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Abstrak :
ABSTRAK
Latar belakang: Intoleransi minum merupakan masalah yang sering dihadapi bayi kurang bulan. Eritromisin merupakan salah satu prokinetik yang sering digunakan, namun pemberiannya masih merupakan kontroversi. Tujuan: Mengetahui efikasi eritromisin oral dalam meningkatkan toleransi minum pada bayi kurang bulan. Metode: Penelitian ini merupakan penelitian uji klinis acak tersamar yang dilakukan pada bayi kurang bulan di RSUP. Sanglah Denpasar dari bulan Juni 2015 hingga Januari 2016. Sampel dilakukan randomisasi menjadi dua kelompok, kelompok perlakuan mendapatkan eritromisin 12,5 mg/kg setiap 8 jam sedangkan kelompok kontrol mendapat plasebo. Luaran primer yang dicari adalah waktu untuk mencapai nutrisi enteral penuh. Luaran sekunder adalah berat badan saat mencapai nutrisi enteral penuh dan lama rawat rumah sakit. Hasil: Selama penelitian didapat 62 sampel, dimana 3 sampel di drop-out. Tiga puluh sampel didapat pada kelompok eritromisin dan 29 sampel pada kelompok kontrol. Tidak ada perbedaan data dasar pada kedua kelompok. Rerata usia gestasi adalah 31,4+1,7 minggu pada kelompok perlakuan dan 32,4+2,2 minggu pada kelompok kontrol. Tidak terdapat perbedaan yang bermakna dalam mencapai nutrisi enteral penuh yakni 10+5,3 hari pada kelompok eritromisin dibandingkan 8+6,5 hari pada kelompok kontrol (p=0,345). Tidak ada perbedaan yang bermakna dalam berat badan saat mencapai nutrisi enteral penuh dan lama perawatan di rumah sakit. Simpulan: Eritromisin dosis oral 12,5 mg/kgBB setiap 8 jam secara rutin tidak mempercepat waktu nutrisi enteral penuh pada bayi kurang bulan. Tidak ada perbedaan berat badan saat mencapai nutrisi enteral penuh dan lama perawatan pada kedua kelompok.

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ABSTRACT
Backgrounds: Feeding intolerance is a common condition that affects premature infants. Erythromycin is one of the prokinetic agents to treat feeding intolerance, but the use of this agent is still controversy. Objectives: To evaluate the effectiveness of oral erythromycin to enhance feeding tolerance in premature infants. Design: This study is a prospective randomized controlled trial on premature infants in Sanglah Hospital from June 2015 until January 2016. Eligible infants were randomized to receive 12.5 mg/kgBW/dose 8 hourly oral erythromycin or plasebo. The primary outcome was the time to establish full enteral feeding. The secondary outcomes were weight at full enteral feeding and duration of hospital stay. Results: There were 62 samples during the study, 3 infants were dropped out. Thirty infants were given erythromycin and 29 infants were given placebo. The baseline of the two groups was similar, mean of gestational age was 31.4+1.7 weeks in erythromycin group and 32.4+2.2 weeks in placebo group. The time to reach full enteral feeding did not differ statistically between the 2 groups, 10+5.3 days in erythromycin group vs 8+6.5 days (p=0,345) in placebo group. There were no significant differences between the two groups regarding the body weight at full enteral feeding and duration of hospital stay. Conclusion: Erythromycin 12.5 mg/kgBW/dose every 8 hours as prophylactic treatment does not enhance feeding tolerance in premature infants. There were no significant differences between the two groups regarding body weight at full enteral feeding and duration of hospital stay.

