Drug Information Handbook Research Articles

Dosage Adjustment as an Efficiency in Treatment Costs for Chronic Kidney Disease Patients

Introduction: Chronic Kidney Disease (CKD) treatment, in all stages, has been shown to impose a big economic burden. To reduce drug costs, dose adjustment can be used in CKD treatment. Apart from saving costs, dose adjustments can also reduce the risk of side effects due to excessive doses. This research aimed to identify the dose suitability of CKD patient treatment and calculate the difference in treatment costs before and after the dose adjustments. Method: This research was a cross-sectional study using descriptive analysis. Data was collected from medical records in UGM Academic Hospital using purposive nonrandom sampling in inpatient CKD patients with decreased creatinine clearance and serum creatinine who underwent hospitalization for at least one year. Result: There were 58.14% male patients and 41.86% female patients. Most of the patients have stage 5 CKD (46.51%) and hypertension comorbidities (59.30%). Around 69.14% of drugs used in treatment required dose adjustment and only 52.33% of them had appropriate doses based on the Lexicomp Drug Information Handbook. The class of drugs that required the most dose adjustments was antibiotics with 14 occurrences. After the dose adjustment, the saved cost from patients with inappropriate doses was IDR 1,766,330. The biggest cost difference after the dose adjustment was IDR 1,090,865, which comes from the antibiotic group. Conclusion: Dosage adjustments can reduce the incidence of medication errors, improve clinical outcomes, and increase the effectiveness of clinical outcomes and cost-effectiveness.

Assessment of Frequency and Severity of ADRS Related with CHOP Therapy in Lymphoma Treatment

Background: Lymphoma a blood related cancer usually treated by using combination of various chemotherapeutic agents, one of the common treatments is CHOP (Cyclophosphamide, Doxorubicin, Vincristine, Prednisone). Objective: Objective of this study was to identify frequency and severity of ADRs affecting various systems due to CHOP therapy from which patients are suffering, so that proper health strategy can be designed to overcome them. Methodology: study conducted was a prospective, observational enrolled 100 patients suffering from Non-Hodgkin Lymphoma and receiving CHOP combination therapy from November 2015 to April 2018 at Cancer Hospital Jamshoro, sampling technique used was purposive. The response on ADRs was recorded and these were verified by comparing against British National Formulary (2017) ad Lexi Comp Drug Information Handbook (2015). Results: Among 100 patients enrolled aged 18-65 years in which females comprise the majority. The common ADRs reported were nausea 71%, fatigue 69% and alopecia 68% The patients who responded about high severity ADRs also tend to stay longer as compared to those with less severity one. Conclusion: The study results show that patients receiving lymphoma treatment suffers from high severity ADRs require supportive medical care as this lead to prolong effects after dose cycle. These patients must be counselled for supportive medication and food intake to prevent additional health risks to achieve maximum therapeutic benefits. Keywords: Cancer, Anticancer Drugs, Chemotherapy, CHOP Therapy, ADRs

Antibiotic Evaluation Use towards Diabetic Foot Ulcer Inpatient at Hospital in Surakarta

A diabetic foot ulcer is one of diabetes mellitus type 2 complications indicated by open sores. Because it contains bacteria, it is treated with antibiotics. Improper use of antibiotics could harm patients due to the length of wound healing. This study aims to determine the appropriate of antibiotics in patients with a diabetic foot ulcers. This is a non-experimental research with descriptive analysis approach. The medical records of diabetic foot ulcer patients undergoing inpatient and antibiotic prescribing are observed. The data obtained were analyzed by comparing the use of antibiotics based on the National Health Service guidelines, the Indonesian National Drug Information, and the Drug Information Handbook. The results of this study showed antibiotics used are metronidazole (4.8%), vancomycin (4.8%) and antibiotics combination are ceftriaxone-metronidazole (47.6%), ceftriaxone-metronidazole-clindamycin (4,8%), levofloxacin-azithromycin-ceftriaxone (4.8%), cotrimoxazole-ciprofloxacin (4.8%), metronidazole-meropenem (4.8%), ceftriaxone-metronidazole-gentamicin (4.8%), metronidazole-clindamycin-ciprofloxacin (4.8%), ceftriaxone-levofloxacin (4.8%), and ceftriaxone-metronidazole-ciprofloxacin (9.5%). The evaluation results according to criteria appropriate usage of antibiotics that is 100% appropriate indication, 100% for appropriate of patients, 42.3% for appropriate drug, and 61.9% for the appropriate dose.

