Drug use study for acute respiratory infection in children under 10 years of age

Iwan Dwiprahasto - Studi penggunaan obat untuk infeksi saluran pernafasan akut pada anak usia kurang dari 10 tahun Latar Belakang: Infeksi saluran pernafasan akut (ISPA) merupakan penyakit yang paling sering terjadi pada anak dan menjadi penyebab utama angka kesakitan dan kematian pada anak khususnya di Negara-negara sedang berkembang. Penyakit ini diderita oleh hamper 50% Balita. Meskipun umumnya disebabkan oleh virus dan bersif at dapat sembuh sendiri, berbagai studi menemukan bahwa penggunaan antibiotika secara kefiru sangat sering terjadi untuk mengatasi penyakit ini.. Tujuan: Penelitian ini bertujuan untuk mengetahui pola peresepan untuk ISPA pada anak oleh dokter umum di praktek swasta. Metoda: Rancangan studi ini adalah cross sectional. Subyek penelitian adalah dokter praktek umum dan seluruh apotik di wilayah provinsi DIY. Data pasien dan pengukuran kecepatan respirasi dikumpulkan dari tempat praktek swasta sedangkan data mengenai peresepan obat diperoleh dari seluruh apotik yang terdapat di Provinsi DIY. Hasil: Seluruh apotek dan sebagian besar dokter umum praktek swasta ikut serta dalam penelitian ini. Jumlah rata-rata obat yang diberikan kepada anak dengan ISPA mencapai 3,74. Obat yang paling sering diresepkan adalah antibiotika disusul oleh parasetamol, ibuprofen, chlorpheniramine maleate, fenobarbita, vitamin C, dekstromtorfan, gliseril guaiakolat, deksametason, prednison, vitamin-B6, efedrin HCL, vitamin B1, and vitamin B2. Medication error sangat sering terjadi. Lebih dari 60% anak dengan ISPA mendapat obat dalam dosis yang tidak tepat, yaitu berlebih (27.51%) atau kurang (41,12%). Pemberian obat dalam sediaan yang tidak tepat ditemukan pada 24.07% resep. Penelitian ini juga menemukan bahwa lebuh dari seperlima penderita ISPA mendapat obat untuk frekwensi pemberian yang keliru. Faktor yang mendorong dokter untuk meresepkan antibiotika pada ISPA antara lain adalah demam, kecepatan respirasi lebih dari normal, dan gejala batuk pilek lebih dari 2 hari. Simpulan: ISPA pada anak sering diterapi secara tidak tepat. Medication error juga sering terjadi dalam penatalaksanaan ISPA di praktek swasta. Sudah saatnya dokter umum mulai meningkatkan mutu peresepan dengan senantiasa mendasarkan pada bukti-bukti ilmiah terbaru

Intervensi pelatihan untuk meminimalkan risiko medication error dipusat pelayanan kesehatan primer

