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Jurnal Farmasi Klinik Indonesia

ijcp
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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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Articles 540 Documents

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Improving Outpatient’s Quality of Life Through Patient Adherence of Antihypertensive Therapy Using “Mobile Phone (SMS) and Brief Counseling‑5A” in Polyclinic of Internal Medicine at PKU Muhammadiyah Bantul Hospital, Yogyakarta Ginanjar Z. Saputri; Akrom Akrom; Endang Darmawan
Indonesian Journal of Clinical Pharmacy Vol 6, No 2 (2017)
Publisher : Universitas Padjadjaran

The Health-Related Quality of Life (HRQoL) is one of the important psycho-social characteristics that can affect patient’s ability to manage therapy. Poor of knowledge of hypertension and the changing lifestyle can affect the quality of life of patients. One of the pharmacist’s interventions in hypertension management is to conduct counseling. Motivational counseling helps health service to assess patient’s understanding and patient’s readiness to change patient’s behavior. Some motivational counseling methods still need to be developed. Therefore, this study aims to find the influence of the “brief counseling-5A” and “motivational SMS” by a pharmacist on the quality of life and blood pressure control in hypertension patients in the internal disease polyclinic, PKU Muhammadiyah Bantul Hospital, Yogyakarta. The study has been done by using the quasi-experimental method with prospective data collection during the period of January until April 2013. Sixty patients have met inclusion criteria and were divided into two groups. Thirty patients (50%) received “brief counseling-5A” and “motivational SMS” as intervention group and the other thirty patients (50%) received usual care as a control group. The data collection was done by interviewing patients. Medication adherence and QoL were assessed by using Morisky Medication Adherence Scale (MMAS) and SF-36. The values of blood pressure are taken from patient’s medical records. Patient’s quality of life showed a good improvement during post study. It is shown in 8 different domains including pain, fatigue, physical function, emotional function, social function, role physical, mental health, and general health. In intervention group, physical function, emotional function, and pain showed highly significant improvement (p<0.05). Systolic and diastolic blood pressure in the intervention group decreased significantly (p<0.05) (systolic p=0.001 and diastolic p=0.018) in the post study. From this study, it is concluded that the “brief counseling-5A by pharmacist” and “motivational SMS” had a positive impact on patient’s QoL and patient’s blood pressure, hence, the therapy outcome has been achieved.Keywords: Adherence, blood pressure, brief counseling, hypertension, quality of life, SMS Peningkatan Kualitas Hidup (QoL) Melalui Kepatuhan Terapi Antihipertensi dengan Mobile Phone Text Messaging (SMS) dan Brief Counseling-5A pada Pasien Rawat Jalan Poliklinik Penyakit DalamRumah Sakit PKU Muhammadiyah Bantul, YogyakartaAbstrakHubungan kesehatan dan kualitas hidup (Health Related Quality of Life) merupakan salah satu karakter psiko‑sosial penting yang dapat memengaruhi kemampuan pasien dalam penatalaksanaan terapi. Kurangnya pengetahuan mengenai hipertensi dan perubahan gaya hidup dapat memengaruhi kualitas hidup pasien. Salah satu intervensi farmasis dalam penatalaksanaan hipertensi adalah konseling. Konseling motivasional membantu pelayanan kesehatan untuk menggali pemahaman pasien serta kesiapan pasien untuk berubah. Tujuan penelitian ini adalah untuk mengetahui pengaruh pemberian brief counseling-5A disertai SMS motivasi oleh farmasis terhadap kualitas hidup dan pengontrolan tekanan darah pasien hipertensi di poliklinik penyakit dalam RS PKU Muhammadiyah Bantul, Yogyakarta. Penelitian dilakukan secara kuasi eksperimental dengan pengambilan data secara prospektif selama periode Januari hingga April 2013. Sejumlah 60 subjek yang memenuhi kriteria inklusi dibagi menjadi dua kelompok yaitu 30 pasien (50%) mendapatkan brief counseling-5A serta SMS motivasional (kelompok perlakuan) dan 30 pasien (50%) mendapatkan pelayanan kefarmasian konvensional (usual care) sebagai kontrol. Pengumpulan data dilakukan dengan melakukan wawancara dan pengisian kuesioner kepatuhan Morisky Medication Adherence Scale (MMAS), dan kuesioner kualitas hidup SF-36. Nilai tekanan darah diambil dari catatan medis. Kualitas hidup pasien hipertensi menunjukkan peningkatan rerata pada kunjungan kedua (post) di semua domain baik nyeri, fatigue, fungsi fisik, fungsi emosi, fungsi sosial, keadaan fisik, keadaan emosi (status mental), dan keadaan umum (kesehatan umum). Perubahan yang bermakna (p<0,05) terjadi pada domain fungsi fisik (FF), fungsi emosi (FE) dan nyeri. Terjadi penurunan tekanan darah sistolik (p=0,001) dan diastolik (p=0,018) pada kelompok perlakuan sementara pada kelompok kontrol tidak terjadi penurunan tekanan darah sistolik (p=0,730) dan diastolik (p=0,786). Berdasarkan hasil penelitian ini, dapat disimpulkan bahwa pemberian brief counseling-5A serta SMS motivasional oleh farmasis pada pasien hipertensi memberikan pengaruh positif terhadap kualitas hidup pasien dan tekanan darah sehingga tujuan terapi antihipertensi tercapai.Kata kunci: Brief counseling, hipertensi, kepatuhan, kualitas hidup, SMS, tekanan darah

