulan hingga 18 tahun yang mendapat antibiotik, analgetik, dan antipiretik, antiinflamasi, antihistamin, antikonvulsan, dan antiemetik. Total pasien yang memperoleh obat off-label adalah 86 (32,58%) dari 264 pasien, golongan obat yang biasa digunakan off-label adalah antiinflamasi 38 (30,64%) dari 124 obat off-label. Jumlah obat off-label menurut kriteria usia adalah 41 (33,06%) dari 124 obat off-label, kriteriadosis 45 (36,29%), pada rute pemberian obat 0 (0%), dan kriteria indikasi 38 (30,65%). Diperlukan penelitian lebih lanjut untuk menentukan keamanan dan kemanjuran obat.Kata kunci: Obat off-label, pasien anak, RSUD Ulin Banjarmasin
Peningkatan Serum Kreatinin Akibat Penggunaan ACEi atau ARB pada Pasien Hipertensi Irawan, Anita
Indonesian Journal of Clinical Pharmacy Vol 3, No 3 (2014)
Publisher : Indonesian Journal of Clinical Pharmacy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (282.486 KB) | DOI: 10.15416/ijcp.2014.3.3.82

Abstract

Pemakaian obat golongan Angiotensin-Converting Enzyme Inhibitor (ACE-I) atau Angiotensin Receptor Blockers (ARB) banyak digunakan pada pasien hipertensi. Kerjanya yang efektif sebagai obat penurun tekanan darah dan renoprotection menjadikan obat ini pilihan utama. Salah satu efek lain dari obat ini dapat meningkatkan serum kreatinin. Seorang wanita 68 tahun dengan riwayat hipertensi masuk rumah sakit pada Juli 2012 dengan diagnosis gagal ginjal kronik (GGK) stage 5 dengan serum kreatinin sebesar 4,29 mg/dL, setelah 5 hari meningkat menjadi 5,5 mg/dL. Riwayat obat yang digunakan adalah valsartan selama 8 bulan yang diganti lisinopril sampai 26 Juli 2012. Nilai serum kreatinin pasien mengalami fluktuasi selama menggunakan pengobatan tersebut dan terus meningkat selama 1 tahun terakhir. Pada Mei 2012 serum kreatinin saat kontrol rawat jalan adalah 3,16 mg/dL. Pasien dicurigai mengalami reaksi obat tidak dikehendaki yang menyebabkan peningkatan serum kreatinin sebesar 20–30% dari batas awal. Oleh karena itu, pada awal Agustus obat ini dihentikan dan dievaluasi pada 4 Agustus diketahui nilai serum kreatinin pasien turun menjadi 4,96 mg/dL dari 5,55 mg/dL. Hasil perhitungan dengan Naranjo Scale menunjukkan penggunaan valsartan/lisinopril menyebabkan reaksi obat yang merugikan (adverse drug reaction). Oleh karena itu diperlukan monitoring dalam penggunaan ACEI dan ARB sehingga reaksi obat yang tidak dikehendaki dapat ditemukan sejak dini dan segera mempertimbangkan manajemen obat selanjutnya.Kata kunci: ACEi, adverse drug reaction, ARB, hipertensi, serum kreatinin Increase of Serum Creatinine as the Outcome of ACEi or ARB UseAngiotensin-Converting Enzyme Inhibitors (ACE-I) or Angiotensin Receptor Blockers (ARBS) are commonly used for patients with hypertension. This drug is the first choice for hypertension treatment due to its works in lowering blood pressure and renoprotection. Another effects of this drugs is increase creatinine serum. A 68 years old woman with hypertension was hospitalized in July 2012. This woman was diagnosed to stage 5 chronic kidney disease (CKD) with serum creatinine level was 4.29 mg/dL, after 5 days increased to 5.5 mg/dL. This patient used is valsartan for 8 months, which replaced with lisinopril until 26 July 2012. Serum creatinine levels was fluctuated while using the treatment and increased during the last one year. In May 2012, when the patient do regularly control, serum creatinine level is 3.16 mg/dL. Adverse drug reactions of lisinopril and valsartan can increase the serum creatinine level by 20–30% from base line score. Therefore, in early August 2012, the drug was discontinued and evaluated on 4th of August, the serum creatinine level of the patient decreased to 4.96 mg/dL from 5.55 mg/dL. The result of Naranjo scale indicated that the use of valsartan/lisinopril cause adverse drug reactions. Monitoring is required for the patient who use ACEI or ARB therapy, so adverse drugreactions can be found from the beginning and the management of drug can be considered appropriately.Key words: ACEi, adverse drug reaction, ARB, creatinine, hypertension
Ketepatan Penggunaan Metotreksat pada Pasien Reumatoid Artritis di Rumah Sakit Emanuel Klampok berdasarkan Kriteria Eksplisit Rizki Puspitasari; Tunggul A. Purwonugroho; Hanif N. Baroroh
Indonesian Journal of Clinical Pharmacy Vol 3, No 3 (2014)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2486.074 KB) | DOI: 10.15416/ijcp.2014.3.3.88