ABSTRAK Intervensi pelatihan untuk meminimalkan risiko medication error di pusat pelayanan kesehatan primer Latar belakang: Medication error cukup sering dijumpai di institusi pelayanan kesehatan. Di rumah sakit angka medication errors dilaporkan sekitar 3-6,9% pada pasien yang menjalani rawat inap. Angka kejadian error akibat kesalahan dalam permintaan obat resep juga bervariasi, yaitu antara 0,03-16,9%. Salah sate peneliti menemukan bahwa 11% medication error di rumah sakit berkaitan dengan kesalahan saat menyerahkan obat ke pasien dalam bentuk dosis atau obat yang keliru. Namun demikian meskipun relatif sering terjadi mediCation error umumnya jarang yang berakhir dengan cedera di pihak pasien. Bahan dan cara: Survei cross sectional dilakukan untuk mengidentifikasi medication error di Puskesmas menggunakan formulir indikator peresepan. Data penggunaan obat untuk ISPA dikumpulkan secara retrospektif dari Puskesmas yang terdapat di 5 kabupaten/kota, Provinsi Kalimantan Timur. Studi quasi experimental dengan rancangan analisis pre dan post test selanjutnya dilakukan untuk menilai dampak pelatihan penggunaan obat yang rasional terhadap penurunan angka kejadian medication error. Ciri pelatihan adalah berbasis pada masalah, motivasional, dan menggunakan konsep farmakoterapi berbasis bukti dan medication error sebagai mated utama. Duapuluh Puskesmas dipilih secara acak dari 5 kabupaten kota untuk berpartisipasi dalam studi. Enam bulan setelah intervensi pelatihan data peresepan dikumpulkan dan dianalisis untuk menilai apakah terdapat penurunan yang bermakna dalam hal angka kejadian medication error. Hasil: 2.585 resep dikumpulkan pada studi data dasar dan hasil analisis menunjukkan bahwa 90% resep tergolong tidak lengkap. Bentuk medication error yang paling sering dijumpai adalah pemilihan obat keliru, cara pemberian obat yang keliru, frekuensi pemberian keliru, dan sediaan keliru. Enam bulan setelah intervensi pelatihan pada penggunaan obat yang rasional angka kejadian medication error turun secara bermakna untuk semua kategori error. Resep yang tidak lengkap menurun dari 94,25% menjadi 58,14% (Balita) Keywords: pelatihan, risiko medication erro

Ketersediaan obat di kabupaten dan mutu peresepan di pusat pelayanan kesehatan primer

ABSTRACT Iwan Dwiprahasto- Drugs availability at districs level and the quality of prescribing in primary health care Background: An excessive use of drugs in primary health care is commonly unavoidable. This in part due to the limited knowledge of prescribers who are mostly paramedics and whose pharmacotherapeutic knowldges are limited. More than 90% patients with acute respiratory infection (ARI) and diarrhea received antibiotics and similar percentage of patients with muscle ache received injection unecessarily. Objective: To improve the availability of drugs at district level and to improve the quality of prescribing at primary health centers (PHCs). Design: Quasi experimental with pre and post test analysis and using a control group for comparison. An interactive, problem-based training intervention was carried out within 2 days period involving all PHCs and district\u27s warehouses in three provinces, i.e West Kalimantan, West Sumater, and West Nusa Tenggara. Monitoring, supervision and feedback were carried out regularly upon completion of the intervention. This study involves 18 districts and 118 PHCs. Results: 11.995 prescriptions were collected at baseline, 6 months and 1 year after intervention. An average number of drugs per prescription decreased significantly 1 year after intervention (

KEBIJAKAN PENGGUNAAN ANTIBIOTIKA PROFILAKSI UNTUK MENCEGAH INFEKSI LUKA OPERASI DI RUMAH SAKIT (THE USE OF ANTIMICROBIAL PROPHYLAXIS TO PREVENT SURGICAL SITE INFECTIONS IN HOSPITAL)

ABSTRACT Background: Surgical site infections (SS\u27s) are a major source of morbidity in hospi¬tals which occur in 2-5% of patients after clean extra-abdominal surgeries (e.g., tho¬racic and orthopedic surgery) and in up to 20% of patients undergoing intra-abdomi¬nal procedures. Studies following patients into the post discharge period have re¬ported even higher rates of postoperative infection. Antimicrobial prophylaxis admi¬nistered just before an operation begins could prevent intraoperative microbial con¬tamination and therefore minimize risk of surgical site infections. Objectives: This study aims to provide evidence on the effect of antimicrobial pro¬phylaxis for surgical procedures to reduce the incidence of surgical site infections. Method: a systematic review was carried out to analyze result of studies on antimi¬crobial prophylaxis for surgical procedures. The review was limited to evidence from Level 1A study designs. Eight relevant studies examining the use of prophylactic an¬tibiotics to prevent surgical site infections were identified, i.e. 6 meta-analyses and 2 systematic reviews. These reviews were of high quality and limited their source mate¬rial to randomized controlled trials. Results: All studies showed a marked reduction in the odds or relative risk of SSI when antibiotic prophylaxis was employed. Two meta-analyses in our review sug¬gested a trend towards lower rates of infection with use of broader-spectrum anti¬biotic rophylaxis, such as third generation cephalosporins. When compared with single dose prophylaxis, multiple dose prophylaxis generally did not result in significant ad¬ditional benefit. the risk of infection with single dose prophylaxis using long-acting antibiotics did not differ significantly from that seen with multiple-dose regimens. Conclusion: The use of antibiotic prophylaxis, administered in a timely manner, could significantly\u27prevent surgical site infections. The reviews suggest that broader spec¬trum antibiotics may be superior to limited-spectrum antibiotics for intra-abdominal or gynecologic surgeries. In addition, single-dose antibiotic prophylaxis appears to be at least as effective as multiple-dose regimens for a broad range of surgical procedures and may pose less risk to patients in terms of adverse events (e.g., C. difficile colitis) and less risk to the population in terms of microbial resistance. Keywords:antimicrobial prophylaxis, surgical site infections, meta-analysis, systematic review, efficaciou

