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Abstrak :
Latar belakang. Displasia bronkopulmonal (DBP) adalah penyakit multifaktorial kronis akibat inflamasi baik prenatal maupun postnatal. Hal ini akan menyebakan komplikasi jangka panjang dalam hal pernapasan, kardiovaskuler, dan neurodevelopmental. Azitromisin sebagai agen antiinflamasi diharapkan dapat mencegah kejadian DBP. Metode. Uji klinis acak terkontrol tidak tersamar dilakukan selama Juni 2021-April 2022 di unit Neonatologi RSCM Jakarta pada 114 subjek dengan usia gestasi 25 minggu-31 minggu 6 hari yang mengalami distress napas. Pasien yang memenuhi kriteria inklusi dan eksklusi dilakukan randomisasi dan dibagi menjadi dua kelompok yaitu kelompok uji/perlakuan dan kelompok kontrol, masing masing sebanyak 57 subjek. Kelompok uji akan mendapatkan azitromisin dalam usia <24 jam selama 14 hari dengan dosis 10 mg/kgbb/intravena selama 7 hari kemudian dilanjutkan 5 mg/kgbb/intravena selama 7 hari. Pasian akan dipantau sampai dengan usia gestasi 36 minggu untuk melihat outcome primer berupa DBP, dan outcome sekunder berupa IVH, PVL, EKN, lama penggunaan O2, durasi penggunaan ventilator mekanik, lama pencapaian full enteral feeding, serta mortalitas pada kedua kelompok. Diagnosis DBP ditegakkan berdasarkan NICHD 2019. Hasil. Angka kejadian DBP secara umum adalah 34.8%. Angka kejadian DBP pada bayi extremely preterm adalah 58.3%, sedangkan pada bayi very preterm adalah 31%. Kejadian DBP lebih banyak pada kelompok kontrol (63% vs 38%) dengan RR 0.611(0.417-0.896). Durasi penggunaan ventilator mekanik lebih pendek pada kelompok yang mendapatkan azitromisin (5.22 vs 12.75,p 0.025). Lamanya pencapaian full enteral feeding lebih pendek pada kelompok uji/perlakuan (13.38 vs 17.14 hari, p 0.04). Angka kejadian EKN lebih rendah pada kelompok uji/perlakuan (19% vs 40%, nilai p 0.014). Mortalitas lebih rendah pada kelompok uji/perlakuan (25% vs 46% , nilai p 0.019) RR 1.660 (95% CI 1.043-2.642). Kesimpulan. Azitromisin dapat menurunkan angka kejadian DBP, mempercepat pencapaian full enteral feeding, menurunkan mortalitas pada bayi prematur. ......Background. Bronchopulmonary dysplasia (BPD) is a chronic multifactorial disease caused by inflammation both prenatal and postnatal. This will lead a long-term complications of respiratory, cardiovascular, and neurodevelopmental. Azithromycin as an antiinflammatory agent is expected to prevent BPD. Methods. A randomized controlled clinical trial, unblinded was conducted during June 2021-April 2022 at the Neonatology unit of RSCM Jakarta on 114 subjects with a gestational age of 25 weeks-31 weeks 6 days who experienced respiratory distress. Patients who met the inclusion and exclusion criteria were randomized and divided into two groups, the intervention group and the control group, each group with 57 subjects. The intervention group will receive azithromycin at the age of <24 hours for 14 days at a dose of 10 mg/kg/intravenous for 7 days then followed by 5 mg/kg/intravenous for 7 days. Patients will be monitored up to 36 weeks' gestation to see the primary outcome in the form of BPD, and secondary outcomes in the form of IVH, PVL, EKN, duration of O2 used, duration of mechanical ventilator used, duration of achieving full enteral feeding, and mortality in both groups. BPD diagnosed based on NICHD 2019. Results. The incidence of BPD in general is 34.8%. The incidence of BPD in extremely preterm infants is 58.3%, while in very preterm infants it is 31%. The incidence of BPD was more in the control group (63% vs 38%) with an RR 0.611(0.417-0.896). The duration of ventilator mechanic used was shorter in the intervention group (5.22 vs 12.75, p 0.025). The duration of achieving full enteral feeding was shorter in the intervention group (13.38 vs 17.14 days, p 0.04). The incidence of NEC was lower in the intervention group (19% vs 40%, p-value 0.014). Mortality was lower in the intervention group (25% vs 46%, p 0.019) RR 1.660 (95% CI 1.043-2.642). Conclusion. Azithromycin can reduce the incidence of BPD, accelerate the achievement of full enteral feeding, reduce mortality in premature infants

