Download Whiplash Rove Beetle Dermatitis Among Students at University

International Journal of Pharmacy Teaching & Practices 2013, Vol.4, Issue 2, supplement II, 666-669.
A Prospective Descriptive Study on the Drug Classification and Medication History
from Tuberculosis Children Outpatients in Dr. M. Djamil Hospital, Padang-Indonesia
*
Dian Ayu Juwita*, Helmi Arifin*, Finny Fitri Yani**, Deswinar Darwin*
Faculty of Pharmacy, University of Andalas, ** Faculty of Medicine, University of Andalas
Introduction
Case Series
*
*
Please cite this paper as: Dian Ayu Juwita , Helmi Arifin , Finny Fitri
**
*
Yani , Deswinar Darwin . A Prospective Descriptive Study on the
Drug Classification and Medication History from Tuberculosis Children
Outpatients in Dr. M. Djamil Hospital, Padang-Indonesia. IJPTP, 2013,
4(2), supplement II, 666-669.
Corresponding Author:
Dian Ayu Juwita
Faculty of Pharmacy, University of Andalas,
Kampus Limau Manis, Padang 25163
Tel 0751-71682
Fax 0751-777057
Email: [email protected]
Abstract
To investigate and analyze the drugs classification, phase of
therapy, and medication history from children outpatients of
tuberculosis. The study was conducted by the method of
prospective and analyzed descriptively on a limited population
for 4 months. Over 57 patients observed, the percentages of
patient in each phase of therapy were 42.1% for intensive
phase and 57.9% for extended phase of therapy. The
identification of drugs that were used reveals that isoniazid
was used in 44.31% of patients; rifampicin in 43.41%,
pyrazinamide in 11.07% and ethambutol in 1.19% of patients.
Anti-tuberculosis drugs were used in single medication in 0%;
two-drug combination in 56.1%; and three-drug combination
in 43.8% of patients. The medication history taking showed
that 98.25% of the cases were new cases; 0% was relapse case;
1.75% was drug withdrawal case; and 0% was medication
failed case. TB treatment in children outpatient in DR. M.
Djamil Hospital Padang has in accordance with standard
children’s TB therapy is using a combination of antituberculosis drugs are tailored to the patient phase of therapy.
Anti-Tuberculosis drugs most commonly used are Isoniazid,
rifampicin and pyrazinamide, where everything is a first-line
anti-TB drugs.
Keywords: tuberculosis children outpatient, anti-tuberculosis
drugs, anti-TB drugs classification, medication history, phase of
therapy
Acute Tuberculosis (TB) has been the leading cause
of death for infectious disease in children and adults
(1,2,3)
. In Indonesia, tuberculosis is a primary health
problem in terms of mortality, morbidity, diagnosis
(3)
and treatment . Indonesia ranks third among TB
high-burden countries after India and China with
approximately
539,000
new
cases
and
(2)
approximately 101,000 deaths per year . Around
10-15% of all cases occur in children aged < 15 years
(3,4)
.
Increased number of tuberculosis incidence in
various places is thought to be triggered by several
causes including: improper diagnosis, inadequate
treatment, unsuccessful prevention programs, the
infection of HIV/AIDS, drug resistance, increased
(3,5)
poverty, and inadequate health services .
Children’s Tuberculosis is a problem that cannot be
ignored, because it is a systemic disease that can
affect almost any organ, causing malnutrition and
disturbance in daily activities. Severe TB can lead to
lung and other organ defects. Without proper
diagnosis and management, TB is most likely to
cause a high mortality rate and the infected children
(6,7)
can be the source of future infection .