N-MID Osteocalcin (N-MID Oc) dan β-Crosslaps (β-CTx) sebagai Penanda Biokimia Bone Turn Over pada Wanita Menopause Eli Halimah; Wiwik Rositawati; Irma Pratiwi
Indonesian Journal of Clinical Pharmacy Vol 5, No 1 (2016)
Publisher : Universitas Padjadjaran

Osteocalcin merupakan senyawa penanda untuk pembentukan tulang sedangkan β-CrossLaps (β-CTx) merupakan fragmen hasil pemecahan kolagen tipe 1. Tujuan penelitian ini yaitu untuk menentukan N-MID osteocalcin (N-MID Oc) dan β-CTx sebagai penanda biokimia Bone Turn Over untuk deteksi dini osteoporosis pada wanita menopause. Nilai N-MID Oc dalam serum ditentukan dengan pereaksi Elecsys N-MID Osteocalcin kit dan nilai β-CTx dalam serum ditentukan dengan pereaksi Elecsys β-CROSSLAPS kit yang bekerja berdasarkan prinsip Electrochemiluminescence Immunoassay (ECLIA). Data yang diperoleh diuji dengan menggunakan Uji-T. Sampel yang dikumpulkan berasal dari wanita normal, osteopenia, dan penderita osteoporosis pada wanita menopause. Hasil penelitian menunjukkan terdapat perbedaan nilai N-MID Oc pada wanita menopause normal dengan wanita menopause osteopenia, wanita menopause normal dengan wanita menopause penderita osteoporosis dan wanita menopause osteopenia dengan wanita menopause penderita osteoporosis (α=0,05), sedangkan pada nilai β-CTx terdapat perbedaan antara wanita menopause normal dengan wanita menopause osteopenia, wanita menopause osteopenia dengan wanita menopause osteoporosis, tetapi antara wanita menopause osteopenia dengan wanita menopause osteoporosis tidak menunjukkan perbedaan (α=0,05). Penelitian ini menunjukkan bahwa N-MID Oc dan β-CTx dapat dijadikan parameter untuk deteksi dini osteoporosis.Kata kunci: N-MID Osteocalcin (N-MID Oc), Osteoporosis, β-CrossLaps (β-CTx) N-MID Osteocalcin (N-MID Oc) and β-Crosslaps (β-CTx) as Biochemical Markers of Bone Turnover in Menopausal Women Osteocalcin is a marker compound for bone formation while the β-crosslaps a fragment split from collagen type 1. The aims of this study were to determined of the value of N-MID osteocalcin (N-MID Oc) and β-CTx as a biochemical marker of Bone Turn Over as early detection of osteoporosis in postmenopausal women. The value of N-MID Oc in serum was determined by reagent Elecsys N-MID Osteocalcin kit and the value of β-CTx in serum was determined by reagent Elecsys β-Crosslaps kit which works with the principle of Electrochemiluminescence Immunoassay (ECLIA). The data obtained were examined using T-test. The sample collected from normal, osteopenia, and osteoporotic in menopausal women. There were a significant difference N-MID Oc between normal, osteopenia, and osteoporotic in menopausal women (α=0,05). There were significant differences of β-CTx between normal and osteopenia, normal and osteoporosis but between osteopenia and osteoporotic menopausal women not showed any difference (α=0,05). N-MID Osteocalcin (N-MID Oc) and β-CTx can be used as parameter for early detection of osteoporosis.Key words: N-MID Osteocalcin (N-MID Oc), Osteoporosis, β-CrossLaps (β -CTx)

Penggunaan Suplemen Herbal sebagai Upaya Swamedikasi di Kota Bandung Dika P. Destiani; Auliya A. Suwantika
Indonesian Journal of Clinical Pharmacy Vol 4, No 1 (2015)
Publisher : Universitas Padjadjaran