Abstrak :
Since the first case was reported at the end of 2019, COVID-19 has spread throughout the world and has become a pandemic. The high transmission rate of the virus has made it a threat to public health globally. Viral infections may trigger acute coronary syndromes, arrhythmias, and exacerbation of heart failure, due to a combination of effects including significant systemic inflammatory responses and localized vascular inflammation at the arterial plaque level. Indonesian clinical practice guideline stated that (hydroxy)chloroquine alone or in combination with azithromycin may be used to treat for COVID-19. However, chloroquine, hydroxychloroquine, and azithromycin all prolong the QT interval, raising concerns about the risk of arrhythmic death from individual or concurrent use of these medications. To date, there is still no vaccine or specific antiviral treatment for COVID-19. Therefore, prevention of infection in people with cardiovascular risk and mitigation of the adverse effects of treatment is necessary.

Abstrak :
Streptococcus pneumonia>e, bakteri patogen yang banyak menyebabkan infeksi sehingga menjadi penyakit pneumokokal yang memiliki morbiditas dan mortalitas tinggi. Antibiotik makrolid seperti eritromisin dan azitromisin merupakan pilihan terapi namun menunjukkan adanya peningkatan resistensi. Terdapat dua mekanisme utama timbulnya resistensi terhadap makrolid, yaitu metilasi ribosom yang diperankan oleh gen erm>(B) dan pompa efluks yang diperankan oleh gen mef>(A). Penelitian ini bertujuan untuk mendeteksi keberadaan gen erm>(B) dan mef>(A) pada isolat Streptococcus pneumoniae> yang resisten terhadap eritromisin dan azitromisin. Sebanyak 60 isolat Streptococcus pneumoniae> diikutsertakan dalam penelitian ini. Uji kepekaan terhadap eritromisin dan azitromisin dilakukan dengan metode difusi cakram. Dari 60 isolat tersebut  didapatkan 33 (55 %) isolat sensitif sedangkan 27 (45 %) isolat resisten terhadap eritromisin dan azitromisin. Selanjutnya keberadaan gen erm>(B) dan mef>(A) dideteksi menggunakan PCR. Di antara 27 isolat Streptococcus pneumoniae> yang resisten terhadap eritromisin dan azitromisin, 7 (25,9 %) isolat memiliki gen erm>(B), 6 (22,2 %) isolat memiliki gen mef>(A), serta 14 (51,9 %) isolat memiliki kedua gen erm>(B) dan mef>(A). Dari 27 isolat tersebut, 11 ( 40,7 %) isolat merupakan serotipe 19 F, dan 9 ( 81,8 % ) isolat di antaranya memiliki kedua gen erm>(B) dan mef>(A). Hasil penelitian menunjukkan proporsi cukup besar baik dari gen erm>(B) atau mef>(A) saja maupun kedua gen secara bersamaan pada isolat Streptococcus pneumoniae> yang resisten terhadap eritromisin dan azitromisin. Sedangkan dari 15 isolat Streptococcus pneumoniae> yang peka terhadap eritromisin dan azitromisin tidak ditemukan gen erm>(B) dan mef>(A). ......Streptococcus pneumoniae>, the leading pathogen of bacterial infection, is responsible for for pneumococcal diseases with severe morbidity and mortality. Macrolides ( e.g erythromycin and azithromycin ) has become drug of choice for pneumococcal diseases, but the prevalence of