The management of TB in children is a unity
between the provision of medical intervention,
nutritional management and treatment of
(2)
. In contrast to adults, Anticomorbidities
tuberculosis drugs (Anti-TB Drugs) in children are
not given two or three times a week but given every
day, so children need to be given extra attention
both on the intensive phase and the extended phase
because they cannot regulate their own treatment,
(3,8)
.
and improper treatment can cause resistance
The treatment should be based on a rational and
appropriate therapy to the treatment phase as well
as the patient's medical history in order to achieve
optimal clinical objectives. The use of drug can be
stated rational if the drug is used as indicated,
considers the patient's condition, appropriate drug
selection, consider the benefits and risks for the
(9,10)
.
patients
The present study was conducted to determine the
type and combination of anti-tuberculosis drugs
used in the DR. M. Djamil Hospital Padang, the
phase of treatment and to take the patient
666
International Journal of Pharmacy Teaching & Practices 2013, Vol.4, Issue 2, supplement II, 666-669.
medication history. This study is expected to be be a reference
data to prevent and minimize the problems that occur in
children as well as improving the success of TB treatment in
children.
Material and Methods
The study was conducted prospectively and analyzed with
descriptive method. The study population included all children
outpatients diagnosed with TB who were in the treatment at
the DR. M. Djamil Hospital Padang from April to July 2010.
Data sources were medical records of pediatric patients
undergoing TB treatment, medical records and laboratory test
results. The collected data were then transferred to the data
collection sheet and analyzed descriptively which included
phase of therapy, type of drug, drug combinations and
medication history.
Results and Findings
Table 1. Observations in pediatric patients with the diagnosis
of tuberculosis
Observation
Quantity
Percentage
Characteristics
(%)
Phase of therapy
a. Intensive phase
24
42.1
therapy
33
57.9
b. Extended phase
therapy
Type of Anti-TB Drugs
A. First-line Drugs
a. Isoniazid
148
44.31
b. Rifampicin
145
43.41
c. Pyrazinamide
37
11.07
d. Ethambutol
4
1.19
B. Second-line Drugs
0
0
Drugs combination
a. Single medication
0
0
b. Two-drug
25
56.1
combination
32
43.8
c. Three-drug
combination
The medication history
a. New cases
56
98.25
b. Relapse case
0
0
c. Drug withdrawal
1
1.75
case
0
0
d. Medication failed
case
Discussion and Conclusion
From 216 pediatric patients who visited the DR. M. Djamil
Hospital Padang during April to July 2010, 57 of them were
diagnosed with tuberculosis and receiving anti-TB drug
therapy.
The survey results revealed that TB treatment with drug
combination had been applied to the treatment of
Tuberculosis children outpatient in DR. M. Djamil Hospital
Padang, which can be seen from the absence of patients
treated with a single anti-TB drug. A total of 56.1%
of patients received 2 anti-TB drugs combination,
while 43.8% receive 3 drugs combination. Types and
combinations of drugs used had also been adjusted
based on the patient’s phase therapy. Patients
receiving 2 drugs combination therapy were much
more because 57.9% of the total TB patients
underwent extended phase therapy, whereas 42.1%
of patients were in the intensive phase therapy.
TB treatment is divided into two phases: the
intensive phase (2 months) and the extended phase
(2)
(4 Months) . The principle of treatment using a
combination at least 3 kinds of drugs in the intensive
phase, followed by 2 kinds of drugs in the extended
(2,11)
. Provision
phase and given daily for 6-12 months
of a combination of drugs and in the long term than
to kill all the TB germs also to reduce the likelihood
(3)
of recurrence . Intensive phase is useful for
destroying populations of acid-fast bacilli (AFB)
quickly, while the extended phase to eliminate the
(3)
rest of the dormant AFB .
Types of anti-tuberculosis drugs most commonly
used were isoniazid and rifampicin. This is because
both of these drugs are important drugs for treating
all types of tuberculosis, and are used both in
intensive phase and extended phase. Isoniazid and
rifampicin are the most effective drugs, relatively
non-toxic, easily administered, and the price is not
(12,13)
.
expensive
The action of anti-tuberculosis drugs is based on
three mechanisms: the killing activity, sterilizing
activity, and preventing resistance. Isoniazid is the
most potent drug in killing bacteria rather than
rifampicin and streptomycin, and is bactericidal and
very effective against bacteria in a state of active
metabolic (growing bacteria), and is bacteriostatic
(5,12)
.
against dormant germs
Rifampicin and pyrazinamide are the most potent
drugs in sterilizing mechanism. Rifampicin is
bactericidal against the bacteria that directly
penetrates most tissues and phagocytic cells.