Swamedikasi menggunakan suplemen herbal di Indonesia belum terdokumentasi karena sebagian besar masyarakat yang mengonsumsinya tidak berkonsultasi dengan tenaga kesehatan. Penelitian retrospektif observasional ini dilakukan di salah satu pusat pelayanan kesehatan di Bandung pada tahun 2014 denganpengambilan data dari data penjualan suplemen herbal. Penjualan swamedikasi suplemen atau vitamin selama tahun 2014 mencapai 30.163 item dengan swamedikasi suplemen herbal untuk penyakit kronik dan degeneratif sebanyak 1.277 item. Berdasarkan kategori terapi, suplemen herbal yang paling banyak dikonsumsi adalah suplemen herbal untuk indikasi hiperlipidemia dengan kandungan bawang putih, lecithin, dan spirulina. Dari hasil penelitian ini dapat dilihat tingginya angka penggunaan swamedikasi suplemen herbal, akan tetapi tidak diketahui apakah masyarakat sudah memperoleh informasi yang benar dari apoteker mengenai cara penggunaannya.Kata kunci: Bandung, herbal, observasional, suplemen, swamedikasiThe Use of Herbal Supplements as One of Self Medications in BandungThe use of herbal supplements as one of self medications in Indonesia has not yet been well-documented since many people used these supplements in absence of medical consultation with pharmacist. This retrospective observational study was conducted at one of healthcare service centers in Bandung. Data related to the sale of herbal supplements during 2014 period was collected and analyzed. We found that 30.163 items of herbal supplements were sold in 2014. Approximately 1.277 sold items were specific supplements for chronic and degenerative diseases. Based on the category of therapy, the most sold item was a herbal supplement for hyperlipidemia with three major ingredients: garlic, lecithin, and spirulina. Despite the huge number of the use of herbal supplements in Indonesia, medical information from pharmacist about the use of herbal supplements is still scarce.Key words: Bandung, herbal, observation, self medication, supplement

Antibiotics utilization review in a neonate intensive care unit of a public hospital in Surabaya Felix Hidayat; Adji P. Setiadi; Eko Setiawan
Indonesian Journal of Clinical Pharmacy Vol 8, No 1 (2019)
Publisher : Universitas Padjadjaran

Antibiotic is one class of drugs that has been frequently used in the Neonatal Intensive Care Unit (NICU). The aim of this study was to identify the profile and to review the cost, appropriateness, and compatibility of antibiotics given to the patients in the NICU of one public hospital in Surabaya during November to December 2015. This was an observational prospective study using medical record as the main source of the data. All of information about eligible patients receiving antibiotics in the NICU was analysed descriptively. There were 32 patients involved in this study. The antibiotics utilization profile consisted of 25 single and 14 combination therapy. Ampicillin and ampicillin-gentamicin were found as the most frequently used in the single and combination therapy, consecutively. From all patients received antibiotics, there were 13 patients had been diagnosed with infections problem and only 2 patients (15.38%) received appropriate antibiotics therapy. The most frequently implemented mode of antibiotics changing strategy was de-escalation i.e. 44.44%. Based on the analysis of compatibility, it was found that there were lots of results of analysis classified as no-information. The average cost of antibiotics per patient was IDR 265,252 (range IDR 16,100 to IDR 2,091,500). There is a need to optimize the use of antibiotics in the NICU in order to minimize the risk of adverse outcomes especially the increased cost and risk of resistance.

Hubungan antara Obesitas, Konsumsi Tinggi Purin, dan Pengobatan terhadap Kadar Asam Urat dengan Penggunaan Allopurinol pada Pasien Hiperurisemia Ema P. Yunita; Dinar I. Fitriana; Atma Gunawan
Indonesian Journal of Clinical Pharmacy Vol 7, No 1 (2018)
Publisher : Universitas Padjadjaran