RATIONALITY OF PRESCRIBING ANTIBIOTICS TO PATIENTS AT THE HEALTH CENTER TELKOMEDIKA CLINIC, YOGYAKARTA

Excessive and inappropriate use of antibiotics in some cases can cause antibiotic resistance problems, increase treatment costs, and side effects of antibiotics. To prevent the emergence of antibiotic resistance, it is necessary to rationalize the administration of antibiotics. The purpose of this study was to determine the rationality of prescribing antibiotics at the Telkomedika Health Center Clinic in the period October-December 2020. 
 This study used a descriptive observational method. Retrospective data collection used 160 samples of prescriptions and medical records of patients with a diagnosis of bacterial infection and a prescription for antibiotics. The data were analyzed descriptively based on rationality of prescribing including the right diagnosis, the right indication, the right choice of drug and the right dose, the right way of administering the drug, the right duration of drug administration, the right patient with theguidelines Drug Information Handbook, then calculated in percentage form and presented in tabular form. 
 Research results The rationale for prescribing antibiotics to patients at the Telkomedika Health Center Clinic in Yogyakarta for the period October - December 2020 is 100% Correct Diagnosis, 100% Correct Indication, 100% Correct Selection of Drugs, 100% Correct Dosage, 100% Correct Method of Drug Administration, 100% Correct Duration of Drug Administration. These results indicate that the prescription screening conducted at the Telkomedika Health Center Clinic in Yogyakarta has been carried out very well and according to the quality standards that have been set. 
 Keywords : rationality, antibiotics, prescribing

The identification of drug related problems (DRPs) using profilaxis antibiotics in orthopedic surgical patients at a Government Hospital in Yogyakarta

Background: Antibiotic prophylaxis in orthopedic surgery cases aims to prevent surgery site infections (SSI). For antibiotic prophylaxis, it is recommended to use the first generation of cephalosporin, namely cefazolin which can kill the bacteria commonly found in orthopedic surgery infection. The prophylactic administration of cefotaxime is not the first line but is definitive for surgical prophylaxis. Objective: The aim of this study was to determine the rationale for the use of antibiotic prophylaxis for orthopedic surgery, the drug problems (DRPs) that occurred and their potential interactions. Method: This study was conducted using a cross sectional design with a total sampling technique of medical record samples from January to February 2019 at the Government Hospital in Yogyakarta. Observational analytical descriptive data processing by ensuring the appropriate of indications, route of administration, timing of administration and an appropriate of prophylactic doses as well as how to compare DPRs to the literature and analysis of potential co drug interaction with Drug Information Handbook (DIH), AHFS Clinical Drug Information, Drug Interaction Facts, and Interactions Stockley’s Drug Interaction. Results: All patients received appropriate therapy for indication, type of drug, routes of administration for pre and postoperative. All patients received an under dose of ranitidine and 1 patient (1,69%) received an over dose of piracetam. Potential interactions that occur include ketorolac-ranitidine, NSAIDs with other NSAIDs, NSAIDs-ranitidine, NSAIDs-ACEi, NSAIDs-bisoprolol, bisoprolol-calcium, calcium-vitamin C, and paracetamol-ranitidine. Conclusion: Pre and postoperative prophylactic antibiotics are rational. The accompanying drug, ranitidine and piracetam were not properly doses. Drug interactions in this study are potential. Keywords: prophylaxis antibiotic, orthopedic surgery, cefotaxim, DRPs

Identifying the pattern and risk factors for potential medication dosing errors in chronic renal impairment of critically ill patients