Abstrak :
Pemberian jus jeruk dengan feksofenadin telah ditemukan menurunkan bioavailabilitas feksofenadin sampai kurang dari 30% melalui hambatan organic-anion transporting polypeptide (OATP), suatu polipeptida yang mentransport obat ke dalam sel dan terdapat pada organ-organ seperti hati, ginjal dan usus. Eritromisin dan klaritromisin adalah substrat dan penghambat CYP3A4, suatu enzim pemetabolisme obat di hati dan usus, dan P-glikoprotein (P-gp), protein yang mentransport obat ke luar dari sel. Karena terdapat tumpang tindih antara substrat dan penghambat CYP3A4, P-gp dan OATP, kami ingin meneliti apakah pemberian bersama jus jeruk lokal (jeruk Siam) akan mempengaruhi bioavailabilitas ke-2 antibakteri tersebut di atas. Kami melakukan 2 studi menyilang, satu studi untuk setiap antibakteri (500 mg), yang diberikan bersama jus jeruk (200 ml) dan bersama air pada 12-13 sukarelawan sehat per studi. Kadar serum antibakteri diukur dengan cara mikrobiologik. Rasio rata-rata (kisaran) AUC0-t dengan jus jeruk / dengan air adalah sbb.: eritromisin : total (n=13) 81.7 (9.7-193.8)%, tidak berubah (n=4) 96.4 (80.5-107.9)%, menurun (n=6) 31.9 (9.7-49.0)%, meningkat (n=3) 161.8 (134.6-193.8)%; klaritromisin : total (n=12) 91.4 (20.6-158.3)%, tidak berubah (n=5) 103.1 (80.9-123.0)%, menurun (n=4) 34.8 (20.6-64.3)%, meningkat (n=3) 147.2 (132.9-158.3)%. Disimpulkan bahwa pemberian eritromisin atau klaritromisin bersama jus jeruk Siam menghasilkan efek yang tidak konsisten terhadap bioavailabilitas ke-2 antibakteri ini pada masing-masing subyek, dengan penurunan yang besar pada hampir separuh dari subyek, meskipun secara total efeknya tidak bermakna secara statistik. (Med J Indones 2004; 14: 78-86)

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Concomitant administration of orange juice with fexofenadine has been found to decrease the bioavailability of fenofenadine to less than 30% via inhibition of organic-anion transporting polypeptide (OATP), a drug uptake transporter expressed in organs such as liver, kidney and intestine. Erythromycin and clarithromycin are substrates and inhibitors of CYP3A4, a drug metabolizing enzyme in the liver and enterocytes, and P-glycoprotein (P-gp), a drug efflux transporter expressed in the same organs as OATP. Since an extensive overlap exists between substrates and inhibitors of CYP3A4, P-gp and OATP transporters, we want to study the effect of coadministration of our local orange (Siam orange) juice on the bioavailability of the above antibacterials. We conducted two 2-way cross-over randomized studies, one study for each antibacterial (500 mg), crossed between administration with orange juice (200 ml) and with water, in 12-13 healthy subjects per study. The serum concentrations of the antibacterials were assayed by microbiological method. The mean (range) ratio of AUC0-t with orange juice/with water were as follows : erythromycin : total (n=13) 81.7 (9.7-193.8)%, unchanged (n=4) 96.4 (80.5-107.9)%, decreased (n=6) 31.9 (9.7-49.0)%, increased (n=3) 161.8 (134.6-193.8)%; clarithromycin : total (n=12) 91.4 (20.6-158.3)%, unchanged (n=5) 103.1 (80.9-123.0)%, decreased (n=4) 34.8 (20.6-64.3)%, increased (n=3) 147.2 (132.9-158.3)%. It was concluded that coadministration of Siam orange juice with erythromycin or clarithromycin produced unpredictable effects on the bioavailability of these antibacterials in individual subjects, with marked decreases in almost half of the subjects, although in totals the effects were not statistically significant. (Med J Indones 2004; 14: 78-86)