Hiperurisemia adalah kondisi ketika kadar asam urat dalam darah melebihi nilai normal. Terdapat banyak faktor yang memengaruhi peningkatan kadar asam urat, seperti obesitas, konsumsi tinggi purin, dan pengobatan. Tujuan dari penelitian ini adalah untuk mengetahui hubungan antara obesitas, konsumsi tinggi purin, dan pengobatan terhadap kadar asam urat dengan penggunaan allopurinol pada pasien hiperurisemia. Data diperoleh melalui rekam medis dan kuesioner dari RSUD Dr. Saiful Anwar, Malang, dan dengan studi potong melintang. Pengambilan sampel dilakukan selama satu bulan (April–Mei 2014). Data dianalisis secara deskriptif dan diuji hipotesis. Sampel penelitian ini adalah 45 pasien hiperurisemia yang memperoleh allopurinol sebagai terapinya selama satu bulan dan pasien dipilih dengan metode pengambilan sampel konsekutif. Hasil dari penelitian ini menunjukkan bahwa tidak terdapat hubungan komparasi yang bermakna secara statistik antara kadar asam urat terhadap obesitas (0,193), konsumsi tinggi purin yaitu makanan laut (0,420), daging (0,469), jerohan (0,054), dan polong-polongan (0,398) juga pengobatan yaitu furosemid (0,631), aspirin dosis rendah (0,773), hidroklorotiazid (0,216), dan spironolakton (0,246). Selain itu, tidak pula terdapat korelasi yang bermakna secara statistik antara kadar asam urat terhadap obesitas (0,197), konsumsi tinggi purin yaitu makanan laut (0,426), daging (0,476), jerohan (0,053), dan polong-polongan (0,404) juga pengobatan yaitu furosemid (0,637), aspirin dosis rendah (0,776), hidroklorotiazid (0,220), dan spironolakton (0,250).Kata kunci: Allopurinol, asam urat, penghambat xantin oksidase Associations between Obesity, High Purine Consumptions, and Medications on Uric Acid Level with the Use of Allopurinol in Hyperuricemia PatientsHyperuricemia is a condition when the blood uric acid level exceeds the normal amount. There are many factors that can increase the uric acid level, such as obesity, high purine consumptions, and medications. The aim of this study was to determine the associations between obesity, high purine consumptions, and medications on uric acid level with the use of allopurinol in hyperuricemia patients. Data were collected through medical records and questionnaires from General Hospital of Dr. Saiful Anwar, Malang, and delivered within a cross-sectional study. Sampling was conducted for one month (April–May 2014). Data were analyzed descriptively and tested hypothetically. The samples of this study were 45 hyperuricemia patients who had gotten allopurinol as their therapy for a month and they were choosen by the consecutive sampling method. The results of this study showed that there were no statistically significant comparative association between uric acid level on obesity (0.193), high purine consumptions i.e. seafoods (0.420), meats (0.469), organ meats (0.054), and pods (0.398) also medications i.e. furosemide (0.631), low dose aspirin (0.773), hydrochlorotiazide (0.216), and spironolactone (0.246). In particular, there were no statistically significant correlations between uric acid level on obesity (0.197), high purine consumptions i.e. seafoods (0.426), meats (0.476), organ meats (0.053), and pods (0.404) also medicines i.e. furosemide (0.637), low dose aspirin (0.776), hydrochlorotiazide (0.220), and spironolactone (0.250).Keywords: Allopurinol, uric acid, xanthin oxidase inhibitor

Penggunaan Antibakteri Golongan Carbapenem pada Pasien Dewasa Rawat Inap Sebuah Rumah Sakit Swasta di Surabaya Steven V. Halim; Rika Yulia; Eko Setiawan
Indonesian Journal of Clinical Pharmacy Vol 6, No 4 (2017)
Publisher : Universitas Padjadjaran