Purpose: Different prescription entries usually complicate the drug therapy for critically ill patients; therefore, we conducted this prospective study to assess the rates for appropriate renal dosing modifications in chronic kidney disease (CKD) patients admitted to the ICU and reported possible related factors of misadjustments. Design: We enrolled adult ICU patients who received at least one drug and experienced CKD with the estimated glomerular filtration rate (eGFR) ≤ of 59 ml/min on ICU admission. The latest Lexicomp drug information handbook recommendations were also applied as a standard guide for renal dosing changes. results: A total of 701 prescription entries were studied in 97 patients, and 13.8% (97 medications) required renal dose adjustment. Of the 97 drugs, 20.6% (20) had not been prescribed appropriately, according to eGFR. Antibiotics were the most likely medication group to require a dose adjustment and comprised the largest number of inappropriate prescriptions in our study. EGFR and the number of drugs that needed dose modification significantly affected renal dosing adjustment accuracy (p = 0.03 and 0.01, respectively). conclusion: These results revealed a high percentage of appropriate renal dose adjustment in ICU compared to other studies that evaluated non-critically ill patients. However, more attention should be paid to patients with a higher number of prescribed medicines for renal dose modification and lower eGFR to reduce medication errors.

The evaluation of compounding prescription and its availability of a licensed product for children at a private hospital in Yogyakarta, Indonesia


 Introduction: The availability of licensed drug formulas for paediatric patients is still limited, so compounded drugs still exist, especially in the form of divided medicinal powder. 
 Aim: This study aimed to determine the profile of divided medicinal powder prescription and its availability in licensed drug formula for paediatric patients. 
 Methods: This research was a cross-sectional study. Prescriptions containing order to compound divided medicinal powder at a ublic Hospital in Yogyakarta Special Region from January to March 2019, were collected and analysed descriptively.
 Results: The total collected prescriptions were 152. The total of active substances given to paediatric patients was 38. The most prescribed drug in the hospital was Triamcinolone. There are 34 active substances already available in licensed drug formulas for paediatric patients, so it is better not to be compounded. However, four active substances are not available as licensed product in the drug information handbook in Indonesia, so, it is reasonable to compound to provide a suitable medication (dose and dosage form) for paediatric patients.

The impact of suitability of empirical antibiotics use on therapeutic outcome of respiratory tract infection patients at inpatient wards of Universitas Gadjah Mada Academic Hospital

Currently, respiratory infection is regarded as one of the most common infectious diseases. This study aims to find out the impact of appropriate use of empirical antibiotic on therapeutic outcomes of patients with respiratory infections at inpatient wards of UGM Academic Hospital. This is a cross-sectional study that uses retrospective data through patient medical records. The population was all patients who received empirical antibiotic therapy for respiratory infections at inpatient ward from July 2018 to July 2019. The sample was collected using the purposive sampling method, and the total number of samples was 192. The appropriate use of empirical antibiotic including the correct type, dosage, route, duration, and frequency was evaluated according to the Antibiotic Guidelines of UGM Academic Hospital 2018, Drug Information Handbook, Frank Shann Drug Doses, Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) 2016 & 2019, Pharmacotherapy Handbook 2015, and Pharmaceutical Care for Respiratory Tract Infections 2005. The data was analyzed descriptively by using Chi-square bivariate analysis. The result shows that 47.9% of 192 patients have received antibiotics properly according to the type, route, dose, frequency, and duration. The results of empirical antibiotic therapy have improved the repair of vital signs in 37.5% of patients. Meanwhile, the result of Chi-square bivariate analysis between the suitability of empirical antibiotic use and the improvement of therapeutic outcome is p=0.478 (p>0.05), which means that it is not statically significant. It can be concluded that there is no correlation between the suitability of empirical antibiotics use and the improvement of the therapy outcomes. Thus, the use of empirical antibiotics based on the guidelines does not always have an impact on the improvement of the treatment outcomes of the patients with respiratory infection at inpatient wards of UGM Academic Hospital.

Polypharmacy and severe potential drug-drug interactions among older adults with cardiovascular disease in the United States

