Evaluasi Kesesuaian Dosis dan Clinical Outcome Amikasin dan Gentamisin di Picu (Pediatric Intensive Care Unit) RSUP Dr. Sardjito Yogyakarta

https://doi.org/10.22146/farmaseutik.v1i1.59233

Novrilia Atika Nabila(1), Ika Puspitasari(2*), Ida Safitri Laksanawati(3)

(1) 1. Mahasiswa Magister Farmasi Klinik, Fakultas Farmasi Universitas Gadjah Mada, Yogyakarta, Indonesia
(2) Faculty of Pharmacy, Universitas Gadjah Mada
(3) 3. Divisi Infeksi Dan Penyakit Tropis, Departemen Ilmu Kesehatan Anak, Fakultas Kedokteran UGM/RSUP Dr. Sardjito, Yogyakarta, Indonesia
(*) Corresponding Author

Abstract


Pemakaian amikasin dan  gentamisin yang memiliki kisaran terapi sempit perlu dilakukan monitoring terapi. Monitoring terapi dilakukan melalui tinjauan secara farmakokinetika dengan menghitung estimasi kadar. Penelitian ini bertujuan untuk melihat estimasi kadar amikasin dan gentamisin pada pasien PICU (Pediatric Intensive Care Unit) dan mengetahui hubungannya terhadap outcome klinis pasien serta kejadian nefrotoksisitas. Penelitian ini merupakan penelitian observational dengan desain cross sectional. Subjek penelitian ini adalah pasien pediatrik yang di rawat di PICU RSUP Dr. Sardjito Yogyakarta periode 2017 – 2019. Jumlah pasien yang memenuhi kriteria inklusi dan eksklusi sebanyak 54 pasien. Hasil estimasi kadar diamati berdasarkan 2 parameter PK-PD yaitu kesesuaian rasio Cmax/MIC dan Cmin>MIC. Hasil dari penelitian ini menunjukkan pada penggunaan amikasin mencapai target rasio Cmax/MIC 17 (74%), dan Cmin > MIC yaitu 3 (13%) pasien. Pada penggunaan gentamisin mencapai target rasio Cmax/MIC 16 (46%), Cmin > MIC yaitu 7 (20%) pasien. Hasil analisis dengan uji Fisher menunjukkan tidak terdapat hubungan yang signifikan kedua parameter tersebut terhadap outcome klinis dengan nilai p > 0.05. Kesesuaian estimasi kadar tidak berpengaruh secara signifikan terhadap kejadian nefrotoksisitas. Tanda-tanda nefrotoksisitas terdapat pada 3 pasien (6%).


Keywords


Estimasi Kadar; Amikasin dan Gentamisin; Pasien PICU; Outcome Klinis; Nefrotoksisitas

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References

Ahmed, S., Wilcox, M.H., Kirby, A., 2020. Measuring outcomes in complicated intra-abdominal infections. Curr. Opin. Gastroenterol. 36, 1–4. https://doi.org/10.1097/MOG.0000000000000591

Aliska, G., Setiabudy, R., Karuniawati, A., Sedono, R., Dewi, T.U., Azwar, M.K., 2017. Optimal Amikacin Levels for Patients with Sepsis in Intensive Care Unit of Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Acta Med Indones 10.

Alqarni, A., Kantor, E., Grall, N., Tanaka, S., Zappella, N., Godement, M., Ribeiro-Parenti, L., Tran-Dinh, A., Montravers, P., 2018. Clinical characteristics and prognosis of bacteraemia during postoperative intra-abdominal infections. Crit. Care 22. https://doi.org/10.1186/s13054-018-2099-5

Arshad, A., Rehman, S., Zaka, M., Tahir Mahmood, K., 2011. Rational Use of Amikacin in Children. J. Pharm. Sci. Res. 3.

Bauer, L., 2008. Applied Clinical Pharmacokinetics. McGraw-Hill Education.

Best, E.J., Gazarian, M., Cohn, R., Wilkinson, M., Palasanthiran, P., 2011. Once-daily gentamicin in infants and children: a prospective cohort study evaluating safety and the role of therapeutic drug monitoring in minimizing toxicity. Pediatr. Infect. Dis. J. 30, 827–832. https://doi.org/10.1097/INF.0b013e31821e405d

Burdet, C., Pajot, O., Couffignal, C., Armand-Lefèvre, L., Foucrier, A., Laouénan, C., Wolff, M., Massias, L., Mentré, F., 2015. Population pharmacokinetics of single-dose amikacin in critically ill patients with suspected ventilator-associated pneumonia. Eur. J. Clin. Pharmacol. 71, 75–83. https://doi.org/10.1007/s00228-014-1766-y

Brunton, L., Lazo, J., Parker, K., 2011. Goodman & Gilman’s The Pharmacological Basis of Therapeutics, Eleventh Edition. McGraw Hill Professional.

Burton, M.E., Schentag, J., 2006. Applied Pharmacokinetics & Pharmacodynamics: Principles of Therapeutic Drug Monitoring, fourth. ed. Lippincott Williams & Wilkins., Philadelphia, PA.