Kasus resistensi terhadap carbapenem merupakan salah satu masalah kesehatan global. Penggunaan yang tidak bertanggung jawab secara luas, berulang, dan dalam jangka waktu yang panjang merupakan faktor yang menentukan terjadinya fenomena tersebut. Tujuan penelitian ini adalah memberikan gambaran penggunaan dan kesesuaian penggunaan carbapenem untuk beberapa penyakit infeksi pada sebuah rumah sakit swasta di Surabaya. Penelitian ini merupakan penelitian deskriptif dengan menggunakan data rekam medis pasien dewasa yang mendapatkan carbapenem selama periode Januari 2014–September 2014 sebagai bahan penelitian. Penggunaan carbapenem dinyatakan dalam defined daily dose (DDD). Proses analisis kesesuaian jenis, dosis, dan durasi pemberian antibiotik dilakukan dengan menggunakan pedoman terapi Infectious Disease Society of America (IDSA) terbaru sebagai pustaka utama dan Drug Information Handbook edisi 22 sebagai pustaka pendukung. Kesesuaian jenis antibiotik dibandingkan dengan hasil kultur juga dianalisis dalam penelitian ini. Sebanyak 255 data rekam medis pasien dewasa dianalisis dalam penelitian ini. Total penggunaan carbapenem selama periode pengamatan sebesar 1462,25 DDD. Densitas penggunaan carbapenem dapat diklasifikasikan rendah yaitu hampir 20% dari total pasien rawat inap per hari mendapat carbapenem (19,39 DDD/100 bed-days). Sebagian besar penggunaan carbapenem diberikan secara IV bolus. Terdapat 72,95% dan 59,52% penggunaan carbapenem yang dinyatakan sesuai berdasarkan analisis dengan menggunakan pedoman terapi dan hasil kultur, secara berturut-turut. Dengan mempertimbangkan profil penggunaan tersebut, carbapenem perlu digunakan secara lebih bertanggung jawab. Penelitian terkait profil resistensi patogen terhadap golongan carbapenem perlu dilakukan sebagai bahan evaluasi pengambilan kebijakan terkait penggunaan antibakteri golongan tersebut.Kata kunci: Carbapenem, DDD, defined daily dose, drug utilization review Carbapenem Utilization among Adults Inpatients in One Private Hospital in SurabayaCarbapenem resistance is one of the most frightening health problems globally. What determines the occurrence of carbapenem resistance phenomenon is the widely, repeated, irresponsible utilization of carbapenem over a long period of time. This research was aimed to provide an overview of the carbapenem utilization and its appropriateness compared with the guidelines. This research was a descriptive research that analyzed medical record data of adult patients who used carbapenem from January to September 2014 in one private hospital in Surabaya. The carbapenem utilization was defined in defined daily dose (DDD). Identifying the appropriateness of antibiotics’ type, dosage regimen, and duration of treatment were conducted by using the newest Infectious Disease Society of America (IDSA) guidelines as the main reference and Drug Infomation Handbook 22th edition (2014) as the secondary reference. Moreover, the appropriateness of type of antibiotics used for each patient was also analyzed by comparing the actual dosage used with the microbiology culture results. There were 255 adult patient’s medical records used in the present research. The total amount of carbapenem utilization during the observation period was 1462.25 DDD. The density of carbapenem utilization could be considered as low, i.e. almost 20% of total inpatients per day being prescribed with carbapenem (19.39 DDD/100 bed-days). There were 72.95% and 59.52% carbapenem utilization which were defined appropriate based on the analysis using IDSA guidelines and bacteria culture results respectively. Considering the profile of antibiotics utilization in this hospital, the antibiotics prescribing pattern could be improved to a more responsible pattern. Further researches exploring the relationship between pathogen resistance and carbapenem consumption need to be conducted in relation to the consideration in making local hospital regulation regarding the use of antibiotics in the hospital settings.Keywords: Carbapenem, DDD, defined daily dose, drug utilization review

Efektivitas Pemberian Terapi Cairan Inisial Dibandingkan Terapi Cairan Standar WHO terhadap Lama Perawatan pada Pasien Demam Berdarah di Bangsal Anak Rumah Sakit PKU Muhammadiyah Bantul Asnia Rahmawati; Dyah A. Perwitasari; Nurcholid U. Kurniawan
Indonesian Journal of Clinical Pharmacy Vol 8, No 2 (2019)
Publisher : Universitas Padjadjaran