Abstract

Metotreksat (MTX) adalah agen antiinflamasi dan imunosupresan yang menjadi lini pertama terapi reumatoid artritis (RA). Penelitian ini bertujuan mengevaluasi penggunaan MTX pada pasien RA di Rumah Sakit Emanuel Klampok berdasarkan kriteria indikasi, indikator proses, komplikasi, dan indikator hasil. Analisis data dilakukan secara deskriptif evaluatif menggunakan data rekam medik13 pasien rawat inap dan 27 pasien rawat jalan. Hasil penelitian menunjukkan ketepatan indikasi 100%. Pasien dengan faktor risiko gangguan GI, hepatotoksik, dan toksisitas bone marrow berturut-turut 35 pasien, 19 pasien, dan 15 pasien. Pemberian MTX dengan dosis tepat sejumlah 32 pasien, dosis tidak tepat dengan ClCr 61–80 mL/menit sejumlah 3 pasien, ClCr 51–60 mL/menit sejumlah 2 pasien, ClCr 10–50 mL/menit sejumlah 1 pasien, dan SGPT >3 nilai normal sejumlah 2 pasien. Interaksi MTX dengan NSAID sejumlah 35 pasien dan dengan agen hepatotoksik sejumlah 19 pasien. Komplikasi terjadi pada 7 pasien berupa gangguan GI dan 1 pasien berupa sirosis. Indikator hasil berupa berkurangnya keluhan klinis seperti nyeri dan kakuterjadi pada 10 pasien dan pasien yang membaik sejumlah 2 pasien. Indikasi penggunaan MTX telah sesuai dengan kriteria sedangkan indikator proses, komplikasi, dan indikator hasil masih belum sesuai.Kata kunci: Metotreksat, reumatoid artritis, Rumah Sakit Emanuel KlampokAccuracy of Methotrexate Use in Rheumatoid Arthritis Patients in Emanuel Klampok Hospital based on Explicit CriteriaMethotrexate (MTX) is the first line therapy for rheumatoid arthritis (RA) as an antiinflammatory and immunosuppressant agent. The purpose of this study was to evaluate the use of MTX in patients with RA at Emanuel Klampok Hospital based on criteria that include indication, process indicators, complication, and outcome indicators. The medical record from 13 inpatients and 27 outpatients who used MTX were compared with the criteria. The results of this study suggested that all of the patients had appropriately indications to use MTX. Patients with risk factors that lead to GI disorders, hepatotoxicity, and bone marrow toxicity were 35 patients, 19 patients, and 15 patients, respectively. There were 32 patients used MTX with the correct dosage, meanwhile incorrect dosage was showed in 3 patients with ClCr 61–80 mL/minute, 2 patients with ClCr 51–60 mL/minute, 1 patient with ClCr 10–50 mL/minute, and 2 patients with SGPT >3 normal value. The interaction with NSAID was detected in 35 patients and the interaction with hepatotoxicity agents in 19 patients. Complication occurred in 7 patients with effects that occur were GI disorders and 1 patient with chirrosis. There were 10 patients with clinical complaints reduced and 2 patients with the better condition. This study suggested that in Emanuel Klampok Hospital, MTX was appropriately use regarding to indication, however, it still not appropriate regarding to process indicators, complication, and outcome indicators.Key words: Emanuel Klampok Hospital, methotrexate, rheumatoid arthritis
Deteksi Gen Resistensi Ampisilin (bla) pada Escherichia coli Isolat Klinik dengan Metode Polymerase Chain Reaction Tiana Milanda; Bonar C. Saragih; Sri A. F. Kusuma
Indonesian Journal of Clinical Pharmacy Vol 3, No 3 (2014)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (7852.854 KB) | DOI: 10.15416/ijcp.2014.3.3.98