BackgroundPolypharmacy continues to be a topic of concern among older adults and puts patients at increased risk of potential drug-drug interactions (DDIs) and negative health outcomes. The objective of this study was to assess the prevalence of polypharmacy among older adults with cardiovascular disease (CVD) and to identify severe potential DDIs.MethodsA retrospective chart review was conducted in a tertiary care center over a three-month period where we reviewed home medications of older adults upon hospital admission. Inclusion criteria were age ≥ 65 years, history of CVD, and admission to the cardiology service. Polypharmacy was defined as 5 or more medications taken concomitantly, hyper-polypharmacy was defined as 10 or more medications taken concomitantly, and severe potential DDIs were considered to be those belonging to category D or X using Lexicomp® Drug Information Handbook. Category D interaction states that modification of therapy should be considered while category X states that the combination should be absolutely avoided.ResultsA total of 404 patients with a mean age of 76.6 ± 7.4 years were included. Patients were taking an average of 11.6 ± 4.5 medications at home and 385 (95%) received polypharmacy, 278 (69%) received hyper-polypharmacy, and 313 (77.5%) had at least one severe potential DDI. Under category D, the most common potential DDIs were drugs with additive central nervous system (CNS) depressant effect and drugs that increase the risk of QT prolongation. Under category X, the most common potential DDIs were non-selective β-blockers that may diminish the bronchodilator effect of β2 agonists and drugs with anticholinergic properties that enhance the ulcerogenic effect of oral solid potassium.ConclusionsPolypharmacy, hyper-polypharmacy, and severe potential DDIs are very common in older adults with CVD. Clinicians should vigilantly review patients’ drug records and adjust therapy accordingly to prevent adverse drug reactions and negative health outcomes.

OPTIMALISASI PELAYANAN APOTIK PANJEN DI DESA WEDOMARTANI NGEMPLAK SLEMAN YOGYAKARTA

Community service activities have been completed to optimize Panjen Pharmacy services. Pharmaceutical services are integrated activities aimed to identify, prevent, and resolve drug problems and health-related problems. The demands of patients and society for improving the quality of pharmaceutical services require the expansion of the old drugs-oriented paradigm into a new patient-oriented paradigm with the philosophy of Pharmaceutical Care. The Panjen Pharmacy in Wedomartani Village, Sleman is still constrained in implementing pharmaceutical services. Based on the results of observations to partners, these problems resulted from A limited number of human resources, lack of facilities and infrastructure, the absence of standardized etiquette, no drug information handbook, and there is no counseling card. The average number of visits by patients who buy drugs at the Panjen Pharmacy per day reaches 35-70 people. So it is necessary to improve services to provide a sense of security to patients about the use of drugs to be consumed. The outcome of this service activity is to optimize Panjen Pharmacy services through increasing human resource capacity, improving infrastructure, availability of standard etiquette, counseling cards, and drug information book achieved with the Participatory Rural Appraisal (PRA) participatory community empowerment model. The continuity of this service activity is the achievement of consistency in the application of a good and correct rationing system, both in terms of Human Resources Utilization (Human Resources), as well as in terms of a management information system that can guarantee the availability of the right type of drug, the right amount, the right quality and the right time. , thus making the pharmacy better in terms of service to the community and healthier.

EVALUASI PENGGUNAAN ANTIBIOTIK PROFILAKSIS PADA PASIEN BEDAH SESAR DI INSTALASI BEDAH SENTRAL RUMAH SAKIT XY MANADO

Sectio Caesarea is a procedure to remove a fetus through surgery on the abdomen and uterus. Sectio Caesarea is performed as an alternative if normal delivery is not possible to deliver birth on the birth canal. Sectio Caesarea can be performed both by design or emergency on high-risk pregnancies. The risk of infection in Sectio Caesarea surgery can be reduced by giving antibiotic prophylaxis therapy. The purpose of this study to evaluate the use of antibiotic prophylaxis in Sectio Caesarea patients at Central Surgical Installation XY Hospital in Manado during 2019. The study has been performed observational, the data were obtained by retrospective and study of patient's fully sampling of medical records. The study result showed that antibiotic prophylaxis in 58 patients with Caesarea surgery was used 55 patients with Ceftriaxone (94,8%) and 3 patients with Cefazolin (5,2%). This shows the selection of the type of cesarean section antibiotic prophylaxis is not appropriate with the General Guidelines for the Use of Antibiotics by the Peraturan Menteri Kesehatan Republik Indonesia in 2011, because there are only 5.2% of the first generation cephalosporin class antibiotics according to the guidelines for cesarean section prophylaxis. Based on the duration of administration, the route of administration and the dose of prophylaxis antibiotics in patients with the cesarean section is by the General Guidelines for the Use of Antibiotics by the Peraturan Menteri Kesehatan Republik Indonesia in 2011, which is supported by the recommendations of the ASHP Therapeutic Guideline and the Drug Information Handbook Ed.17.