Demam berdarah dengue (DBD) merupakan penyakit infeksi yang disebabkan oleh virus dengue. Kasus DBD di Kabupaten Bantul pada tahun 2016 berjumlah 1.706 dengan 13 kematian. Salah satu kunci keberhasilan terapi pada pasien DBD adalah menjaga tercukupinya kebutuhan cairan pasien selama fase kritis. Penelitian ini bertujuan untuk mengetahui perbedaan pemberian terapi cairan inisial terhadap perbaikan klinis, laboratoris dan lama rawat inap dibandingkan terapi standar WHO pada pasien dengue fever (DF) dan dengue hemorrhagic fever (DHF) di bangsal anak RS PKU Muhammadiyah Bantul. Penelitian ini dilakukan di bangsal anak RS PKU Muhammadiyah Bantul pada bulan Februari sampai dengan Juni tahun 2018 menggunakan metode eksperimental single blind randomised clinical trial pada dua kelompok yaitu cairan standar WHO (n=24) dan cairan inisial (n=24). Hasil yang diukur yaitu luaran terapi suhu badan, hematokrit, trombosit dan lama rawat inap. Perbedaan antarkelompok dianalisis dengan unpaired t-test dan Mann-Whitney. Berdasarkan hasil penelitian, kedua kelompok tidak menunjukkan perbedaan bermakna terhadap rata-rata suhu badan dan hematokrit (p>0,05), sedangkan kedua kelompok menunjukkan perbedaan yang bermakna terhadap rata-rata peningkatan trombosit dan lama rawat inap (p<0,05). Hal ini menunjukkan bahwa kelompok cairan inisial memiliki rata-rata lama rawat inap lebih cepat 4,00±0,7 hari dibanding kelompok standar WHO yang disertai dengan peningkatan trombosit selama menjalani rawat inap. Simpulan dari penelitian ini adalah pemberian terapi cairan inisial tidak memberikan perbedaan yang signifikan terhadap rata-rata suhu badan dan hematokrit, sedangkan efektivitas antara kedua kelompok menunjukkan perbedaan yang bermakna terhadap rata-rata peningkatan trombosit dan lama rawat inap.Kata kunci: Cairan inisial, demam berdarah dengue, hematokrit, lama rawat inap, suhu badan, trombosit Effectiveness of Initial Fluid Therapy Compared to WHO Standard Therapy on the Length of Stay of Patients with Dengue Fever in Children’s Ward PKU Muhammadiyah Bantul HospitalAbstract Dengue hemorrhagic fever (DHF) is an infectious disease caused by the dengue virus. The number of dengue cases in Bantul Regency in 2016 was 1,706 with 13 deaths. One of the keys to successful therapy in DHF patients is to maintain adequate fluid requirements for patients during the critical phase. This study aimed to determine differences in initial fluid therapy for clinical, laboratory improvement and length of stay compared to WHO standard therapy in dengue fever (DF) and DHF patients in pediatric ward PKU Muhammadiyah Bantul Hospital, Yogyakarta, Indonesia. This research was conducted in the pediatric ward of PKU Muhammadiyah Bantul Hospital in February 2018 to June 2018 using a single blind randomized clinical trial experimental method. Samples were divided into two groups, namely WHO standard fluid (n=24) and initial fluid (n=24). The results measured were body temperature, hematocrit, platelets and length of stay. Differences between groups were analyzed using unpaired t-test and Mann-Whitney. The two groups showed a significant difference toward the increase in platelets and length of stay (p<0.05). This suggests that the initial fluid group had an average length of stay 4.00±0.7 days faster than the WHO standard group which was accompanied by an increase in platelets during hospitalization. In conclusion, the initial fluid therapy did not give a significant difference to the mean body temperature and hematocrit, while the effectiveness between the two groups showed a significant difference toward the increase in platelets and length of stay.Keywords: Body temperature, dengue hemorrhagic fever, hematocrit, initial fluid, length of stay, platelets

Implementasi Antimicrobial Stewardship Program di Kawasan Asia: Sebuah Kajian Sistematis Eko Setiawan; Yosi I. Wibowo; Adji P. Setiadi; Yul'aini Nurpatria; Hernycane Sosilya; Dian K. Wardhani; Menino O. Cotta; Mohd-Hafiz Abdul-Aziz; Jason Roberts
Indonesian Journal of Clinical Pharmacy Vol 8, No 2 (2019)
Publisher : Universitas Padjadjaran

Antimicrobial Stewardship Program (ASP) merupakan salah satu program yang direkomendasikan untuk meningkatkan ketepatan penggunaan antibiotik, khususnya pada setting rumah sakit. Keberhasilan implementasi program tersebut ditentukan oleh banyak faktor, antara lain komunikasi antartenaga kesehatan dan ketersediaan sumber daya manusia maupun sarana-prasarana. Sampai saat ini, bukti penelitian terkait implementasi ASP di Asia khususnya di negara low- dan lower-middle income economies masih terbatas. Tujuan kajian sistematik ini adalah mengidentifikasi jenis strategi ASP yang diimplementasikan di berbagai negara Asia dengan berbagai income status, dan memberikan gambaran dampak dari implementasi ASP terhadap luaran klinis, mikrobiologis, dan finansial. Proses penelusuran pustaka dilakukan dengan menggunakan basis data PUBMED dan kata kunci “antimicrobial stewardship” dan “Asia” yang dikombinasikan dengan Boolean operator yaitu “AND”. Total terdapat 28 penelitian dari sembilan negara diikutsertakan dalam kajian akhir. Belum ditemukan bukti penelitian terpublikasi terkait ASP di Indonesia. Hanya terdapat satu penelitian berasal dari negara lower-middle income economies dan penelitian tersebut dilakukan pada institusi kesehatan tersier. Sebagian besar penelitian, yakni 22, berasal dari negara high-middle income economies, dan 18 dari antaranya dilakukan di rumah sakit tersier atau rumah sakit yang berafiliasi pada institusi pendidikan tinggi. Jenis intervensi ASP yang paling banyak diimplementasikan adalah audit peresepan antibiotik secara prospektif dan disertai dengan pemberian umpan balik, dan penerapannya terbukti dapat menghasilkan luaran yang positif baik secara klinis, mikrobiologis, maupun finansial. Dengan mempertimbangkan dampak positif tersebut, sangat diharapkan agar ASP dapat diimplementasikan pada institusi kesehatan di Indonesia dengan memperhatikan ketersediaan sumber daya dan konteks budaya lokal.Kata kunci: Antibiotik, ketepatan penggunaan, program pengendalian resistensi, resistensi antibiotik The Implementation of Antimicrobial Stewardship Program in Asian Region: A Systematic ReviewAbstractAntimicrobial Stewardship Program (ASP) is one of the recommended programs to optimize the prudent use of antimicrobials, particularly in the hospital settings. The successful ASP implementation is determined by numerous factors, including communication among healthcare workers, and the availability of human resources and facilities. There is limited evidence available regarding the ASP implementation in Asia, particularly in the low- and lower-middle income countries. This systematic review aimed to identify the type of ASP interventions implemented in Asian countries according to the income status and to describe the impact of ASP implementation on the clinical, microbiological, and financial outcomes. The search strategy was undertaken using PUBMED, and the search terms were “antimicrobial stewardship” and “Asia” which were combined with the use of a Boolean operator “AND”. In total, 28 articles from nine countries were included in the final review. No article from Indonesia could be found in this systematic review. There was only an article from a lower-middle income country that was conducted in a tertiary health institution. Most of the articles (22 articles) were from high-middle income countries and 18 of them were conducted either in the tertiary care or university affiliated hospitals. Prospective audit with intervention and feedback was the most frequent ASP used in which positive outcomes on the clinical, microbiological, and financial outcomes have been evidenced. The positive impact of ASP implementation should suggest the needs to initiate the program in the healthcare facilities in Indonesia while taking into account the available resources and the local cultures.Keywords: Antibiotic resistance, antibiotics, prudent use, stewardship program

