Ajeng Diantini

Antibiotic Resistance in Sepsis Patients: Evaluation and Recommendation of Antibiotic Use

Background: The appropriate selection of empirical antibiotics based on the pattern of local antibiotic resistance can reduce the mortality rate and increase the rational use of antibiotics. Aims: We analyze the pattern of antibiotic use and the sensitivity patterns of antibiotics to support the rational use of antibiotics in patients with sepsis. Materials and Methods: A retrospective observational study was conducted in adult sepsis patient at one of Indonesian hospital during January-December 2011. Data were collected from the hospital medical record department. Descriptive analysis was used in the processing and interpretation of data. Results: A total of 76 patients were included as research subjects. Lung infection was the highest source of infection. In the 66.3% of clinical specimens that were culture positive for microbes, Klebsiella pneumoniae, Escherichia coli, Staphylococcus hominis were detected with the highest frequency. The six most frequently used antibiotics, levofloxacin, ceftazidime, ciprofloxacin, cefotaxime, ceftriaxone, and erythromycin, showed an average resistance above 50%. Conclusions: The high use of antibiotic with a high level resistance requires a policy to support its rational use. Local microbial pattern based on site infection and pattern of antibiotics sensitivity test can be used as supporting data to optimize appropriateness of empirical antibiotics therapy in sepsis patients.

Potential Activity of Fevicordin-A from Phaleria macrocarpa (Scheff) Boerl. Seeds as Estrogen Receptor Antagonist Based on Cytotoxicity and Molecular Modelling Studies

Fevicordin-A (FevA) isolated from Phaleria macrocarpa (Scheff) Boerl. seeds was evaluated for its potential anticancer activity by in vitro and in silico approaches. Cytotoxicity studies indicated that FevA was selective against cell lines of human breast adenocarcinoma (MCF-7) with an IC50 value of 6.4 μM. At 11.2 μM, FevA resulted in 76.8% cell death of T-47D human breast cancer cell lines. Critical pharmacophore features amongst human Estrogen Receptor-α (hERα) antagonists were conserved in FevA with regard to a hypothesis that they could make notable contributions to its pharmacological activity. The binding stability as well as the dynamic behavior of FevA towards the hERα receptor in agonist and antagonist binding sites were probed using molecular dynamics (MD) simulation approach. Analysis of MD simulation suggested that the tail of FevA was accountable for the repulsion of the C-terminal of Helix-11 (H11) in both agonist and antagonist receptor forms. The flexibility of loop-534 indicated the ability to disrupt the hydrogen bond zipper network between H3 and H11 in hERα. In addition, MM/GBSA calculation from the molecular dynamic simulations also revealed a stronger binding affinity of FevA in antagonistic action as compared to that of agonistic action. Collectively, both the experimental and computational results indicated that FevA has potential as a candidate for an anticancer agent, which is worth promoting for further preclinical evaluation.

Off-label paediatric drug use in an Indonesian community setting.

Off‐label medication is often used in the treatment of paediatric patients. However, it should be restricted due to the lack of evidence related to its efficacy and safety. Little is known about the frequency of off‐label drug use or the degree of scientific evidence supporting this practice in Indonesia. The aim of this study was to investigate the off‐label prescribing practice for paediatric patients in Bandung city, Indonesia.

Catechin isolated from Garcinia celebica leaves inhibit Plasmodium falciparum growth through the induction of oxidative stress

Background: Resistance of antimalarial drugs to Plasmodium falciparum has become a major concern in malaria eradication. Although it is also affected by several socioeconomic factors, a new antiplasmodial agent is needed for a global malaria control program. Objective: In this study, we attempted to uncover the antiplasmodial properties of Garcinia celebica, an Indonesian medicinal plant, along with the responsible compound and its possible mechanism. Materials and Methods: The G. celebica leaves were ethanol extracted and fractionated based on their polarity using n-hexane, ethyl acetate, and water. The antiplasmodial activity was tested in vitro against chloroquine-resistant P. falciparum at 100 μg/ml for 72 h. The active compound of the most active ethyl acetate fraction was subsequently isolated using column chromatography and identified by nuclear magnetic resonance. Results: The IC50of (+)-catechin, the characterized compound, against P. falciparum was 198 μM in 24 h and experiment. The isolated catechin inhibited P. falciparum growth in both trophozoite and schizont stages. An additional experiment also suggests that the antiplasmodial property of catechin occurs through the induction of the oxidative stress to P. falciparum. Conclusion: This result shows that the potential of catechin and its antimalarial properties should be explored further. Abbreviations used: RBC: Red Blood Cells; IC50: Inhibition Concentrattino 50; MeOH: Methanol; RPMI: Roswell Park Memorial Institute; EI: Electron Ionization.