Rifampicin can kill organisms that are resistant to
many types of drugs, such as intra-cell organisms
and which are in the abscess cavity and lungs, while
pyrazinamide is active sterilization agent to fight the
remnants of organisms in the cell that can lead to
(12,14)
.
relapse
The least Anti-TB drug prescribed in the treatment
of tuberculosis in Dr. M. Djamil Hospital Padang was
ethambutol, with the percentage of 1.19%. This drug
is not widely used in the treatment of children
tuberculosis
because
ethambutol
is
not
recommended for general use in children as it can
cause neuritis retrobuller which could result in loss
of visual acuity and red-green color blindness. But
the administration of this drug should be considered
in children with severe and drug resistant
667
International Journal of Pharmacy Teaching & Practices 2013, Vol.4, Issue 2, supplement II, 666-669.
tuberculosis if other drugs are not available or cannot be used
(13,15)
.
The entire prescribed drugs were first-line anti-TB drugs and
there was no indication for the administration of second-line
drugs. The second-line anti-TB drugs include streptomycin (S),
Para-amino salicylic acid (PAS), ethionamide, ofloxacin,
levofloxacin, ciprofloxacin, kanamycin, etc. First-line drugs are
better in efficacy and safety rather than second-line drugs.
With these drugs, the tuberculosis patient can be cured.
Second-line drugs are considered to use if the resistance arises
with the first-line drugs, hence those drugs are replaced with
at least 2-3 second-line drugs which are known to remain
potential, so the patient received 5 or 6 drugs at once.
However, second-line drugs have not been approved for use in
children regarding the low efficacy and the risk of toxicity in
(2,12,13,16)
.
children
A total of 56 cases out of 57 cases of TB occurred in Dr. M.
Djamil Hospital Padang were new cases. In which the patients
have not been treated with anti-TB drugs or have been
prescribed the drugs for less than one month (30 days). While
one patient was drug withdrawal case (treatment after dropout/default), in which the treatment of patients who had at
least 1 month of treatment and stopped for 2 months or more
then come back for treatment. After interviewing the parents,
it was known that the patient experienced drug withdrawal
since 4 months before, because the parents went out of town
so that no one gave anti-TB drugs to the patient. This problem
is likely to happen due to less education for families about TB
and its management. Patients and parents do not know about
the long-term TB treatment, regular, and should not be
interrupted, and do not aware of the potential risk of breaking
the rule. Therefore it is strongly recommended to educate the
patients and parents on the significance of completing the
treatment to the end in order to avoid resistance and prevent
recurrence. Once the resistance happens, the treatment will
(3,17)
.
be more difficult and require longer time
This study concludes the following:
1. TB treatment on children outpatients in DR. M. Djamil
Hospital Padang was in accordance with standard children’s TB
therapy in which the combination of anti-tuberculosis drugs
are adjusted based on the phase of the therapy.
2. Anti-Tuberculosis drugs most commonly used were
isoniazid, rifampicin and pyrazinamide, that are all included in
first-line anti-TB drugs.
3. From the patient's medication history, it was still found the
children TB patient experiencing drug withdrawal.
References
1. Salazar, G.E., Schmitz, T.L., Cama, R., Sheen, P., Franchi, L.M.,
centeno, G., Valera, C., Leyva, M., Montenegro-James, S.,
Oberhelman, R., Gilman, R.H., Thompson, M.J. & the working
group on TB in Peru., 2001. Pulmonary Tuberculosis in Children
in a Developing Country. Pediatrics, 108(2), h.448-6
2. Departemen Kesehatan Republik Indonesia. 2006, Pedoman
Nasional Penanggulangan Tuberkulosis, Edisi 2, Cetakan ke-1.
Jakarta: Departemen Kesehatan Republik Indonesia.