Cobussen, M., Stassen, P.M., Posthouwer, D., van Tiel, F.H., Savelkoul, P.H.M., Havenith, T., Haeseker, M.B., 2019. Improving peak concentrations of a single dose regime of gentamicin in patients with sepsis in the emergency department. PLoS ONE 14. https://doi.org/10.1371/journal.pone.0210012

Dahlan, M.P., 2016. Besar sampel dalam penelitian kedokteran dan kesehatan. Epidemiologi Indonesia, Jakarta.

Djuwarno, E.N., 2014. Hasil Evaluasi Penggunaan Gentamisin Untuk Terapi Pneumonia Pada Pasien Geriatri Rawat Inap Di Rumah Sakit Umum Pusat Dr. Sardjito Yogyakarta. Universitas Gadjah Mada.

Duszynska, W., Taccone, F.S., Hurkacz, M., Kowalska-Krochmal, B., Wiela-Hojeńska, A., Kübler, A., 2013. Therapeutic drug monitoring of amikacin in septic patients. Crit. Care Lond. Engl. 17, R165. https://doi.org/10.1186/cc12844

El Halal, M.G. dos S., Barbieri, E., Filho, R.M., Trotta, E. de A., Carvalho, P.R.A., 2012. Admission source and mortality in a pediatric intensive care unit. Indian J. Crit. Care Med. Peer-Rev. Off. Publ. Indian Soc. Crit. Care Med. 16, 81–86. https://doi.org/10.4103/0972-5229.99114

Engler, D., Schellack, N., Naude, A., Gous, A.G.S., 2013. Use of amikacin in neonates and related ototoxicity. Prof. Nurs. Today 17, 24–27.

Fukuoka, N., Aibiki, M., 2008. Recommended dose of arbekacin, an aminoglycoside against methicillin-resistant Staphylococcus aureus, does not achieve desired serum concentration in critically ill patients with lowered creatinine clearance. J. Clin. Pharm. Ther. 33, 521–527. https://doi.org/10.1111/j.1365-2710.2008.00947.x

Johnson, A.-W.B.R., Osinusi, K., Aderele, W.I., Gbadero, D.A., Olaleye, O.D., Adeyemi-Doro, F.A.B., 2008. Etiologic agents and outcome determinants of community-acquired pneumonia in urban children: a hospital-based study. J. Natl. Med. Assoc. 100, 370–385. https://doi.org/10.1016/s0027-9684(15)31269-4

Kang, J.S., Lee, M.H., 2009. Overview of therapeutic drug monitoring. Korean J. Intern. Med. 24, 1–10. https://doi.org/10.3904/kjim.2009.24.1.1

Katarnida, S.S., Karyanti, M.R., Oman, D.M., Katar, Y., 2016. Pola Sensitifitas Bakteri dan Penggunaan Antibiotik. Sari Pediatri 15, 122–6. https://doi.org/10.14238/sp15.2.2013.122-6

Katzung, B., Masters, S., Trevor, A., 2009. Basic and Clinical Pharmacology, 11th Edition. Mcgraw-hill.

Kaur, G., Vinayak, N., Mittal, K., Kaushik, J.S., Aamir, M., 2014. Clinical outcome and predictors of mortality in children with sepsis, severe sepsis, and septic shock from Rohtak, Haryana: A prospective observational study. Indian J. Crit. Care Med. Peer-Rev. Off. Publ. Indian Soc. Crit. Care Med. 18, 437–441. https://doi.org/10.4103/0972-5229.136072

Kiel, Patrick J, Lo, M., Stockwell, D., Patel, G.P., 2008. An Evaluation of Amikacin Nephrotoxicity in the Hematology/Oncology Population: Am. J. Ther. 15, 131–136. https://doi.org/10.1097/MJT.0b013e31815adfde

Kitano, Y., Wakatake, H., Saito, H., Tsutsumi, K., Yoshida, H., Yoshida, M., Takita, M., Yoshida, T., Masui, Y., Taira, Y., Fujitani, S., 2020. Clinical outcomes of urinary tract infection caused by extended spectrum beta-lactamase producing Enterobacteriaceae: a retrospective observational study comparing patients with and without systemic inflammatory response syndrome. Acute Med. Surg. 7, e472. https://doi.org/10.1002/ams2.472

Kramer, A.A., Zimmerman, J.E., 2011. The relationship between hospital and intensive care unit length of stay. Crit. Care Med. 39, 1015–1022. https://doi.org/10.1097/CCM.0b013e31820eabab

Lexicomp, 2018. Drug Information Handbook: A Clinically Relevant Resource for All Healthcare Professionals. Wolters Kluwer.