macrolides-resistant Streptococcus pneumoniae >have been rising in recent years. There are two major mechanisms mediating resistance to macrolides, >ribosomal methylation by >erm>(B) gene, and efflux pump by mef>(A) gene. The aims of this study is to detect erm>(B) and mef>(A) genes in erithromycin and azithromycin-resistant Streptococcus pneumoniae> isolates. A total of 60 Streptococcus pneumoniae> isolates were analyzed using antimicrobial suscepbility test ( disk diffusion method ) to determine their drug resistance to erythromycin and azithromycin. Among 60 isolates, 33 (55 %) isolates were susceptible, and 27 (45 %) isolates were resistant to erythromycin and azithromycin. The presence of erm>(B) and mef>(A) was determined by PCR. Among of 27 erythromycin and azithromycin Streptococcus pneumonia>-resistant isolates, 7 (25,9 %) isolates carried erm>(B) gene, 6 (22,2 %) isolates carried mef>(A) genes, and 14 (51,9 %) isolates carried both erm>(B) and mef>(A) genes. Of these 27 isolates, 11 ( 40,7 %) isolates belongs to serotype 19 F, with 9 ( 81,8 %) isolates carried both erm>(B) and mef>(A) genes. In conclusion, there was a high proportion of either erm>(B) and mef>(A) genes alone or both of these genes in erythromycin and azithromycin-resistant Streptococcus pneumoniae> isolates. Of 15 erythromycin and azithromycin-susceptible Streptococcus pneumoniae> isolates, no erm>(B) and mef>(A) genes were found.

Abstrak :
ABSTRAK
Pneumonia komunitas merupakan salah satu penyakit infeksi yang umum terjadi danmerupakan salah satu penyebab kematian dan kesakitan terbanyak. Penyakit ini memilikidampak terhadap sosioekonomi dimana tingginya biaya kesehatan terutama disebabkanoleh biaya rawat inap. Evaluasi farmakoekonomi dilaksanakan untuk menilai efektivitasbiaya antibiotik untuk mengetahui apakah pengobatan antibiotik memberikan outcometerapi yang baik dengan biaya yang minimal. Penelitian dilakukan terhadap kombinasiseftriakson-azitromisin dan levofloksasin tunggal sebagai antibiotik empiris untuk pasienpneumonia rawat inap. Analisis efektivitas biaya dilakukan dengan membandingkan totalbiaya medis langsung dan efektivitas yang dilihat dari lama rawat masing-masingkelompok pengobatan. Penelitian dilakukan di RSUP Persahabatan, Jakarta, dengandesain penelitian studi kohort retrospektif, dimana pengambilan data dilakukan secararetrospektif terhadap data sekunder, berupa rekam medis pasien dari tahun 2014-2016.Jumlah pasien yang dilibatkan dalam analisis 100 pasien, yaitu 64 pasien menggunakanantibiotik seftriakson iv dan azitromisin oral, dan 36 pasien menggunakan levofloksasiniv tunggal. Median biaya antibiotik berbeda signifikan antara kelompok seftriaksonazitromisindan kelompok levofloksasin, yaitu Rp.130.756,- dan Rp.286.952,-. Medianbiaya medis langsung kelompok seftriakson-azitromisin lebih tinggi dibandingkankelompok levofloksasin tunggal, yaitu Rp. 6.494.998,- dan Rp. 5.444.242,-. Keberhasilanterapi kelompok seftriakson-azitromisin yaitu 95,3 , sementara keberhasilan terapikelompok levofloksasin sebesar 97,2 namun tidak terdapat perbedaaan signifikan.Median lama rawat LOS dan lama rawat terkait antibiotik LOSAR kelompoklevofloksasin berturut-turut sebesar 6 hari dan 5 hari, lebih singkat dibandingkan LOSdan LOSAR kelompok seftriakson-azitromisin, yaitu 7 hari dan 6 hari. Nilai ACERkelompok levofloksasin sebesar Rp.56.011,-/persen efektivitas lebih rendahdibandingkan kelompok seftriakson-azitromisin sebesar Rp. 68.153,-/persen efektivitas.Berdasarkan hasil penelitian disimpulkan bahwa levofloksasin lebih cost-effectivedibanding kombinasi seftriakson-azitromisin.

