Interview-based cross-sectional needs assessment to advance the implementation of an effective antibiotic stewardship program in Indonesian hospitals

Antibiotic resistance has become a global health issue, negatively affecting the quality and safety of patient care, and increasing medical expenses, notably in Indonesia. Antibiotic stewardship programs (ASPs) aim to reduce resistance rates and their implementation in hospitals, has a high priority worldwide.We aimed to monitor the progress in the organizational implementation of ASPs in Indonesian hospitals by an Antimicrobial Resistance Control Program (ARCP) team and to identify possible hurdles. We conducted a cross-sectional study with structured interviews based on a checklist designed to assess the achievement of structural indicators at the organizational level in four private and three public hospitals in four regions (Surabaya, Sidoarjo, Mojokerto, Bangil) in East Java, Indonesia.The organizational structure of public hospitals scored better than that of private hospitals. Only three of the seven hospitals had an ARCP team. The most important deficiency of support appeared to be insufficient funding allocation for information technology development and lacking availability and/or adherence to antibiotic use guidelines. The studied hospitals are, in principle, prepared to adequately implement ASPs, but with various degrees of eagerness. The hospital managements have to construct a strategic plan and to set clear priorities to overcome the shortcomings

Endophytes as alternative paclitaxel sources : chemistry and genetics of Taxomyces andreanae and the endophytic flora of Wollemia nobilis

Whether suffering a pathogenic attack, basking in symbiotic comfort, or seemingly symptomless, plants constantly participate in molecular interplay with various classes of microbial organisms. One of the means of interorganismal communication in this dynamic continuum are secondary metabolites. The chemical diversity bearing pharmaceutical potential thus implied reaches beyond the plant kingdom and offers an expended view promising to transform glimpses of reductionist research of the past years to snapshots of an exuberant world of systems biology. Endophytes seem to fit perfectly into this natural ‘warehouse’, only a small part of which we have been able to tap into so far. The introductory section of the hereby presented thesis (chapter 2) provides an elaborate overview on the current state of knowledge about endophytic organisms – microbes colonizing internal tissues of all plant species, creating a huge biodiversity with yet unknown novel natural products presumed to push forward the frontiers of drug discovery (Staniek et al., 2008). Paclitaxel, the world’s first billion dollar anticancer blockbuster, was primarily obtained from Taxus brevifolia. While the search for alternative sources of the powerful antineoplastic agent brought an array of reports on paclitaxel producing endophytes, causing quite a controversy over the past two decades, the world’s market still relies on yew-derived supply of the valuable diterpene.

Biopharmaceutics

Biopharmaceutics, in connection with pharmacokinetics, is the field that investigates and describes everything that happens with a medicinal product and the active substance between the moment of administration, the moment it exerts its action and the moment it is eliminated from the body. Biopharmaceutics connects the physico-chemical properties of an active substance and its dosage form, especially through the drug release characteristics, with its fate and action in the living organism. Actually biopharmaceutics describes how medicine formulation technologies can affect pharmacokinetics and pharmacodynamics. The route of administration, the way the active substance is released from the dosage form, and the way the body handles (absorbs, distributes, metabolises and excretes) the active substance, together determine its (duration of) action, its efficacy and the occurrence of adverse effects. This chapter explains general principles of biopharmaceutics and its relation to pharmacokinetics in the light of their implications on the design of medicines. It describes the general biopharmaceutical principles that are relevant to the major routes of administration: parenteral, oromucosal, oral, rectal, dermal, nasal, pulmonary and ocular. Topics discussed include solubility and dissolution, bioavailability, partition coefficient and pH partition theory, the biopharmaceutical classification system (BCS), excipient-, food-, drug- and herb-drug interactions, first-pass effects and drug metabolism, bioequivalence and new developments in the field of advanced drug delivery systems.</p