Effect of Pharmacist Counseling on the Success of Therapy and the Quality of Life of Hypertensive Patients in a Hospital in East Nusa Tenggara

Abstract Hypertension is a chronic disease that requires an intensive monitoring from time to time to prevent complications leading to cardiovascular disease. In addition, its complex health needs have an effect on the treatment process and the motivation of the patient for treatment. Therefore, pharmacist counseling is expected to provide information to patients in handling health problems, especially related to the treatment of hypertension. Counseling is expected to provide behavioral changes to optimize therapeutic effects and improve the quality of life of patients. The purpose of this study is to analyze the influence of pharmacist counseling on the success of therapy and quality of life of hypertensive patients. The study was conducted at a hospital in Kupang, East Nusa Tenggara to outpatients in Depo Induk implementing true experimental design and pretest posttest with control group with simple random sampling method during April - June 2017. The data collection included blood pressure, age, gender, education level, treatment success seen from decreased or controlled blood pressure, and quality of life with Short Form- 36 (SF-36). The subjects of the study were 100 people divided into 50 people in the non-counseling group (who merely received information on medication as usual by pharmacist in Depo Induk) and 50 people in the counseling group (who received drug information service as usual by pharmacist in Depo Induk and individual counseling by pharmacist/researcher). Counseling was given in the form of giving insight about drugs, hypertension, and non-pharmacological approach (lifestyle modification) in managing hypertension. The results showed that with counseling, pharmacists can improve treatment success proven by the decrease of systolic blood pressure (-9 mmHg, p=0,000) and diastolic blood pressure (-7 mmHg, p=0,000); improve the quality of life of hypertensive patients with p<0.000 value of both pre and posttest and treatment (counseling) and also validated by final data test results between non-counseling group and counseling group.

SATISFACTION LEVEL OF PATIENTS, PHYSICIANS, AND PRIVATE PRIMARY HEALTHCARE CENTER MANAGERS WITH CHRONIC DISEASE MANAGEMENT PROGRAM IN INDONESIA

Objective: Program PengelolaanPenyakitKronis (PROLANIS) or Chronic Disease Management Program (CDMP) is a healthcare system that was conducted by Healthcare and Social Security Agency in Indonesia to improve patients’ quality of life. The objective of this study was to analyze level satisfaction of patients, physicians, and private Primary Healthcare Centers (PHCs) with this program, focusing on hypertension care. Methods: This study was conducted in 7 private PHCs in Bandung City, Indonesia. A cross sectional study was performed to measure patient satisfaction with PSQ-18 on 143 PROLANIS patients with hypertension. A total number of 8 physicians and 7 private PHC managers were involved in this study. Level satisfaction of physicians and private PHC managers were observed by using in-depth interviews. Results: The results showed that patient satisfaction was estimated to be 68.52±8.54, which could be interpreted that patient satisfy with PROLANIS. In-depth interviews showed that physicians did not satisfy with PROLANIS due to several factors (e.g., unintegrated prescription systems, lack of medicines, uncompleted laboratory facilities, lack of physicians, unintegrated referral services, and lack of collaboration between primary and secondary healthcare system). On the other hand, private PHC managers were quite satisfied with PROLANIS due to its linearity with other activities in private PHCs. Conclusion: Level satisfaction of patients with PROLANIS is quite good, while physicians might not satisfy with this program. In particular, private PHC managers confirmed that they are satisfied with this program