Risk predictors for malaria in pregnancy and the role of chloroquine in low endemic area

ABSTRACT Iwan Dwiprahasto - Risk predictor for ma/aria in pregnancy and the role of chloroquine in /ow endemic area Background: Pregnant women in malaria-endemic areas are uniquely susceptible to infection with Plasmodium falciparum and this susceptibility is greatest during first pregnancies. Malaria causes serious complications in pregnant women, especially in those who have a low level of acquired immunity before pregnancy. Objective: to assess the risk predictors for malaria during pregnancy and the role of chloroquine in low endemic area of malaria in Jepara district Design: A longitudinal study of all pregnant mother was carried out in Batealit and Mayong I subdistricts of Jepara district between June 1997-August 1999. All pregnant women were screened for peripheral parasitaemia through active surveillance. Women who had parasitaemia were treated with chloroquine for 3 days. Blood smears were then examined on days 4, 7, 14 and 21 after completion of the chloroquine course. All women irrespective of the blood smear results at enrolment were followed up once every two weeks until delivery. Results: Among 3099 pregnant women enrolled in the study, only 58 women had malaria infection, giving an incidence rate of 1.9/100 pregnant women. In this study low income is a significant risk predictor for malaria (OR= 11.0395%Cl: 3.91-31.08). Women who had reported a history of malaria or history of taking antimalarial drugs 6 months before their last menstrual period (LMP) showed an increased risk of developing malaria during pregnancy (OR= 10.5695%Cl: 4.57-23.72 and OR = 10.9095%Cl: 4.4825.61) respectively. Among those infected by P.falciparum and P. vivax and treated with chloroquine, complete parasite clearance was found in day 7. Conclusions: This study shows that low income, history of malaria within 6 months before LMP and history of taking antimalarial drugs within 6 months before LMP are best predictor for malaria in pregnancy in low endemic area. This study also shows that chloroquine is still effective for treating malaria falciparum in pregnancy in Batealit and Mayong I subdistricts, Jepara Keyword: malaria - pregnancy - low endemic area - risk-predictor - chloroquin

Inappropriate use of antibiotics in the treatment of acute respiratory infections for the underfive children among general practitioners.

