Population Pharmacokinetics of Vancomycin in Thai Patients

Population pharmacokinetics of vancomycin in Thai adult patients was determined by non-linear mixed-effects approach using 319 vancomycin serum concentrations from 212 patients. The data were best fitted by a two-compartment model and it was used to examine the effect of patient characteristics on the vancomycin pharmacokinetics. In the final model, there was a linear relationship between vancomycin clearance, CL (L/h), and creatinine clearance calculated by Cockcroft-Gault equation, CLCr (mL/min): CL  =0.044  ×  CLCr. Meanwhile, volume of central compartment, V1 (L), was linearly related with the age (years old): V1 = 0.542  × Age. Intercompartment clearance (Q) and volume of peripheral compartment (V2) was 6.95 L/h and 44.2 L, respectively. The interindividual variability for CL, V1, Q, and V2 was 35.78, 20.93, 39.50, and 57.27%, respectively. Whereas, the intraindividual variability was 4.51 mg/L. Final model then was applied to predict serum vancomycin concentrations on validation group. Predictive performance revealed a bias of −1.43 mg/L (95% CI: −5.82–2.99) and a precision of 12.2 mg/L (95% CI: −1.60–26.16). In conclusion, population pharmacokinetic of vancomycin in Thai adult patients was developed. The model could be used to create vancomycin dosage regimen in the type of patient similar with the present study

Analisis Kualitatif Mengenai Peran dan Perilaku Apoteker di Apotek Terkait Penggunaan Telefarmasi Selama Pandemi COVID-19

Pandemi coronavirus disease-19 (COVID-19) menyebabkan perubahan pelayanan kesehatan. Upaya mengurangi penyebaran COVID-19 adalah menjaga jarak dan menghindari kerumunan. Pada layanan kesehatan, telefarmasi memberikan akses cepat dan kenyamanan yang baik. Penelitian ini bertujuan mengeksplorasi peran dan perilaku apoteker dalam penggunaan telefarmasi serta faktor-faktor yang mempengaruhi penerapan telefarmasi selama pandemi COVID-19. Penelitian dilakukan menggunakan metode non-eksperimental kualitatif fenomenologis melalui wawancara mendalam. Informan diambil hingga data jenuh dan diperoleh 5 informan. Wawancara dilakukan langsung maupun online. Keabsahan data melalui uji kredibilitas dengan member checking, uji transferabilitas dengan uraian rinci, uji dependabilitas dan uji konfirmabilitas melalui peer debrifing. Hasil wawancara dianalisis secara deskriptif dengan proses berpikir induktif. Peran apoteker dalam telefarmasi selama pandemi COVID-19 adalah memberikan layanan telefarmasi yang profesional, sedangkan perilaku apoteker adalah memanfaatkan telefarmasi untuk memberikan layanan farmasi klinik dan menggunakan media yang bervariasi. Faktor pendukung penerapan telefarmasi selama pandemi adalah kerja sama rekan sejawat dan keluarga pasien, peraturan terkait dukungan telefarmasi, dan pandemi COVID-19; sedangkan faktor penghambatnya adalah teknologi, hambatan finansial pasien, penerimaan pasien terhadap telefarmasi, keterbatasan sumber daya manusia dan waktu

Peningkatan Kemampuan Apoteker sebagai Peneliti dalam Upaya Antimicrobial Resistance Awareness

Hingga saat ini, resistensi antimikroba masih menjadi masalah akibat ketidakrasionalan penggunaan antimikroba. Diperlukan minat dan pemahaman dari praktisi Apoteker untuk meneliti terkait antimikroba sehingga dapat berkontribusi terhadap penyelesaian masalah tersebut. Akan tetapi, penelitian lebih umum dilakukan oleh para akademisi dibandingkan dengan praktisi. Oleh sebab itu, dirancang sebuah kegiatan pengabdian masyarakat yang bertujuan meningkatkan minat dan pemahaman praktisi Apoteker terkait penelitian antimikroba. Bentuk kegiatan yang dilakukan adalah Focus Group Discussion (FGD) yang diawali dengan paparan ilmiah oleh narasumber. Peserta di setiap kelompok diatur terdiri dari gabungan akademisi dan praktisi Apoteker. Pada sesi FGD, praktisi Apoteker memaparkan permasalahan terkait antimikroba berdasarkan pengalaman kerjanya. Para akademisi berkontribusi untuk menyusun permasalahan menjadi sebuah kerangka penelitian yang dapat diaplikasikan. Berdasarkan post-assessment, kegiatan FGD antara akademisi dan praktisi terbukti meningkatkan minat dan pemahaman peserta terkait penelitian antimikroba. Kolaborasi antara akademisi dan praktisi perlu ditingkatkan untuk mengatasi masalah praktikal termasuk resistensi antimikroba