The Prevalence of Prescribing Medications Associated with Geriatric Syndromes among Discharged Elderly Patients.

ABSTRACTIntroduction:A geriatric syndrome is a group of signs and symptoms that occur in older people and do not fit into a discrete disease. Several medications were reported to be associated with the incidence of geriatric syndromes.Objective:The objective of this study was to investigate the prevalence and pattern of medications associated with geriatric syndromes (MAGSs) among the discharged elderly patients (≥65 years old).Materials and Methods:This is a cross-sectional study that was conducted at a Malaysian teaching hospital from October to December 2018. The discharge medications of geriatric patients were reviewed to identify MAGSs using Beers criteria, Lexicomp drug information handbook, and the United States Food and Drug Administration (USFDA) drug inserts. Chi-square test was used to compare MAGS prescribed between categories. Spearman’s rank-order correlation was used to test the correlation between the presence of MAGS and the number of discharge medications. A binomial logistic regression was applied to determine the predictors of prescribing MAGSs.Results:A total of 400 patients (mean ± standard deviation [SD] age, 72.0 ± 5.0 years) were included, and 45.3% of them were females. The most common diseases were hypertension followed by diabetes mellitus. The mean ± SD number of discharge medications per patient was 4.2 ± 2.5. The MAGSs were prescribed in 51.7% of the patients, and 54 patients were discharged with more than one MAGSs. The most commonly prescribed MAGSs were opioid analgesics, vasodilators, and β-blockers, which are associated with falls, depression, and delirium. Polypharmacy was found in 138 patients, and it was significantly associated with the presence of MAGSs (P < 0.001). No significant differences were found in prescribing MAGSs based on the patients’ gender, race, and age.Conclusion:The prescribing of MAGSs occurred in half of the discharged elderly patients. Physicians should be aware of the medications that are associated with special side effects in the elderly patients, and should switch to safer alternatives when possible.

Herb-drug interactions: a novel algorithm-assisted information system for pharmacokinetic drug interactions with herbal supplements in cancer treatment.

To develop a system to estimate the risk of herb-drug interactions that includes the available evidence from clinical and laboratory studies, transparently delineates the algorithm for the risk estimation, could be used in practice settings and allows for adaptation and update. We systematically searched Drugbank, Transformer, Drug Information Handbook, European and German Pharmacopoeia and MEDLINE for studies on herb-drug interactions of five common medicinal plants (coneflower, ginseng, milk thistle, mistletoe and St. John's wort). A diverse set of data were independently extracted by two researchers and subsequently analysed by a newly developed algorithm. Results are displayed in the form of interaction risk categories. The development of the algorithm was guided by an expert panel consensus process. From 882 publications retrieved by the search, 154 studies were eligible and provided 529 data sets on herbal interactions. The developed algorithm prioritises results from clinical trials over case reports over in vitro investigations and considers type of study, consistency of study results and study outcome for clinical trials as well as identification, permeability, bioavailability, and interaction potency of an identified herbal perpetrator for in vitro investigations. Risk categories were assigned to and dynamically visualised in a colour-coded matrix format. The novel algorithm allows to transparently generate and dynamically display herb-drug interaction risks based on the available evidence from clinical and laboratory pharmacologic studies. It provides health professionals with readily available and easy updatable information about the risk of pharmacokinetic interactions between herbs and oncologic drugs.

Robert D. Kerscher, founder of Lexi-Comp, dies at 69.

Robert D. Kerscher, who founded the company that published Drug Information Handbook, hospital-specific formulary manuals, and an assortment of other point-of-care references, died on November 23, 2017, at the age of 69. His son, Steven Kerscher, said his father had battled prostate cancer for 6

DRUG-DRUG INTERACTIONS (DDIs);