Comparison of Effects of The Hypoglycemia Management Protocol with 40% Dextrose Concentrated Solution to the Post-Correction Blood Sugar Response through Intravenous Infusion and Intravenous Bolus Yuriani Yuriani; Retnosari Andrajati; Laurentius A. Pramono
Indonesian Journal of Clinical Pharmacy Vol 8, No 2 (2019)
Publisher : Universitas Padjadjaran

Hypoglycemic patients who receive 40% dextrose (D40%) concentrated solution in the correction process need to avoid excessive blood glucose spikes. Administration of D40% was found in two different ways, through intravenous infusion (iv infusion) and intravenous bolus (iv bolus) and the effects of both types of administration were unknown. The purpose of this study was to compare the effect of a hypoglycemia treatment protocol using D40% concentrated solution to the post-correction blood sugar response through iv infusion and iv bolus at two different hospitals with two distinct protocols. This comparative analytical cross-sectional study was conducted retrospectively at St. Carolus Hospital (D40% iv infusion group) and Bella Hospital (D40% iv bolus group). Blood glucose responses, in form of coefficient of variation and degree of overcorrection, were compared between groups. The overall median blood glucose response was 69.5 (3–195) mg/dL for iv infusion group (n=60) and 77 (15–249) mg/dL for iv bolus group (n=62) (p=0.259). The coefficient of variation with iv infusion and iv bolus group were 47.18% and 52.75%, respectively. The median of degree of overcorrection in iv infusion group was lower compared with iv bolus group, 10% (0–138%) versus 23% (0–195%), respectively. Both D40% protocols did not have a significant correlation with the degree of overcorrection (Mann-Whitney test; p=0.099). D40% iv infusion and bolus administration had no effect to the post-correction blood sugar response.Keywords: Blood glucose, dextrose 40%, hypoglycemia, intravenous bolus, intravenous infusion Perbandingan Efek Protokol Manajemen Hipoglikemia dengan Larutan Pekat Dekstrosa 40% secara Intravena Infus dan Intravena Bolus terhadap Respon Gula Darah PascakoreksiAbstrakPasien hipoglikemia yang menerima larutan pekat dekstrosa 40% (D40%) dalam proses koreksinya perlu menghindari lonjakan gula darah yang berlebih. Cara pemberian D40% diberikan dengan dua cara yang berbeda yaitu melalui intravena infus (iv infus) dan intravena bolus (iv bolus), dan efek dari kedua jenis pemberian tersebut belum diketahui. Tujuan dari penelitian ini adalah membandingkan efek protokol manajemen hipoglikemia dengan larutan pekat D40% secara iv infus dan iv bolus terhadap respon gula darah pascakoreksi di dua rumah sakit dengan protokol yang berbeda. Penelitian analitik komparatif secara potong lintang ini dilakukan secara retrospektif di RS St. Carolus (kelompok iv infus D40%) dan RS Bella (kelompok iv bolus D40%). Respon gula darah, dalam bentuk koefisien variasi dan derajat overkoreksi, dibandingkan antara kedua kelompok. Median kenaikan gula darah pada kelompok iv infus D40% 69,5 (3–195) mg/dL (n=60 pasien) dan kelompok iv bolus D40% 77 (15–249) mg/dL (n=62 pasien) (p=0,259). Koefisien variasi dengan iv infus adalah 47,18% dan iv bolus 52,75%. Median derajat overkoreksi iv infus D40% lebih rendah dibandingkan iv bolus D40%, dengan masing-masing 10% (0–138%) dan 23% (0–195%). Kedua cara pemberian D40% tidak memiliki hubungan yang bermakna dengan derajat overkoreksi (uji Mann-Whitney; p=0,099). Pemberian iv infus dan bolus D40% tidak memiliki pengaruh terhadap respon gula darah pascakoreksi.Kata kunci: Dekstrosa 40%, gula darah, hipoglikemia, intravena bolus, intravena infus