Abstrak :
Penyakit tonsilofaringitis termasuk dalam infeksi saluran pernafasan akut yang kasusnya banyak di masyarakat, mencapai 40 - 60 % kunjungan pasien ke Puskesmas. Dari Sistim Pencatatan dan Pelaporan Terpadu Puskesmas menunjukkan bahwa tonsilofaringitis adalah yang paling sering ditemui di lapangan. Dilain pihak pengobatan antibiotika irasional terus berlangsung, tidak terkecuali ISPA. Padahal menurut laporan WHO, kebanyakan penyakit ISPA disebabkan oleh virus bukan bakteri, hanya 10 % gejala ISPA yang memang betul-betul memerlukan antibiotika. Sementara DepKes RI mengeluarkan pedoman Pengobatan Dasar Berdasar Gejala bagi Puskesmas, dimana faringitis oleh infeksi kuman ditetapkan pilihan I amoksisilin, pilihan II ampisilin, pilihan III penisilin V dan terakhir pilihan IV eritromisin Oleh karena itu perlu adanya evaluasi dengan cost effectiveness analysis antara amoksisilin dan eritromisin pada terapi tonsilofaringitis, agar diketahui pilihan yang tepat secara ekonomis di masyarakat. Penelitian dilakukan di daerah Jakarta Barat pada Puskesmas Tambora, mulai bulan Juni sampai dengan September 2002. Dalam evaluasi disertakan faktor-faktor yang berhubungan dengan kesembuhan terapi tonsilofaringitis mulai internal umur, jenis kelamin, pendidikan, status gizi, penghasilan keluarga, kepatuhan minum obat, adanya pengaruh minum obat simptomatis sebelumnya, ada tidaknya efek samping obat dan eksternal terpapar oleh polusi ditempat kerja, kepadatan hunian rumah serta kondisi lingkungan rumah. Desain penelitian kohort, perhitungan sampel uji beda dua mean. Jumlah sampel jadi 241 orang dengan rincian 120 orang menerima pengobatan dengan amoksisilin dan 121 orang menerima pengobatan dengan eritromisin. Jugs dilakukan pemeriksaan kultur kuman dan tes resistensi terhadap 75 spesimen swap, sebagai kontrol terhadap proses terapi yang rasional. Keduanya sensitif, namun eritromisin lebih sensitif dari amoksisilin. Hasil kesembuhan penderita tonsilofaringitis dari 120 orang penderita yang diterapi amoksisilin: 101 (84,2%) orang penderita yang sembuh dan dari 121 orang yang diterapi eritromisin 115 (95,0%) orang penderita yang sembuh. Dalam analisa statistik nilai p = 0,005 bermakna, yang berarti bahwa kesembuhan dipengaruhi oleh adanya perbedaan jenis antibiotika yang digunakan dan nilai RR = 8,007, yang berarti kesembuhan dengan terapi eritromisin lebih baik 8.007 kali dibanding amoksisilin. Berdasarkan perhitungan akhir, unit cost untuk amoksisilin Rp. 182.405,97, lebih murah dibanding eritromisin, yaitu Rp. 156.834,90. Maka terapi tonsilofaringitis yang menggunakan antibiotika eritromisin lebih cost effective dibanding dengan terapi yang menggunakan amoksisilin.

