Manajemen Terapi Bakterial Meningitis Akut pada Pasien Anak (Fokus Terapi Antibiotik dan Kortikosteroid)

Meningitis bakterial akut adalah kondisi peradangan otak yang berkembang dengan cepat akibat infeksi bakteri pada selaput otak (meningen) atau pada ruang subarachnoid (ruang berisi cairan di antara meningen). Manifestasi klinis yang umum meliputi sakit kepala, demam, kejang dan kakukuduk dengan penegakan diagnosis berdasarkan analisis cairan serebrospinal. Penatalaksanaan kasus bakterial meningitis akut, khususnya pada pasien anak-anak difokuskan pada pemilihan antibiotik dan kortikostreroid sebagai kunci pengobatan, diikuti dengan terapi suportif lain seperti antidemam dan antikonvulsi. Terdapat kasus anak berusia 1 tahun dengan diagnosa bakterial meningitis, laporan kasus ini bertujuan untuk mengkaji pemilihan, dosis, cara pemberian serta monitoring efektivitas antibiotik dan kortikosteroid sebagai terapi pada kasus ini. Pasien mendapatkan perawatan di RSUD Dr. Soetomo selama 4 hari dengan mendapatkan injeksi ceftriaxone dan deksametason per kg berat badan. Pada kasus ini dilakukan pengamatan berupa observasi kondisi klinis pasien setiap harinya hingga pasien mengalami perbaikan kejang dan demam sejak hari ke-2 perawatan. Pada hari ke-4, pasien diperbolehkan pulang dengan melanjutkan terapi per oral untuk menjalani rawat jalan. Kesimpulannya, pasien dengan meningitis bakterial akut perlu pemberian antibiotik yang harus dimulai sesegera mungkin yang ditujukan untuk eradikasi bakteri penginfeksi selaput otak sedangkan pemberian injeksi kortikosteroid ditujukan untuk menurunkan respon inflamasi yang terjadi di otak agar tidak memperparah prognosis penyakit pada kondisi akut

Therapy of resistant hypertension in patients with chronic kidney disease complications of anemia in hemodialysis: A case report

Chronic Kidney Disease (CKD) is closely related to hypertension. Increasing the severity of CKD is associated with more difficult blood pressure control. Appropriate therapeutic management is needed to prevent complications due to uncontrolled hypertension. We report the case of a 78- year-old female patient with a diagnosis of hypertension and end-stage CKD with a history of undergoing hemodialysis for 4 years. The patient has been taking antihypertensive drugs such as Angiotensin Receptor Blockers, Calcium Channel Blockers and Diuretics. However, the administration of three antihypertensive drugs still could not help achieve the expected blood pressure target where the systolic blood pressure was still above 160 mmHg. The patient also has anemia as a common complication of chronic kidney disease. Appropriate management of therapy with fourth-line therapy and hemoglobin repair is necessary to achieve improved clinical outcomes and reduce renal worsening

Safety of metamizole analgesic therapy in patients with dyspepsia syndrome: A case report

The selection of drugs in patients who have experienced dyspepsia syndrome needs to be studied for its use. Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of drugs that are effective in controlling various inflammatory conditions and treating inflammatory symptoms such as pain but are limited in their use in patients with dyspepsia. We report case of patients with metamizole NSAIDs during three days of hospitalization with a diagnosis of dyspepsia. Other side effects such as cardiovascular, neurological disorders and agranulocytosis can also occur with the use of metamizole. There were no side effects that exacerbated dyspepsia symptoms in patients or other side effects during the three days of using metamizol. It can be concluded that short-termmetamizole therapy is safe for use in patients with dyspeptic syndrome. Concomitant use with gastric acid blocking agents such as H2 receptor antagonists may also reduce the effects of gastrointestinal disturbances

Hepatoprotector in cases of dengue hemorrhagic fever as a prevention of hepatic damage: a case report

Dengue Hemorrhagic Fever (DHF) is classified as an arbovirus disease which is a public health problem in the world. The causative agent of DHF is the dengue virus, namely the RNA virus of the genus Flavivirus and the family Flaviviridae. Hepatic impairment is often observed in DHF cases with asymptomatic or asymptomatic elevations in serum transaminases up to severe manifestations in the form of acute liver failure. It was reported that DHF patients had mild hepatic impairment with clinical manifestations of mild hepatomegaly, hypoalbumin, normal SGOT/SGPT values, and clinical conditions of nausea – vomiting. To prevent worsening liver damage, combination therapy with Ursodeoxycholic Acid (UDCA) and curcumin was given as a hepatoprotector. The use of curcumin can reduce serum levels of transaminase, Malondialdehyde (MDA) or markers of oxidative stress and increase hepatic glutathione concentrations which work in free radical detoxication, while the role of UDCA is as a hepatoprotector by reducing the level of oxidative stress in liver cells

High dose glucocorticoids inducing hyperglycemia in patients with diabetes mellitus experiencingrecurent ischemic stroke attacks: A case report