Abstract

Escherichia coli merupakan bakteri batang Gram negatif yang dapat menjadi patogen jika jumlahnya meningkat atau berada di luar saluran pencernaan. E. coli yang patogen akan menghasilkan enterotoksin yang menyebabkan diare atau infeksi pada saluran kemih. Ampisilin merupakan salah satu antibiotik pilihan untuk mengatasi penyakit infeksi tersebut. Akhir-akhir ini ampisilin tidak lagi digunakan sebagai obat pilihan karena banyaknya kasus resistensi E. coli terhadap antibiotik tersebut. Penelitian ini bertujuanuntuk mendeteksi keberadaan gen yang bertanggung jawab terhadap resistensi antibiotik ampisilin pada E. coli isolat klinik. Sampel yang digunakan adalah hasil isolasi urin midstream pasien dengan gejala sistitis di Rumah Sakit Hasan Sadikin (RSHS) Bandung. Uji resistensi antibiotik menggunakan metode Polymerase Chain Reaction (PCR), baik PCR-koloni maupun PCR-DNA. Berdasarkan hasil uji resistensi terhadap ampisilin, E. coli hasil isolasi telah resisten terhadap ampisilin. Elektroforesis hasil PCR-koloni dan PCR-DNA menunjukkan bahwa resistensi terhadap ampisilin disebabkan oleh gen bla berukuran 199 pb. Diperlukan pemilihan antibiotik yang selektif dan rasional untuk mencegah resistensi ampisilin pada pasien dengan gejala sistitis.Kata kunci: bla, Escherichia coli, gen resistensi ampisilin, polymerase chain reactionDetection of Ampicillin Resistance Genes (bla) in Clinical Isolates ofEscherichia coli with Polymerase Chain Reaction MethodEscherichia coli is a rod negative Gram which could be pathogenic, if its value increases or located in outer gastrointestinal tract. Pathogenic E. coli will produce enterotoxin which will cause diarrhea or infection in urine tract. Ampicilin was one of particular antibiotics to overcome infection. Ampicilinnowadays is no longer used as first choice medicine, because of its resistance case. The aim of this research was to detect the presence of gene which is responsible to ampicilin resistant E. coli. We used isolated midstream urine from cystitis object in Hasan Sadikin Hospital as samples. Polymerase Chain Reaction (PCR) method (colony-PCR and DNA-PCR) were performed to invenstigate the antibiotic resistency. Based on the result of antibiotic susceptibility testing to ampicillin, E. coli samples were resistant to ampicilin. Electropherogram products of colony-PCR and DNA-PCR showed that the resistance case of ampicilin caused by bla gene (199 bp). Our result suggested that bla gene may be use to detect the ampicilin resistance. Furthermore, selective and rational antibiotic treatment is required toprevent ampicillin resistance in patients with symptoms of cystitis.Key words: Ampicillin resistance gene, bla, Escherichia coli, polymerase chain reaction
Pengoptimalan Peran Apoteker dalam Pemantauan dan Evaluasi Insiden Keselamatan Pasien Wara Kusharwanti; Sekar C. Dewi; Margarita K. Setiawati
Indonesian Journal of Clinical Pharmacy Vol 3, No 3 (2014)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2924.155 KB) | DOI: 10.15416/ijcp.2014.3.3.67