Introduction: Drug-drug interaction refers to an altered or impaired responseof drug as a resultant of the other drug’s activity. However, recently advancement in field oftherapeutics has leaded the therapy toward more rational and logical trend in order to improvethe patients’ health with respect to cost effectiveness. Objective: To assess the various levels ofDDIs in Prescriptions at public sector teaching hospital of Hyderabad, Pakistan. Study Designand Settings/Methodology: A descriptive observational questionnaire based study has beenconducted by collecting initially 250 random prescriptions of various patients prescribed withmultiple drugs. Tertiary care hospital OPD and In-patient wards were visited for a period of06 months. The Prescriptions (℞) so collected were analyzed and assessed individually fordrug interactions using Standard drug interaction software i.e.. Lexi-comp’s Lexi-Interact, DrugInformation Handbook, Hansten and Horn’s drug interactions. Results: For this study, a total 250Prescriptions were collected. It was observed that 30 (12%) prescriptions contained with singlemedication, 10 (4%) prescriptions were unreadable, 210 (84%) prescriptions were containedmore than one medication. Moreover, 210 (84%) poly-pharmacy prescriptions focused keenly.Subsequently, 51 (24%) prescriptions ensured the prevalence of DDIs and 159 (76%) were Non-DDIs prescriptions. Similarly, 13 ℞ contained four or more than four drugs, 32 ℞ contained threedrugs and 06 prescriptions contained two drugs correspondingly. Conclusion: It was clearlyconcluded that the most potential reason of DDIs are Poly pharmacy. So it is of utmost needto enhance the health care policies in overall healthcare system in order to antagonize DDIsassociated morbidity and mortality among society.

English

Introduction: Drug-drug interaction refers to an altered or impaired responseof drug as a resultant of the other drug’s activity. However, recently advancement in field oftherapeutics has leaded the therapy toward more rational and logical trend in order to improvethe patients’ health with respect to cost effectiveness. Objective: To assess the various levels ofDDIs in Prescriptions at public sector teaching hospital of Hyderabad, Pakistan. Study Designand Settings/Methodology: A descriptive observational questionnaire based study has beenconducted by collecting initially 250 random prescriptions of various patients prescribed withmultiple drugs. Tertiary care hospital OPD and In-patient wards were visited for a period of06 months. The Prescriptions (℞) so collected were analyzed and assessed individually fordrug interactions using Standard drug interaction software i.e.. Lexi-comp’s Lexi-Interact, DrugInformation Handbook, Hansten and Horn’s drug interactions. Results: For this study, a total 250Prescriptions were collected. It was observed that 30 (12%) prescriptions contained with singlemedication, 10 (4%) prescriptions were unreadable, 210 (84%) prescriptions were containedmore than one medication. Moreover, 210 (84%) poly-pharmacy prescriptions focused keenly.Subsequently, 51 (24%) prescriptions ensured the prevalence of DDIs and 159 (76%) were Non-DDIs prescriptions. Similarly, 13 ℞ contained four or more than four drugs, 32 ℞ contained threedrugs and 06 prescriptions contained two drugs correspondingly. Conclusion: It was clearlyconcluded that the most potential reason of DDIs are Poly pharmacy. So it is of utmost needto enhance the health care policies in overall healthcare system in order to antagonize DDIsassociated morbidity and mortality among society.

Prevalence and predictors of antibiotic prescription errors in an emergency department, Central Saudi Arabia.

BackgroundInappropriate antibiotic (ATB) prescriptions are a threat to patients, leading to adverse drug reactions, bacterial resistance, and subsequently, elevated hospital costs. Our aim was to evaluate ATB prescriptions in an emergency department of a tertiary care facility.MethodsA cross-sectional study was conducted by reviewing charts of patients complaining of infections. Patient characteristics (age, sex, weight, allergy, infection type) and prescription characteristics (class, dose, frequency, duration) were evaluated for appropriateness based on the AHFS Drug Information and the Drug Information Handbook. Descriptive and analytic statistics were applied.ResultsSample with equal sex distribution constituted of 5,752 cases: adults (≥15 years) =61% and pediatrics (<15 years) =39%. Around 55% complained of respiratory tract infections, 25% urinary tract infections (UTIs), and 20% others. Broad-spectrum coverage ATBs were prescribed for 76% of the cases. Before the prescription, 82% of pediatrics had their weight taken, while 18% had their weight estimated. Allergy checking was done in 8% only. Prevalence of inappropriate ATB prescriptions with at least one type of error was 46.2% (pediatrics =58% and adults =39%). Errors were in ATB selection (2%), dosage (22%), frequency (4%), and duration (29%). Dosage and duration errors were significantly predominant among pediatrics (P<0.001 and P<0.0001, respectively). Selection error was higher among adults (P=0.001). Age stratification and binary logistic regression were applied. Significant predictors of inappropriate prescriptions were associated with: 1) cephalosporin prescriptions (adults: P<0.001, adjusted odds ratio [adj OR] =3.31) (pediatrics: P<0.001, adj OR =4.12) compared to penicillin; 2) UTIs (adults: P<0.001, adj OR =2.78) (pediatrics: P=0.039, adj OR =0.73) compared to respiratory tract infections; 3) obtaining weight for pediatrics before the prescription of ATB (P<0.001, adj OR =1.83) compared to those whose weight was estimated; and 4) broad-spectrum ATBs in adults (P=0.002, adj OR =0.67).ConclusionPrevalence of ATB prescription errors in this emergency department was generally high and was particularly common with cephalosporin, narrow-spectrum ATBs, and UTI infections.