Acute respiratory infection (ARI) is the commonest illness in children and the leading cause of morbidity and mortality in many developing countries. It comprises approximately 50% of all illness in children under five years. Unfortunately, most children are commonly treated inappropriately. A population based study involving all general practitioners (GPs) and pharmacies in Yogyakarta Special Province was carried out in June-July 1992 to provide data on antibiotic utilization for acute respiratory infection (ARI). One hundred and ninety one out of 207 GPs and all pharmacies participated in the study by completing structured form distributed during the study. Ninety three percent of patients with ARI seen by GPs were given antibiotic. Based on WHO criteria on ARI, only 7-14% of all patients were eligible to be given antibiotics. The most frequently used antibiotics for the underfives were ampicillin (38.8%) followed by cotrimoxazole (29.2%), amoxycillin (14.9%), and erythromycin (6.13%). Sixty three per cent of drug cost prescribed for the underfives children were accounted for by antibiotics. It can be concluded that inappropriate use of antibiotics was found in more than 75% patients under 5 years of age. In addition to poor indication for antibiotic use inappropriateness was also found in terms of dose, the length of antibiotic use, drug administration, and drug dosage form. Key words: ARI - innapropriate use of antibiotics - underfive children - general practitioners - prescribing pattern Infeksi saluran pernafasan akut (ISPA) merupakan salah satu penyakit yang paling sering diderita dan menjadi penyebab utama kematian pada anak di negara sedang berkembang. Namun demikian hampir sebagian besar penderita ternyata diterapi secara tidak adekuat. Suatu studi cross-sectional telah dilakukan untuk melihat pola peresepan untuk ISPA, dengan melibatkan seluruh dokter umum dan apotek yang berada di Provinsi DIY, antara bulan Juni hingga Juli 1992. Seratus sembilan puluh satu dokter umum (dari total 207) dan seluruh apotek bersedia untuk ikut serta dalam penelitian. Dokter diminta untuk menulis identitas penderita ISPA pada formulir yang telah disediakan. Berdasarkan formulir tersebut dilacak pola peresepan masing-masing melalui penelusuran resep di apotek-apotek. Antibiotika ternyata diresepkan pada 93% pasien dengan ISPA. Berdasarkan kriteriia WHO untuk ISPA, ditemukan bahwa hanya 7-14% pasien yang seharusnya mendapat antibiotika. Antibiotika yang paling sering diresepkan berturut-turut antara lain adalah ampisilin (38%), kotrimoksazol (29,2%), amoksisilin (14,9%), dan eritromisin (6,13%). Dafi segi biaya, 63% biaya obat untuk ISPA digunakan untuk antibiotika. Studi ini menyimpulkan bahwa lebih dari 75% peresepan untuk balita tergolong tidak rasional. Di samping tidak jelasnya indikasi pemakaian antibiotika, dosis, cara pemberian, frekuensi dan lama pemberian ternyata juga tidak tepat

Improving the use of antibiotics in primary health centres through a problem-based pharmacotherapy training approach

ABSTRACT Iwan Dwiprahasto & Erna Kristin - Improving the use of antibiotics in primary health centres through a problem-based pharmacotherapy training approach Background: Inappropriate use of antibiotics in the treatment of common diseases such as acute respiratory infection (ARI) and diarrhoea has been the major health problems in primary health centres (PHCs). Beside increasing the risk of adverse event, excessive use of antibiotics has also led to bacterial resistance worldwide. Objective: To improve the quality of prescribing of Primary Health Centers\u27 (PHCs) physicians and paramedics particularly in the treatment of ARI and diarrhoea. Design: Prospective intervention study with control group involving 113 PHCs\u27 physicians in both arms. Thirteen districts were randomly selected for study area, in which intervention was carried out in 8 districts while 5 other districts as control group. A systematic problem-based approach of 3 days training were carried out in the intervention group using 3 sets of modules, followed by self monitoring & regular visit & feedback by a Training Team. Evaluation on prescribing was carried out 3 times, i.e at the 6th , 12th, &18th month after intervention. Results: More than 17 thousands and 8600 prescriptions for ARI and diarrhoea were collected during the study. There was a significant reduction in the use of antibiotics for ARI in the intervention group from 92.3 before the study, to 67.4, 52.8 and 39.5%, 6, 12, & 18 month after the study (p0.05). There has been significant antibiotics prescribing shift toward more rational choice in the intervention group 18 months after the study. Conclusions: A systematic problem-based pharmacotherapy training followed by self monitoring & regular visit & feedback significantly improved antibiotic prescribing for ARI and diarrhoea. Key words: antibiotics - prescribing - problem-based pharmacotherapy training - acute respiratory infection - diarrhoe