Abstract

Apoteker dapat berkontribusi dalam perawatan pasien dengan mengoptimalkan penggunaan obat dan meminimalisasi efek obat yang tidak diharapkan dengan cara mengidentifikasi Medication Related Problems (MRPs), memberikan solusi terhadap MRPs, dan mencegah MRPs melalui pelayanan farmasi klinik. Tujuan penelitian ini adalah mengintegrasikan kegiatan farmasi klinik dengan kegiatan keselamatan pasien untuk mengoptimalkan peran apoteker dalam pemantauan dan evaluasi insiden keselamatan pasien (IKP). Penelitian ini merupakan penelitian kuasi eksperimental dengan pengambilan data secara prospektif yang dilakukan pada bulan Mei–Juli 2012 dengan subjek penelitian pasien rawat inap sebanyak 5173 pasien. Hasil penelitian ini menunjukkan terdapat 150 MRPs yang terjadi pada 142 pasien. MRPs dikelompokkan dalam 5 kategori insiden, yaitu Kondisi Potensial Cedera (2,67%), Kondisi Nyaris Cedera (16,67%), Kondisi Tidak Cedera (58,66%), Kejadian Tidak Diharapkan (22%), dan sentinel (0%). Setiap MRPs ditindaklanjuti dengan rekomendasi yang diukur tingkat penerimaannya, yaitu diterima sesuai rekomendasi (81,64%), diterima dengan modifikasi (5,70%), diterima tanpa dilakukan perubahan (12,56%.). Setelah itu dilakukan pemetaan risk grading matrix. Integrasi kegiatan farmasi klinik dengan kegiatan keselamatan pasien diwujudkan melalui sistem pelaporan yang memuat MRPs, kategori insiden, dampak klinik, rekomendasi pemecahan masalah, dan risk grading matrix.Kata kunci: Apoteker farmasi klinik, keselamatan pasien, risk grading matrix Optimization of Pharmacists Roles in Patient Safety Monitoring andEvaluationPharmacists can contribute to patient care by optimizing the use of drugs and minimizing adverse drugs effect. This can be performed by identifying the presence of Medication Related Problems (MRPs) and providing a solution to prevent the MRPs through clinical pharmacy services. The aim of this study was to integrate clinical pharmacy activities with patient safety activities in order to optimize the roles of pharmacists both in monitoring and evaluation of patient safety incidents. This study was a quasi-experimental study with prospective data collection which was conducted in May–July 2012 with 5173 hospitalized patients as subjects. The results showed that there were 150 MRPs occurred in 142patients. The existing MRPs were grouped in 5 categories of incidents; Potential Injury (2.67%), Almost Injury (16.67%), No Injury (58.66%), Unexpected Incidents (22%), and Sentinel (0%). Each MRPs was followed by recommendations which level of acceptance were measured; accepted according to the recommendations (81.64%), accepted with modifications (5.70%), and accepted without changes (12.56%). Furthermore, risk grading matrix mapping was also performed. Based on these results,integration of clinical pharmacy activities to patient safety activities was performed through report system. This report including MRP, incident categories, clinical impacts, recommendation, and risk grading matrix.Key words: Clinical pharmacists, patient safety, risk grading matrix
Overview Off-label Drug Uses in Pediatric Patients at Ulin’s Hospital, Banjarmasin Nani Kartinah; Difa Intannia; Nahyanti Fitri
Indonesian Journal of Clinical Pharmacy Vol 3, No 3 (2014)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (349.307 KB) | DOI: 10.15416/ijcp.2014.3.3.77

Abstract

Profile of off-label drug uses in Indonesia particularly in South Borneo is yet unknown. Study of off-label drug uses is necessary because its safety and effectiveness treatment for children are not guaranteed. The purpose of this study was to identify the percentage of pediatric patients who received off-label drug, the most commonly drug that used as an off-label drug, and the percentage of off-label drug based on the criteria, including: age, dose, route of administration, and indication. This research used a prospective study. The study population on this research was patients aged a month to 18 years who is treated at Ulin’s Hospital during March to May 2013. The samples of this research were patients who received antibiotics, analgesics, and antipyretics, anti-inflammatory, antihistamine, anticonvulsant, and antiemmetic drug therapy. There was 86 people (32.58%) of the 264 patients who received an off-label drug, anti-inflammatory drug was the most commonly used as an off-label drug with 38 cases (30.64 %) of the 124 cases of an off-label drug, and based on the criteria, there was 41 cases (33,06 %) off-label of age, 45 cases (36.29%) off-label of dose, no cases off-label of route of administration, and 38 cases (30,65 %) off-label of indication. Further research is needed to determine the safety and efficacy of an off-label drug.Key words: Off-label drug, pediatrics, RSUD Ulin BanjarmasinGambaran Penggunaan Obat Off-label pada Pasien Pediatrik di Rumah Sakit Ulin, BanjarmasinPenggunaan obat off-label pada anak-anak di Indonesia khususnya Kalimantan Selatan tidak diketahui. Penelitian ini diperlukan karena tidak terdapat jaminan keamanan dan efektivitas pengobatan bagi anakanak. Tujuan dari penelitian ini adalah untuk mengidentifikasi pasien anak yang mendapatkan obat offlabel, mengidentifikasi obat yang paling umum digunakan sebagai off-label, dan menentukan persentase obat off-label berdasarkan kriteria usia, dosis, cara pemberian, dan indikasi. Metode penelitian ini menggunakan prospektif studi. Populasi penelitian adalah pasien 1 bulan hingga18 tahun yang dirawat di RSUD Ulin pada bulan Maret hingga Mei 2013. Sampel penelitian adalah semua pasien usia 1 bulan hingga 18 tahun yang mendapat antibiotik, analgetik, dan antipiretik, antiinflamasi, antihistamin, antikonvulsan, dan antiemetik. Total pasien yang memperoleh obat off-label adalah 86 (32,58%) dari 264 pasien, golongan obat yang biasa digunakan off-label adalah antiinflamasi 38 (30,64%) dari 124 obat off-label. Jumlah obat off-label menurut kriteria usia adalah 41 (33,06%) dari 124 obat off-label, kriteriadosis 45 (36,29%), pada rute pemberian obat 0 (0%), dan kriteria indikasi 38 (30,65%). Diperlukan penelitian lebih lanjut untuk menentukan keamanan dan kemanjuran obat.Kata kunci: Obat off-label, pasien anak, RSUD Ulin Banjarmasin
Peningkatan Serum Kreatinin Akibat Penggunaan ACEi atau ARB pada Pasien Hipertensi Anita Irawan
Indonesian Journal of Clinical Pharmacy Vol 3, No 3 (2014)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2947.395 KB) | DOI: 10.15416/ijcp.2014.3.3.82