Lopez-Novoa, J.M., Quiros, Y., Vicente, L., Morales, A.I., Lopez-Hernandez, F.J., 2011. New insights into the mechanism of aminoglycoside nephrotoxicity: an integrative point of view. Kidney Int. 79, 33–45. https://doi.org/10.1038/ki.2010.337

Mahmoudi, L., Mohammadpour, A.H., Ahmadi, A., Niknam, R., Mojtahedzadeh, M., 2013. Influence of sepsis on higher daily dose of amikacin pharmacokinetics in critically ill patients. Eur. Rev. Med. Pharmacol. Sci. 17, 285–291.

Mareville, J., Gay, J., Cliquennois, E., Herbaux, C., Pasquier, F., Allorge, D., Blondiaux, N., Berthon, C., Alfandari, S., 2012. Therapeutic drug monitoring of aminoglycosides in acute myeloid leukaemia patients. Scand. J. Infect. Dis. 44, 398–401. https://doi.org/10.3109/00365548.2011.645868

Maulida, M., Prof. Dr. M. Kuswandi, S., Ratna Yuliani, M.B.S., 2016. Pola Resistensi Bakteri Terhadap Antibiotik Pada Penderita Sepsis Bayi Di Ruang Picu Dan Nicu RSUP Dr. Soeradji Tirtonegoro Klaten Periode Agustus 2013-Agustus 2015 (s1). Universitas Muhammadiyah Surakarta. http://eprints.ums.ac.id/43323/10/LAMPIRAN.pdf

Nangalu, R., Pooni, P.A., Bhargav, S., Bains, H.S., 2016. Impact of malnutrition on pediatric risk of mortality score and outcome in Pediatric Intensive Care Unit. Indian J. Crit. Care Med. Peer-Rev. Off. Publ. Indian Soc. Crit. Care Med. 20, 385–390. https://doi.org/10.4103/0972-5229.186218

Picard, W., Bazin, F., Clouzeau, B., Bui, H.-N., Soulat, M., Guilhon, E., Vargas, F., Hilbert, G., Bouchet, S., Gruson, D., Moore, N., Boyer, A., 2014. Propensity-Based Study of Aminoglycoside Nephrotoxicity in Patients with Severe Sepsis or Septic Shock. Antimicrob. Agents Chemother. 58, 7468–7474. https://doi.org/10.1128/AAC.03750-14

Pollack, M.M., Holubkov, R., Reeder, R., Dean, J.M., Meert, K.L., Berg, R.A., Newth, C.J.L., Berger, J.T., Harrison, R.E., Carcillo, J., Dalton, H., Wessel, D.L., Jenkins, T.L., Tamburro, R., 2018. Pediatric Intensive Care Unit (PICU) Length of Stay: Factors Associated with Bed Utilization and Development of a Benchmarking Model. Pediatr. Crit. Care Med. J. Soc. Crit. Care Med. World Fed. Pediatr. Intensive Crit. Care Soc. 19, 196–203. https://doi.org/10.1097/PCC.0000000000001425

Roberts, J.A., Lipman, J., 2006. Antibacterial dosing in intensive care: pharmacokinetics, degree of disease and pharmacodynamics of sepsis. Clin. Pharmacokinet. 45, 755–773. https://doi.org/10.2165/00003088-200645080-00001

Ryoo, S.M., Kang, G.H., Shin, T.G., Hwang, S.Y., Kim, K., Jo, Y.H., Park, Y.S., Choi, S.-H., Yoon, Y.H., Kwon, W.Y., Suh, G.J., Lim, T.H., Han, K.S., Choi, H.S., Chung, S.P., Kim, W.Y., 2018. Clinical outcome comparison of patients with septic shock defined by the new sepsis-3 criteria and by previous criteria. J. Thorac. Dis. 10, 845–853. https://doi.org/10.21037/jtd.2018.01.96

Taccone, F.S., Laterre, P.-F., Spapen, H., Dugernier, T., Delattre, I., Layeux, B., De Backer, D., Wittebole, X., Wallemacq, P., Vincent, J.-L., Jacobs, F., 2010a. Revisiting the loading dose of amikacin for patients with severe sepsis and septic shock. Crit. Care Lond. Engl. 14, R53. https://doi.org/10.1186/cc8945

Tai, D., Dick, P., To, T., Wright, J.G., 2006. Development of pediatric comorbidity prediction model. Arch. Pediatr. Adolesc. Med. 160, 293–299. https://doi.org/10.1001/archpedi.160.3.293

Thakur, K.T., Motta, M., Asemota, A.O., Kirsch, H.L., Benavides, D.R., Schneider, E.B., McArthur, J.C., Geocadin, R.G., Venkatesan, A., 2013. Predictors of outcome in acute encephalitis. Neurology 81, 793–800. https://doi.org/10.1212/WNL.0b013e3182a2cc6d

Van Eldere, J., 2003. Multicentre surveillance of Pseudomonas aeruginosa susceptibility patterns in nosocomial infections. J. Antimicrob. Chemother. 51, 347–352. https://doi.org/10.1093/jac/dkg102

Winter, M.E., 2004a. Basic Clinical Pharmacokinetics, fourth. ed. Lippincott Williams & Wilkins.



DOI: https://doi.org/10.22146/farmaseutik.v1i1.59233

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