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ABSTRACT
Community Acquired Pneumonia CAP is one of the most common infectious diseasesand is one of the leading causes of death and morbidity. This disease has an impact onsocioeconomic where the high cost of health is mainly caused by the cost ofhospitalization. A pharmacoeconomic evaluation was conducted to assess the costeffectivenessof antibiotics to find out whether antibiotic treatment results in a goodtherapeutic outcome with a minimal cost. The study was conducted on a combination ofceftriaxone azithromycin and single levofloxacin as an empirical antibiotic for inpatientCAP patients. Cost effectiveness analysis is conducted by comparing the total directmedical costs and the effectiveness measured from length of stay of each treatmentgroup. The study was conducted in RSUP Persahabatan, Jakarta, with a cohortretrospective design study, where retrospective data retrieval was conducted onsecondary data, in the form of patient medical records from 2014 2016. The number ofpatients involved in the analysis of 100 patients, ie 64 patients using combination of ivceftriaxone and oral azithromycin, and 36 patients using single iv levofloxacin. Medianantibiotic costs differed significantly between the ceftriaxone azithromycin group andthe levofloxacin group, which were Rp.130,756, and Rp.286,952, . Median directmedical costs of the ceftriaxone azithromycin group were higher than the singlelevofloxacin group, which was Rp. 6,494,998, and Rp. 5,444,242, . Success rate ofgroup of ceftriaxone azithromycin group was 95.3 , while the success rate oflevofloxacin group was 97.2 but there was no significant difference. Median length ofstay LOS and length of stay antibiotic related LOSAR of levofloxacin group wererespectively 6 days and 5 days, shorter than LOS and LOSAR of ceftriaxoneazithromycingroup, which were 7 days and 6 days. The value of the ACER levofloxacingroup was Rp.56.011, percent effectiveness, lower than the ceftriaxone azithromycingroup of Rp. 68.153, percent effectiveness. Based on the results of the study, it isconcluded that levofloxacin is more cost effective than a combination of ceftriaxoneazithromycin.

Abstrak :
Resistensi Neisseria gonorrhoeae terhadap antibiotika merupakan masalah global di dunia. Sulitnya pertumbuhan N. gonorrhoeae di laboratorium menyebabkan uji kepekaan antibiotika sulit dilakukan secara reguler. Tujuan penelitian ini untuk mendeteksi N. gonorrhoeae dari spesimen endoserviks dan karakterisasi mutasi gen terkait resistensi terhadap sefiksim dan azitromisin sebagai antibiotika pilihan yang direkomendasikan WHO dan Kemenkes RI. Spesimen endoserviks dari wanita pekerja seks (WPS) dilakukan pewarnaan Gram, kultur, dan uji kepekaan antibiotika. Uji molekuler SYBR green real time PCR digunakan untuk mendeteksi N. gonorrhoeae, mutasi gen penA (Ala501Val/Pro, Gly545Ser) dan 23S rRNA (A2059G, C2611T). Resistensi 9 isolat N. gonorrhoeae terhadap sefiksim, levofloksasin, kanamisin sebesar 11,1%, 33,3%, 77,8% secara berurutan. Tidak ditemukan resistensi terhadap azitromisin dan seftriakson. Sedangkan resistensi terhadap penisilin, tetrasiklin, dan siprofloksasin ditemukan pada semua isolat. Uji SYBR green real time PCR berhasil mendeteksi N. gonorrhoeae dari spesimen endoserviks dan karakterisasi mutasi gen terkait resistensi terhadap sefiksim dan azitromisin. Dibandingkan pewarnaan Gram dan kultur, uji ini meningkatkan tingkat kepositifan sebesar 27% dan 15%. Tidak ditemukan mutasi pada gen penA dan 23S rRNA. ......Antimicrobial resistance in Neisseria gonorrhoeae is a global problem in the world. Due to N. gonorrhoeae is difficult to grow in the laboratory, antimicrobial susceptibility testing cannot be performed regularly. The aim of this study is to detect N. gonorrhoeae from endocervical specimens and to characterize gene mutations associated with cefixime and azithromycin resistance as the drugs of choice recommended by WHO and the Indonesian Ministry of Health. Endocervical specimens from female sex workers (FSW) were examined