Cost Analysis of Cancer Side Effects Therapy in Cancer Patients in Rumah Sakit Prof. Dr. Margono Soekarjo Purwokerto

Cancer is the leading cause of death in Indonesia. Generally, cancer therapy use chemotherapy, radiation, surgery or combination of those. Various side effects caused by cancer therapy make the use of additional drugs. This leads to an increase in total cost incurred to cancer patients. The purpose of this study was to describe the treatment of cancer therapy’s side effects as well as the average cost of side effects treatment, and its percentage in the total cost of cancer patients in Rumah Sakit Margono Soekarjo. This research was a descriptive study with retrospective data by total sampling method obtained from patients’ medical and receipts records of five most common cancers (breast, nasopharynx, Non Hodgkins Lhympoma (NHL), ovarian, and cervix) during January-December 2010. The average cost of patient’s side effects treatment was calculated by the average cost of side effects compared to the average total direct costs incurred to cancer patients. The samples was obtained from the population of 2261 patients who met the inclusion criteria, that are 73 patients consist of 62 female patients and 11 male patients. The most common side effects of cancer therapy were nausea and vomiting (59.80%), nausea-vomiting, anemia, and pain (16.44%), and nausea-vomiting and anemia (15.07%). The most used therapy was vitamin B complex followed by histamine-2 inhibitor. The average cost of side effects for breast cancer was Rp 1,715,373 (8.73%), nasopharynx was Rp 1,149,049 (6.98 %); NHL was Rp 360,778 (1.97 %); ovary was Rp 911,118 (3.61 %) and cervical was Rp 1,416,027 (8.87 %). The results indicated that the hospital needs to pay more attention on nausea-vomiting effect of chemotherapy, and also cervical cancer side effects therapy as the most costly. Keywords: Cost Analysis, Cancer, Side Effects, Prof. Dr. Margono Soekarjo Hospita

Pengembangan Instrumen Pengukuran Kepuasan Pasien atas Layanan Pharmaceutical Care

 Development and validation of the instrument to assess patient satisfaction to pharmaceutical care is important to be conducted. It will provide a reliable tool so that research to measure patient satisfaction regarding to pharmaceutical care could be further developed. First, content of the questionnaire was developed based on the literature review and focus group discussion of the panel. Then, the draft was tested to 5 respondents as a readability measurement. After received input from readability test’s respondents and made some changes, panel re-tested the questionnaire as content validity analysis. Finally, the questionnaire was distributed to other 30 respondents to get data for factor analysis, construct validity test and reliability test. Thirteen items was found as important factors that inuence patient satisfaction to pharmaceutical care based on literature review and focus group discussion activity. The questionnaire was further tested on 30 respondents. In the factor analysis assessment, categorization of items could not be made. Validation test using Pearson correlation and reliability test using Cronbach’s Alpha toward each item on the questionnaire showed that all items were valid and reliable, except one item in the “hope” section. Further study with greater number of respondents is required to re-validate this questionnaire. Salah satu cara untuk menilai kualitas pharmaceutical care adalah dengan mengukur kepuasan pasien. Pengembangan dan validasi instrumen kepuasan pasien terkait dengan pharmaceutical care penting dilakukan untuk tersedianya instrumen yang komprehensif, valid dan reliabel sehingga penelitian untuk mengukur kepuasan pasien terhadap pharmaceutical care dapat dikembangkan. Kuesioner dibangun berdasarkan studi literatur dan diskusi mendalam dengan stakeholders. Selanjutnya, dilakukan uji readability terhadap responden/ pasien, untuk kemudian diuji ulang validitas isinya oleh panel akademisi dan praktisi.Validasi kemudian dilakukan dengan jumlah responden yang lebih besar dengan metode cross-sectional analysis. Hasil isian kuesioner digunakan untuk analisis faktor, uji validitas dan uji reliabilitas kuesioner. Hasil focus group discussion antara peneliti dengan praktisi apoteker didapatkan 13 faktor yang mempengaruhi kepuasan pasien terhadap pelayanan kefarmasian di apotek. Validitas kuesioner selanjutnya diuji pada 30 responden. Pada analisis faktor, tidak diperoleh dimensi yang dapat mengelompokkan pernyataan/ faktor yang ada. Uji validasi dengan menggunakan Pearson correlation dan uji reliabilitas dengan menggunakan nilai Cronbach’s Alpha terhadap masing-masing 13 pernyataan pada kuesioner harapan dan kenyataan diperoleh pernyataan yang valid dan reliabel pada semua pernyataan, kecuali satu pernyataan pada bagian harapan. Penelitian lebih lanjut dengan jumlah responden yang lebih banyak diperlukan untuk memvalidasi ulang kuesioner ini