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Cost Effectiveness Analysis Between Amoxicillin And erythromycin for The Tonsilopharyngftis Therapies at Puskesmas Tambora, West Jakarta 2002. Tonsilopharyngitis is one of the acute respiratory infection cases which frequently found in society. In fact, 40-60% patients who come to the Puskesmas are infected. The Integrated Reporting and Recording System of Puskesmas shows that tonsilopharyngitis is the most commonly case found in the society. On the other hand, the irrational antibiotic treatment, including ISPA, is continuously conducted. According to WHO, most of the ISPA diseases are mainly caused by virus rather than bacteria. Only 10 % of ISPA symptoms need antibiotic. Depkes RI has published a guidance of the basic treatment based on symptoms, which are given for the Puskesmas. It is stated that the pharyngitis caused by a germ infection determined as option 1 amoxicillin, option II ampicillin, and option III penicillin V and option IV erythromycin. The techniques of cost effectiveness analysis between the amoxicillin and erythromycin for the tonsilopharyngitis are done in order to know the right use of therapy in the society economically. The research is held at Puskesmas Tambora located in west Jakarta started from June until September 2002. It is included in the evaluation the factors which related to the convalescence of the tonsilopharyngitis therapy antibiotic. The internal factors, namely, education, nutrition status, family income, medicine consumption, the previous effect of the symptomatic medicine consumption, the existence of the side effect of the medicine, and the external factors are air pollution in the workplace, thickness of the habitation and the environment condition. Cohort research design is the sample test of the two different means. There are 241 patients for the sample. 120 of them are given with the amoxicillin therapy and the other 121 patients are given with the erythromycin therapy. The culture examination of the germ and the resistance test for the 785-swap specimen are also conducted as the control of the rational therapy. Both of the used antibiotics are still sensitive for the tonsilopharyngitis germ, and the erythromycin is more sensitive rather than amoxicillin. The tonsilopharyngitis healing result of the 120 patients who have given the amoxicillin therapy consists of 101 (84,2%) patients, and 115 (95%) out of the 121 patients who have given the erythromycin therapy are recuperated. In a statistic analysis, p= 0.005 is valuable. It means that the recuperation is influenced by the different kinds of antibiotic used, and RR = 8,007, which has a recovery meaning for the therapy is 8.007 times better than amoxicillin. Based on the final calculation, unit cost for the amoxicillin is Rp 182.405,97 and for the erythromycin is RP 156.834,90. Thus, tonsilopharyngitis therapy, which is using erythromycin, is more cost effective rather than the tonsilopharyngitis therapy using amoxicillin

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 :
Studi keragaman genetik dilakukan untuk mengetahui hubungan kekerabatan bakteri asam laktat indigenos Indonesia yang memiliki kemampuan resistansi terhadap chloramphenicol dan erythromycin. Hasil uji resistansi menunjukkan bahwa isolat DH1, DH7, dan S34 resistan terhadap chloramphenicol (5 μg/ml), sedangkan isolat T8 resistan terhadap erythromycin (15 μg/ml). Isolat D2, S23, dan T8 diketahui resistan terhadap kombinasi chloramphenicol dan erythromycin (1 μg/ml). Analisis BLAST menunjukkan bahwa isolat bakteri asam laktat terdiri atas Lactobacillus plantarum, L. fermentum, Pediococcus acidilactici, dan P. pentosaceus. Analisis pohon filogenetik diketahui bahwa isolat D2, S12, S34, T3, dan T8 memiliki kekerabatan yang dekat dengan L. plantarum. Isolat R31 dan DH1 memiliki kekerabatan yang dekat dengan L. fermentum. Isolat LK14, S23, R24, DH7,DS13, GR3, HB3 memiliki kekerabatan yang dekat dengan genus Pediococcus.

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Study on genetic diversity was useful to determine the kinship of Indigenous Indonesia lactic acid bacteria which have the capability of resistance to chloramphenicol and erythromycin. The resistance test showed isolates DH1, DH7, and S34 that were resistant to chloramphenicol (5 μg/ml), whereas T8 was resistant to erythromycin (15 μg/ml). Isolates D2, S23, and T8 were remain resistant to the combination of chloramphenicol and erythromycin (1 μg/ml). The results of BLAST analysis showed that there were four different species of lactic acid bacteria, such as Lactobacillus plantarum, L. fermentum, Pediococcus acidilactici, and P. pentosaceus. The results of phylogenetic trees analysis showed that isolates D2, S12, S34, T3, and T8 have a close kinship with L. plantarum, whereas isolates R31 and DH1 have a close kinship with L. fermentum. Moreover, isolates LK14, S23, R24, DH7, DS13, GR3, HB3 have a close kinship to the genus Pediococcus.