using Gram staining, culture, and susceptibility testing. Molecular SYBR green real-time PCR were used to detect N. gonorrhoeae and mutations in penA (Ala501Val/Pro, Gly545Ser) and 23S rRNA (A2059G, C2611T). Resistance of 9 isolates N. gonorrhoeae to cefixime, levofloxacin, kanamycin, were 11,1%, 33,3%, 77,8%, respectively. Resistance to azithromycin and ceftriaxone were not found. Whereas resistance to penicillin, tetracycline, and ciprofloxacin were found in all isolates. SYBR green real time PCR was successfully detect N. gonorrhoeae from endocervical specimens and characterize gene mutations associated with cefixime and azithromycin resistance. Compared to Gram and culture, this method could increase positivity rates as much as 27% and 15%. Mutation in penA and 23S rRNA were not found.

Abstrak :
Azithromycin (AZI) adalah antibiotika yang digunakan secara luas. AZI merupakan obat yang memiliki spesifikasi kelarutan yang rendah dalam air serta memiliki nilai bioavailabilitas oral rendah yaitu sebesar 37%. Rendahnya kelarutan dan bioavailabilitas oral AZI dapat berdampak pada rendahnya efek terapetik obat tersebut. Teknik enkapsulasi dan sistem penghantar obat melalui nanocarrier adalah metode alternatif untuk meningkatkan bioavailabilitas obat yang memiliki kelarutan rendah dalam air. Nanopartikel kitosan (NPKS) adalah salah satu polimer yang paling umum digunakan sebagai penghantar obat. Pada penelitian ini nilai efisiensi enkapsulasi dan kapasitas pemuatan AZI pada NPKS berhasil ditingkatkan dengan memodifikasi NPKS menggunakan ekstrak daun binahong (EDB). Metabolit sekunder pada EDB dapat bereaksi dengan gugus amina pada NPKS dan meningkatkan sifat hidrofobiknya sehingga interaksi antara NPKS dengan AZI menjadi lebih baik. Hal tersebut dapat terlihat dari nilai efisiensi enkapsulasi dan kapasitas pemuatan AZI yang sangat baik untuk NPKS- EDB-AZI yaitu pada nilai 95,24 ± 1,30% dan 55,74 ± 1,03%. Hasil karakterisasi TEM menunjukkan bahwa NPKS-EDB-AZI terdistribusi secara homogen dengan ukuran partikel 24,6 ± 2,9 nm. Berdasarkan hasil uji pelepasan obat in vitro, NPKS-EDB-AZI melepaskan AZI sebesar 1,12 ± 0,33% ketika ditempatkan pada pH 1,6 selama 2 jam, 82,05 ± 2,23% pada pH 6,8 selama 6 jam, dan 93,44 ± 1,94% ketika ditempatkan pada pH 7,4 selama 16 jam. Penelitian ini menunjukan bahwa NPKS yang termodifikasi EDB dapat dimanfaatkan sebagai sistem penghantar azithromycin dengan nilai efisiensi pemuatan dan kapasitas pemuatan yang baik, serta memberikan sifat pelepasan obat secara terkontrol. ......Azithromycin (AZI) is a widely used antibiotic. AZI is a drug that has a low solubility in water and a low oral bioavailability value of 37%. The low solubility and oral bioavailability of AZI can have an impact on the low therapeutic effect of the drug. Encapsulation techniques and drug delivery systems via nanocarriers are alternative methods to improve the bioavailability of drugs that have low solubility in water. Chitosan nanoparticles (NPKS) are one of the most commonly used polymers as drug conductors. In this study, the value of encapsulation efficiency and AZI loading capacity on NPKS was successfully increased by modifying NPKS using binahong leaf extract (EDB). Secondary metabolites in EDB can react with amine groups in NPKS and increase their hydrophobic properties so that the interaction between NPKS and AZI becomes better. This can be seen from the excellent encapsulation efficiency and AZI loading capacity values for NPKS-EDB-AZI, namely 95.24 ± 1.30% and 55.74 ± 1.03%. The results of TEM characterization showed that NPKS-EDB-AZI was homogeneously distributed with a particle size of 24.6 ± 2.9 nm. Based on the results of in vitro drug release tests, NPKS-EDB-AZI released AZI of 1.12 ± 0.33% when placed at pH 1.6 for 2 hours, 82.05 ± 2.23% at pH 6.8 for 6 hours, and 93.44 ± 1.94% when placed at pH 7.4 for 16 hours. This study shows that EDB-modified NPKS can be used as an azithromycin delivery system with good loading efficiency and loading capacity and controlled drug release properties.