Population Pharmacokinetics of Vancomycin in Thai Patients

Population pharmacokinetics of vancomycin in Thai adult patients was determined by non-linear mixed-effects approach using 319 vancomycin serum concentrations from 212 patients. The data were best fitted by a two-compartment model and it was used to examine the effect of patient characteristics on the vancomycin pharmacokinetics. In the final model, there was a linear relationship between vancomycin clearance, CL (L/h), and creatinine clearance calculated by Cockcroft-Gault equation, CL Cr (mL/min): CL = 0.044 × CL Cr . Meanwhile, volume of central compartment, V 1 (L), was linearly related with the age (years old): V 1 = 0.542 × Age. Intercompartment clearance (Q) and volume of peripheral compartment (V 2 ) was 6.95 L/h and 44.2 L, respectively. The interindividual variability for CL, V 1 , Q, and V 2 was 35.78, 20.93, 39.50, and 57.27%, respectively. Whereas, the intraindividual variability was 4.51 mg/L. Final model then was applied to predict serum vancomycin concentrations on validation group. Predictive performance revealed a bias of −1.43 mg/L (95% CI : −5.82-2.99) and a precision of 12.2 mg/L (95% CI: −1. 60-26.16). In conclusion, population pharmacokinetic of vancomycin in Thai adult patients was developed. The model could be used to create vancomycin dosage regimen in the type of patient similar with the present study

Potensi interaksi obat nutrasetikal pada epilepsi anak

Background: The trend of using nutraceuticals in Indonesia increases every year. This study aims to describe nutraceuticals consumed in pediatrics with epilepsy as additional antiepileptic therapy and analyze their potential drug interactions. Methods: This research was a cross-sectional study with total sampling method which was carried out in the period of June to July 2020. Inclusion criteria were children with epilepsy aged 0-17 years who were members of the Indonesian Epilepsy Community, had a doctor's diagnosis of epilepsy, received oral antiepileptic medication, and took nutraceutical products/food supplements. Data were analyzed descriptively based on data obtained through electronic data filling sheets and interviews. Results: There were 106 participants from the Indonesian Epilepsy Community in total, with 14 children (13.2 %) using nutraceutical supplements. They were male (n=8; 57.1%), 2-12 years old (n=10; 71.4%), and good nutritional status (n=10; 71.4%). Most nutraceuticals consumed were dietary supplements containing vitamins (n=10; 71.4%). Of the eight potential drug interactions identified, 25% (n=2) were significant interactions, and 75% (n=6) were minor interactions. The potential for major interactions occurred in administering nutraceutical products containing vitamin D with the antiepileptic drug phenytoin and phenobarbital. Conclusion: In this study, nutraceuticals and antiepileptic drugs had a little clinically meaningful interaction effect.Pendahuluan: Tren penggunaan nutrasetikal di Indonesia terus meningkat dari tahun ke tahun. Nutrasetikal menjadi bagian dari terapi penunjang untuk pengobatan epilepsi. Penelitian ini bertujuan untuk memberikan gambaran penggunaan nutrasetikal pada penderita epilepsi anak sebagai terapi tambahan dan bagaimana potensi interaksi obat yang terjadi. Metode: Desain penelitian yang digunakan adalah studi cross-sectional dengan teknik pengambilan data total sampling selama 2 bulan. Subyek penelitian adalah anak penderita epilepsi dengan rentang usia 0 – 17 tahun, diagnosis dokter berupa epilepsi, mendapat terapi pengobatan antiepilepsi oral dan mengkonsumsi produk nutrasetikal/ suplemen makanan. Analisis data dilakukan secara deskriptif berdasarkan data yang diperoleh melalui lembar pengisian data elektronik dan wawancara. Identifikasi potensi interaksi obat dilakukan menggunakan pustaka dan mesin pencarian elektronik Hasil: Total sejumlah14 subyek penelitian berjenis kelamin laki-laki (n=8; 57,14%) dengan rentang usia 2-12 tahun (n=10; 71,43%) dan status gizinya baik (n=10; 71,43%). Karakteristis nutrasetikal yang paling banyak digunakan adalah suplemen makanan yang mengandung nutrisi vitamin sebesar 71,43% (n=10). Dari sejumlah 8 potensi interaksi obat yang diidentifikasi, diperoleh interaksi mayor sebesar 25% (n=2) dan interaksi obat minor sebesar 75% (n=6) yang melibatkan fase absorbsi, metabolisme, dan eliminasi obat. Potensi interaksi obat mayor terjadi pada pemberian produk nutrasetikal berisi vitamin D dengan obat antiepilepsi fenitoin dan fenobarbital.  Kesimpulan: Potensi interaksi obat yang terjadi antara produk nutrasetikal dan antiepilepsi tidak memiliki interaksi obat yang bermakna karena 75% potensi interaksi obat yang diperoleh adalah interaksi obat minor. Potensi interaksi obat antiepilepsi bisa diatasi dengan pemberian jarak waktu pemberian obat pada nutrasetikal yang mengandung vitamin B12 dan asam folat. &nbsp