Stroke is an acute and focal neurological syndrome characterized by clinical deficits resulting from vascular injuries such as infarction or hemorrhage in the central nervous system. Given the prevalence of multiple comorbidities among stroke patients, they often find themselves on more than five medications, falling into the category of polypharmacy. Beyond treatments aimed at improving stroke outcomes and managing comorbid conditions, the presence of additional diseases may necessitate new therapies, potentially leading to side effects that can intersect and exacerbate the existing disease. This case report aims to present instances of hyperglycemia in stroke patients undergoing high-dose glucocorticoid therapy and discuss potential strategies to address this issue. In this particular case, human insulin was selected to rapidly control the patient's hyperglycemic condition. Subsequently, adjustments to basal and bolus insulin doses were made based on the frequency of use and duration of action of the glucocorticoid, specifically methylprednisolone. In conclusion, the hyperglycemia induced by glucocorticoids was identified through postprandial sugar monitoring, necessitating treatment through modifications to basal and bolus insulin doses. Strategies for managing hyperglycemia should be tailored to the pharmacokinetics of glucocorticoids and insulin

Hyperuricemia, use of antituberculosis drugs, and liver injury: Case Report

Anti-tuberculous drug can cause idiosyncratic drug-induced liver injury (DILI). Considering the benefit risk, there will discontinuation therapy and rechallenge after symptom resolve. In addition to anti-tuberculosis drugs, liver injury can occur in patients with hyperuricemia. We report a 60-year-old male patient who had just used the initiation phase of OAT for 20 days experiencing hepatotoxic side effects characterized by complaints of nausea and vomiting for one week. Liver function examination results were normal with AST 23 u/L and ALT 9 u/L. OAT administration was temporarily stopped and started gradually with 150 mg rifampicin, 150 mg isoniazid and 500 mg ethambutol. The second day after using OAT again, given the full dose of 300 mg rifampicin, 300 mg isoniazid and 1000 mg ethambutol. The patient's condition improved after thismodification of therapy so that therapy with three anti-TB drugs was continued until he was discharged from the hospital

Manajemen Terapi Bakterial Meningitis Akut pada Pasien Anak (Fokus Terapi Antibiotik dan Kortikosteroid): Management of AcuteBacterial Meningitis Therapy in Pediatric Patients (Focus on Antibioticand Corticosteroid Therapy)

Acute bacterial meningitis is an inflammatory condition of the brain that develops rapidly due to bacterial infection in the lining of the brain (meninges) or in the subarachnoid space (fluid-filled space between the meninges). Common clinical manifestations include headache, fever, convulsions, and nuchal rigidity with diagnosis based on cerebrospinal fluid analysis. Management of cases of acute bacterial meningitis, especially in pediatric patients, focuses on selecting antibiotics and corticosteroids as the key treatment, followed by other supportive therapies such as antifever and anticonvulsants. There is a case of a 1-year-old child with a diagnosis of bacterial meningitis, this case report aims to examine the selection, dosage, method of administration, and monitoring of the effectiveness of antibiotics and corticosteroids as therapy in this case. The patient received treatment at RSUD Dr. Soetomo for 4 days by receiving ceftriaxone and dexamethasone injections per kg of body weight. In this case, observation was carried out in the form of observing the patient's clinical condition every day until the patient experienced an improvement in seizures and fever from the 2nd day of treatment. On the 4th day, the patient was allowed to go home and continue oral therapy for outpatient treatment. In conclusion, patients with acute bacterial meningitis need to be given antibiotics which must be started as soon as possible, aimed at eradicating bacteria that infect the lining of the brain, while corticosteroid injections are aimed at reducing the inflammatory response that occurs in the brain so as not to worsen the prognosis of the disease in my condition. Keywords:          bacterial meningitis, ceftriaxone, dexamethasone   Abstrak Meningitis bakterial akut adalah kondisi peradangan otak yang berkembang dengan cepat akibat infeksi bakteri pada selaput otak (meningen) atau pada ruang subarachnoid (ruang berisi cairan di antara meningen). Manifestasi klinis yang umum meliputi sakit kepala, demam, kejang dan kakukuduk dengan penegakan diagnosis berdasarkan analisis cairan serebrospinal. Penatalaksanaan kasus bakterial meningitis akut, khususnya pada pasien anak-anak difokuskan pada pemilihan antibiotik dan kortikostreroid sebagai kunci pengobatan, diikuti dengan terapi suportif lain seperti antidemam dan antikonvulsi. Terdapat kasus anak berusia 1 tahun dengan diagnosa bakterial meningitis, laporan kasus  ini  bertujuan  untuk mengkaji pemilihan, dosis, cara pemberian serta monitoring efektivitas antibiotik dan kortikosteroid sebagai terapi pada kasus ini. Pasien mendapatkan perawatan di RSUD Dr. Soetomo selama 4 hari dengan mendapatkan injeksi ceftriaxone dan deksametason per kg berat badan. Pada kasus ini dilakukan pengamatan berupa observasi kondisi klinis pasien setiap harinya hingga pasien mengalami perbaikan kejang dan demam sejak hari ke-2 perawatan. Pada hari ke-4, pasien diperbolehkan pulang dengan melanjutkan terapi per oral untuk menjalani rawat jalan. Kesimpulannya, pasien dengan meningitis bakterial akut perlu pemberian antibiotik yang harus dimulai sesegera mungkin yang ditujukan untuk eradikasi bakteri penginfeksi selaput otak sedangkan pemberian injeksi kortikosteroid ditujukan untuk menurunkan respon inflamasi yang terjadi di otak agar tidak memperparah prognosis penyakit pada kondisi akut Kata Kunci:         bakterial meningitis, ceftriaxone, deksametaso