Abstrak :
Corona Virus 2019 (COVID-19) ialah penyakit menular yang berkembang sejak bulan Desember 2019 di Wuhan, ibu kota Provinsi Hubei China, sejak itu virus ini menyebar keseluruh dunia dan menjadi global pandemi. Di Indonesia, pada Juli 2021, dikeluarkanlah surat edaran tentang Pelaksanaan Distribusi Obat dengan Persetujuan Darurat untuk penanganan terapi COVID-19 yaitu; Remdesivir, Favipiravir, Oseltamivir, Immunoglobulin, Ivermectin, Tocilizumab, Azithromycin dan Dexamethasone. Pasien yang ingin membeli obat yang mengindikasikan COVID-19 diwajibkan membawa resep dokter. Analisis resep dilakukan sesuai dengan Surat Edaran (SE), meninjau aspek administratif, aspek farmasetik dan aspek klinis. Hasil penelitian ini dapat disimpulkan bahwa terdapat 11 resep pengobatan COVID-19 pada bulan Juli 2021. Terjadi ketidaklengkapan kajian resep baik secara administrasi, farmasetik, serta aspek klinis. Namun seluruh resep telah memiliki ketepatan indikasi dan dosis. ......Corona Virus 2019 (COVID-19) is an infectious disease that developed in December 2019 in Wuhan, the capital of China's Hubei Province, since then this virus has spread throughout the world and has become a global pandemic. In Indonesia, in July 2021, a circular letter regarding the Implementation of Drug Distribution with Emergency Approval was issued for the handling of COVID-19 therapy, namely; Remdesivir, Favipiravir, Oseltamivir, Immunoglobulin, Ivermectin, Tocilizumab, Azithromycin, and Dexamethasone. Patients who want to buy drugs that indicate COVID-19 are required to bring a doctor's prescription. Prescription analysis was carried out by the Circular Letter, reviewing administrative aspects, pharmaceutical aspects, and clinical aspects. The results of this study can be concluded that there were 11 prescriptions for COVID-19 treatment in July 2021. There were incomplete prescription studies both administratively, pharmaceutically, and clinically. However, all prescriptions have accurate indications and dosages.

Vitacimin is a lozenge product containing vitamin C, produced by PT Takeda Indonesia. The high demand for Vitamin C products has continued to surge dramatically since the global entry of the COVID-19 pandemic in Indonesia in early 2020. With the increasing market demand for Vitacimin, it is also necessary to analyze and optimize the duties and work of employees (packers) in packaging Vitacimin products. This observation is focused on line 3 secondary packaging using machine vision tools that have optical functions, namely object inspection and inspection and pattern recognition. The machine vision tool used is Camera Vision Baumer, which is currently running on a trial period by placing employees who serve as selectors and back up the Camera Vision function. In this study, it can be concluded that the Camera Vision Baumer tool works well and the selector in charge of performing the back up function of the Camera Vision Baumer task can be switched.