Sources of Information Used When Prescribing for Children, a Survey of Hospital Based Pediatricians

Due to the lack of properly tested medicines for children, there is little available information with regards to indications and dosing of medications in children. To collect data on sources where hospital based pediatricians obtain prescribing information when treating children and the extent of collaboration with the hospital pharmacist. Two hundred and fifty pediatricians in different hospitals within different cities in Jordan were asked to fill in a structured questionnaire regarding information sources used when prescribing for children. Questionnaires were collected from 162 (64.8%) hospital based pediatricians, who have completed the questionnaire by the designated date. Most (75.5%) reported that the Lexi Comp's Drug Information Handbook was the source that they most frequently used for drug information when prescribing for in children. The BNF and the BNFc (British National Formulary for children) were found to be the most sources that contain sufficient information that aids pediatricians when prescribing for children. A minority (22%) claimed to consult with the hospital pharmacist when they face difficulties when prescribing for children. Pediatricians rely on different information sources when they prescribe for children. Those sources vary in their reliability in aiding pediatrician when prescribing. Further work should be done in the provision of useful information on pediatric drug therapy to pediatricians. More steps should be taking place to activate collaboration and interaction between pediatricians and pharmacists as well.

Book Review: Drug Information Handbook: A Comprehensive Resource for All Clinicians and Healthcare Professionals, 22nd Edition

Book Review: Drug Information Handbook: A Comprehensive Resource for All Clinicians and Healthcare Professionals, 22nd Edition

EVALUASI PENGGUNAAN OBAT ANTI HIPERTENSI PADA PASIEN GAGAL GINJAL KRONIK YANG MENJALANI HEMODIALISIS

The intervention led to various complications in dialysis patients include hypertension intradialitik as a result of hemodynamic changes.The phenomenon of the paradox of which caused activation of endogenous vasopresor due to changes in volume status and antihypertensive medication terdialisisnya factor. This study aims to determine patterns of use of antihypertensive drugs, evaluating the rationality and side effects of antihypertensive drugs based on literarur. This study was performed with the patient’s condition based on the observation of patients to see medical records drug data, laboratory data of patients and patient’s condition.Retrospective study of hemodialysis patients in the hospital PKU Muhammadiyah Yogyakarta year period from 2009 to 2010. Patients according to inclusion criteria, anti-hypertensive drug receipts and complete medical record data. Evaluation of rationality involves the use of antihypertensive drugs right dose, right patient and side effects based on the Drug Information Hand Book 2005, Handbook of Clinical Drug Data, 2002. The study found 60 patients who fit the inclusion criteria. Based on the research patterns of use of antihypertensive drugs in patients with hemodialysis is captoril, furosemide, nifedipine, lisinopril, amlodipine, valsatran and clonidin. Evaluation rationality inappropriate use of drugs dose use of captopril 11 patients of 34 patients and furosemide 18 patients from 52 patients, inappropriate use of captopril patients was 9 patients of 34 patients.Side effects that occur in patients with hypokalemia due to the use of furosemide is 40 patients, cough due to captopril was 13 patients, side effects of nifedipine gastrointestinal disorders cough and 11 patients, 5 patients cough lisinopril. Conclusion:he use of antihypertensive medications in hemodialysis patientsat RSU PKU Muhammadiyah Yogyakarta is rational.