3. Rahajoe, N.N., Basir, D., Makmuri, M.S.,
Kartasasmita, C.B., 2008. Pedoman Nasional
Tuberkulosis Anak. Edisi ke-2 dengan Revisi. UKK
Respirologi PP Ikatan Dokter Anak Indonesia.
Jakarta.
4. Kruk, A., Gie, R.P., Schaaf, S. & Marais, B.J., 2008.
Symptom-Based Screening of Child Tuberculosis
Contacts: Improved Feasibility in Resource-Limited
Settings. Pediatrics, 121, h.1646-7.
5. Departemen Kesehatan Republik Indonesia. 2005.
Pharmaceutical Care Untuk Tuberculosis, Direktorat
Bina Farmasi Komunitas Klinik. Jakarta.
6. Miller FJW. 1982. Tuberculosis in children.
Evolution, epidemiology, treatment, prevention.
Edinburgh : Churcill-Livingstone.
7. Chauhan, L.S., Arora, V.K., 2004. Formulation of
guidelines for diagnosis and treatment of pediatric
TB cases under RNTCP. Indian J Tuberc, 51, h.102-4.
8. Basir, D., 2002. Upaya penanggulangan dan peran
serta masyarakat terhadap masalah tuberkulosis
pada anak. Pidato Pengukuhan sebagai Guru Besar
Tetap dalam Ilmu Kesehatan Anak pada Fakultas
Kedokteran Universitas Andalas Padang.
9. Aslam M., Tan C.K., Prayitno A., 2000, Farmasi
Klinis : Menuju Pengobatan Rasional dan
Penghargaan Pilihan Pasien. Penerbit PT Elex Media
Komputindo Kelompok Gramedia. Jakarta.
10. Trisna Yulia., 2004., Idealisme Farmasis Klinik di
Rumah Sakit. Pengantar Farmasi Klinik. Jakarta.
11. Sunarjo, D., 2007, Tuberkulosis Pada Anak
(Diagnosis dan Tatalaksana), SMF Anak BRSD RAA,
Soewondo Pati. http://www.google.com.diakses
Januari 2010.
12. Katzung BG., 2004. Farmakologi Dasar dan Klinik.
Edisi 8. Bagian Farmakologi Fakultas Kedokteran
Universitas Airlangga. Penerbit Salemba Medika.
Surabaya.
13. Munoz, F.M. & Starke, J.R., 2004. Tuberculosis
(Mycobacterium Tuberculosis). Dalam : R.E.
Behrman, R.M. Kliegman, H.B. Jenson, penyunting.
Nelson Textbook of Pediatrics. Edisi ke-17.
Philadelphia : Saunders.
14. Gunawan, S.G., 2007. Farmakologi dan Terapi,
Edisi ke-5, Departemen Farmakologi dan Terapeutik
Fakultas Kedokteran Universitas Indonesia. Gaya
Baru. Jakarta.
15. Rahajoe, N.N., Supriyatno, B., Setyanto, D.B.,
2010. Buku Ajar Respirologi Anak. Edisi Pertama.
Badan Penerbit IDAI. Jakarta.
16. Muchtar, A., 2006. Farmakologi Obat Anti
Tuberculosis
(OAT)
Sekunder.
Departemen
Farmakologi dan Terapeutik FKUI/Departemen
Farmakologi Klinik RSCM, Jurnal Tuberkulosis
Indonesia, 3(2), h.23-29.
17. Drobac, P.C., Mukherjee, J.S., Joseph, J.K.,
Mitnick, C., Furin, J.J., Castillo, H.D., Shin, S.S. &
Becerra, M.C., 2006. Community-Based Therapy for
668
International Journal of Pharmacy Teaching & Practices 2013, Vol.4, Issue 2, supplement II, 666-669.
Children With Multidrug-Resistant Tuberculosis. Pediatrics,
117, h.2022-8.
AUTHORS’ CONTRIBUTIONS
Authors contributed equally to all aspects of the study.
PEER REVIEW
Not commissioned; externally peer reviewed.
CONFLICTS OF INTEREST
The authors declare that they have no competing interests.
669