Abstract

Pemakaian obat golongan Angiotensin-Converting Enzyme Inhibitor (ACE-I) atau Angiotensin Receptor Blockers (ARB) banyak digunakan pada pasien hipertensi. Kerjanya yang efektif sebagai obat penurun tekanan darah dan renoprotection menjadikan obat ini pilihan utama. Salah satu efek lain dari obat ini dapat meningkatkan serum kreatinin. Seorang wanita 68 tahun dengan riwayat hipertensi masuk rumah sakit pada Juli 2012 dengan diagnosis gagal ginjal kronik (GGK) stage 5 dengan serum kreatinin sebesar 4,29 mg/dL, setelah 5 hari meningkat menjadi 5,5 mg/dL. Riwayat obat yang digunakan adalah valsartan selama 8 bulan yang diganti lisinopril sampai 26 Juli 2012. Nilai serum kreatinin pasien mengalami fluktuasi selama menggunakan pengobatan tersebut dan terus meningkat selama 1 tahun terakhir. Pada Mei 2012 serum kreatinin saat kontrol rawat jalan adalah 3,16 mg/dL. Pasien dicurigai mengalami reaksi obat tidak dikehendaki yang menyebabkan peningkatan serum kreatinin sebesar 20–30% dari batas awal. Oleh karena itu, pada awal Agustus obat ini dihentikan dan dievaluasi pada 4 Agustus diketahui nilai serum kreatinin pasien turun menjadi 4,96 mg/dL dari 5,55 mg/dL. Hasil perhitungan dengan Naranjo Scale menunjukkan penggunaan valsartan/lisinopril menyebabkan reaksi obat yang merugikan (adverse drug reaction). Oleh karena itu diperlukan monitoring dalam penggunaan ACEI dan ARB sehingga reaksi obat yang tidak dikehendaki dapat ditemukan sejak dini dan segera mempertimbangkan manajemen obat selanjutnya.Kata kunci: ACEi, adverse drug reaction, ARB, hipertensi, serum kreatinin Increase of Serum Creatinine as the Outcome of ACEi or ARB UseAngiotensin-Converting Enzyme Inhibitors (ACE-I) or Angiotensin Receptor Blockers (ARBS) are commonly used for patients with hypertension. This drug is the first choice for hypertension treatment due to its works in lowering blood pressure and renoprotection. Another effects of this drugs is increase creatinine serum. A 68 years old woman with hypertension was hospitalized in July 2012. This woman was diagnosed to stage 5 chronic kidney disease (CKD) with serum creatinine level was 4.29 mg/dL, after 5 days increased to 5.5 mg/dL. This patient used is valsartan for 8 months, which replaced with lisinopril until 26 July 2012. Serum creatinine levels was fluctuated while using the treatment and increased during the last one year. In May 2012, when the patient do regularly control, serum creatinine level is 3.16 mg/dL. Adverse drug reactions of lisinopril and valsartan can increase the serum creatinine level by 20–30% from base line score. Therefore, in early August 2012, the drug was discontinued and evaluated on 4th of August, the serum creatinine level of the patient decreased to 4.96 mg/dL from 5.55 mg/dL. The result of Naranjo scale indicated that the use of valsartan/lisinopril cause adverse drug reactions. Monitoring is required for the patient who use ACEI or ARB therapy, so adverse drugreactions can be found from the beginning and the management of drug can be considered appropriately.Key words: ACEi, adverse drug reaction, ARB, creatinine, hypertension

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