Keri Lestari

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.

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.

Incidence, causative drugs, and economic consequences of drug-induced SJS, TEN, and SJS–TEN overlap and potential drug–drug interactions during treatment: a retrospective analysis at an Indonesian referral hospital

Background Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute life-threatening adverse drug reactions (ADRs) that are commonly caused by medications. Apart from their contribution to morbidity and mortality, these diseases may also present substantial consequences on health care resources. In this study, we aimed to identify the incidence, causative drugs, and economic consequences of these serious ADRs and potential drug–drug interactions (DDIs) during treatment. Methods A retrospective study that included 150 patients diagnosed with drug-induced SJS, SJS–TEN overlap, and TEN, from 2009 to 2013 in a referral hospital in West Java Province, Indonesia, was conducted to analyze the causative drugs, cost of illness (COI) as a representation of economic consequences, and potential DDIs during treatment. Results The results showed that analgesic–antipyretic drugs were the most frequently implicated drugs. The COIs for SJS, SJS–TEN overlap, and TEN patients were 119.49, 139.21, and 162.08 US dollars per day, respectively. Furthermore, potential DDIs with several therapeutic medications and corticosteroids used to treat SJS, SJS–TEN overlap, and TEN were also identified. Conclusion This study showed that analgesic–antipyretic was the major causative drug which contributed to SJS, SJS–TEN overlap, and TEN. Furthermore, our results also showed that SJS, SJS–TEN overlap, and TEN may cause considerable financial consequences to patients.

Accelerating the introduction of rotavirus immunization in Indonesia

The introduction of the rotavirus vaccine in Indonesia is currently in its infancy. Delay in its development might be caused by factors related to the perceived value of the vaccine, health system characteristics and policy considerations. Other factors, which may also interfere with optimizing the introduction, are financial barriers because Indonesia is a lower-middle-income country. Creating fiscal space to finance new immunization programs, such as for the rotavirus immunization, is very important to ensure the sustainability of new programs so that such programs would be financed over the long term and not endanger the sustainability of the Indonesian government’s financial position. This article provides an illustration of the various steps needed to accelerate the introduction of the rotavirus immunization.

Pharmaceutical Counseling Has a Positive Impact on Quality of Life of Hypertension Patients

Pharmacists play a major role in educating patients regarding drug therapy, in order to achieve optimal health outcomes. The aim of this study was to investigate the effect of pharmaceutical counseling on quality of life (QoL) of hypertensive patients with renal impairment at one of public hospital in Bandung, Indonesia. This study used a prospective experimental design with pretest-posttest design for 2 months. Inclusion criteria in this study were hypertensive patients with renal impairment who received antihypertensive drugs, aged >18 years, and signed the informed consent. Exclusion criteria were patients who were not able to fill in the questionnaire, patients with end stage renal diseases, diabetes, and pregnant or lactating patients. Pharmaceutical counseling was given during 2 months of the therapy. Pharmaceutical counseling consisted of education on the appropriate use of drugs and disease management. Schedule of their own medication and leaflet containing educational information were given to the subjects. QoL was assessed using a previously validated Mini-Questionnaire of QoL in Arterial Hypertension (MINICHAL). The questionnaire consisted of 16 two dimensions questions, i.e., mental health and somatic manifestation. We found that the mean increase in mental health status (49.5±5.3) was higher than that of somatic dimension (32.7±3.6). Both dimensions had statistically significant improvement (P value <0.05). In conclusion, pharmaceutical counseling is beneficial to improve QoL of hypertension patients. Keywords: hypertension, renal impairment, quality of life

Consumption Time of Captopril Influenced the Outcomes of Patients with Stage 1 Hypertension

Differences in drugs consumption time may affect its absorption and metabolism in the body which could lead to differences in its efficacy. For hypertension patients, one of the most frequently used drugs for lowering blood is captopril. However, information regarding the influence of consumption time on captopril efficacy was limited. Therefore, this study was conducted to compare the efficacy of captopril in lowering blood pressure when administered before and after meal. This was an experimental study with two treatment groups, conducted at Dr. Soedarso General Hospital, Pontianak, Indonesia, during April-June 2015. Statistical analysis was performed using Mann-Whitney, Exact-Fisher, and T-test. We found out that the reduction of systolic blood pressure in group who consumed captopril before and after meal was 30 mmHg and 25 mmHg, respectively (p 0.05). In conclusion, it is recommended to take captopril on an empty stomach since it showed better efficacy when administered before meal compared to after meal consumption. Keywords: hypertension, captopril, absorption

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.