Hematologic Toxicities of Chemotherapy in Lung Cancer Patients: A Retrospective Study in Dr. M. Djamil Hospital Padang, Indonesia Yori Yuliandra; Hansen Nasif; Sabrina Ermayanti; Lilik Sulistyowati; Dian A. Juwita
Indonesian Journal of Clinical Pharmacy Vol 8, No 2 (2019)
Publisher : Universitas Padjadjaran

The use of chemotherapeutic agents in the management of cancer is often followed by a range of toxicities to various organ systems. A retrospective study on the hematologic toxicities of chemotherapy in lung cancer patients has been carried out. The study was conducted by a cross-sectional method from medical records of four-year data in 2010–2014 at Dr. M. Djamil Hospital Padang, West Sumatra, Indonesia. Data from medical records of patients diagnosed with lung cancer and underwent chemotherapy, not suffering from primary hematologic diseases, and with normal kidney and liver function prior to chemotherapy were studied. A number of 22 medical records of lung cancer patients which met the criteria with a total of 40 chemotherapy cycles were observed. The study revealed that a combination of carboplatin-paclitaxel was the most common chemotherapy used for the patients (72.7%). The hematologic toxicities comprised anemia, leukopenia, and thrombocytopenia with the severity ranging from grade 1–3. Carboplatin-paclitaxel was the only combination that caused these three toxicities, and the only combination to cause thrombocytopenia as well. Anemia was the major hematologic toxicity experienced by more than half of the patients. The study concludes that there is a reasonably high incidence of hematologic toxicities from chemotherapy among lung cancer patients.Keywords: Anemia, chemotherapy, hematologic toxicity, leukopenia, lung cancer, thrombocytopenia Toksisitas Hematologis Akibat Kemoterapi pada Pasien Kanker Paru: Studi Retrospektif di RSUP Dr. M. Djamil PadangAbstrak Penggunaan obat kemoterapi dalam pengobatan kanker sering disertai dengan toksisitas pada beberapa sistem organ. Kajian retrospektif terhadap toksisitas hematologis akibat kemoterapi pada pasien kanker paru sudah dilaksanakan. Studi ini dilaksanakan dengan metode cross-sectional dari data rekam tahun 2010–2014 di RSUP Dr. M. Djamil Padang, Sumatera Barat. Data pasien yang didiagnosis menderita kanker paru yang menjalani kemoterapi, tidak menderita penyakit hematologis dan gangguan hematopoiesis, serta memiliki fungsi ginjal dan hati yang normal dimasukkan ke dalam kajian. Sejumlah 22 pasien memenuhi kriteria dengan jumlah siklus kemoterapi sebanyak 40. Hasil kajian ini mengungkap bahwa kombinasi karboplatin-paklitaksel merupakan kemoterapi yang paling banyak digunakan (72,2%). Toksisitas hematologis yang terjadi meliputi anemia, leukopenia, dan trombositopenia dengan tingkat keparahan 1–3. Karboplatin-paklitaksel merupakan satu-satunya kombinasi kemoterapi yang menyebabkan ketiga toksisitas hematologis tersebut, sekaligus juga merupakan satu-satunya kombinasi yang menimbulkan trombositopenia. Anemia merupakan toksisitas hematologis yang paling banyak terjadi meliputi lebih dari separuh pasien. Penelitian ini menyimpulkan bahwa terdapat toksisitas hematologis yang cukup tinggi akibat kemoterapi pada pasien kanker paru.Kata kunci: Anemia, kanker paru, kemoterapi, leukopenia, toksisitas hematologis, trombositopenia

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Rizky Abdulah

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