Kajian penggunaan obat kisaran terapi sempit (Gentamisin dan Aminofilin Intravena) di Rumah Sakit Panti rapih Yogyakarta periode Januari-Juni 2005

RISDYASTUTI, Adria Anindyasita, dr. Iwan Dwiprahasto, M.Med.Sc.,Ph.D

2006 | Tesis | S2 Ilmu Farmasi (Magister Farmasi Klinik)

Dalam konsep farmakoterapi, obat dengan kisaran terapi sempit harus digunakan secara hati-hati karena penggunaan secara intravena dapat menghasilkan efek yang lebih cepat. Therapeutic drug monitoring (TDM) direkomendasikan bagi pasien yang menerima obat kisaran terapi sempit. Penelitian ini bertujuan untuk mengkaji penggunaan obat kisaran terapi sempit, yaitu aminofilin dan gentamisin yang diberikan pada pasien rawat inap di Rumah Sakit Panti Rapih Yogyakarta periode Januari – Juni 2005. Penelitian dilakukan menggunakan rancangan cross-sectional dengan melibatkan pasien yang menerima terapi gentamisin dan aminofilin pada periode pengamatan. Pengumpulan data dilakukan secara retrospektif dari rekam medik. Jumlah pasien dewasa sebanyak 146 pasien, terdiri dari 76 pasien gentamisin dan 70 pasien aminofilin. Kelompok gentamisin terdiri atas 67,11% pria dan 32,89% wanita. Perbandingan pria dan wanita di kelompok aminofilin hampir sama, yaitu 55,26% pria dan 44,76% wanita. Diagnosis menunjukkan gentamisin banyak digunakan untuk pasca medikasi operasi appendiks (27,62%) dan fraktur tulang (15,78%). Aminofilin banyak digunakan untuk menangani sesak nafas pada penyakit gangguan paru seperti asma (41,43%). Ketidaktepatan dosis terdapat sebesar 20,69% gentamisin dan 50% aminofilin. Potensi interaksi secara teoritis ditemukan pada gentamisin-ceftriaxon (31,58%) dan aminofilin-dexametason (35,71%). Length of stay (LOS) pasien gentamisin adalah 6–8 hari (36,84%) dengan penggunaan gentamisin 5 hari (22,37%). Pasien aminofilin memiliki LOS 3–5 hari (54,29%) dengan penggunaan aminofilin 3 hari (32,86%). Data lab yang dimonitor dalam penggunaan gentamisin adalah fungsi ginjal (86,84%) dan hati (73,68%), sedangkan untuk aminofilin berupa pemeriksaan thorax paru (90%), elektrokardiogram (81,43%) serta fungsi hati (85,71%). Faktor yang mendasari kemungkinan switch therapy adalah penggantian sediaan/jenis obat sebesar 28,95% (gentamisin) dan 57,14% (aminofilin). Adapun respon klinis sembuh untuk pasien gentamisin 78,95% dan aminofilin 92,86%. Penelitian menunjukkan bahwa, pada kasus tertentu, TDM perlu dilakukan. Therapeutic drug monitoring penting untuk memastikan bahwa penggunaan obat berada dalam batas yang aman. Dosis, efek samping dan interaksi obat adalah hal-hal yang juga perlu diperhatikan dalam penggunaan obat kisaran terapi sempit.

In pharmacotherapy, narrow therapeutic margins drugs must be used carefully because the use of these drugs intravenously may exert a faster effect. Therapeutic drug monitoring (TDM) is therefore recommended for patients receiving these drugs. The purpose of this study is to evaluate the use of narrow therapeutic drugs such as aminophylline and gentamicin in patients hospitalized at Panti Rapih Hospital Yogyakarta from January – June 2005 period. The study was conducted using cross-sectional design and involving patients who received gentamicin or aminophylline during the study period. Data were collected retrospectively from medical record. Out of 146 patients involved in the study, 76 received gentamicin and 70 received aminophylline. In the gentamicin group, 67,11% were men and 32,89% were women. In the aminophylline group, the proportion of male and female patients were almost similar, i.e. 55,26% and 44,76% respectively. With regard to the diagnosis gentamicin was mostly used for post operative appendicitis (27,62%) and post operative bone fracture (15,78%). Aminophylline was mostly used to treat suffocation due to lung disease such as asthma (41,43%). The study showed that inapropriate dose was detected in 20,69% patients who received gentamicin and 50% patients who received aminophylline. A potential drug interaction were found in the use of gentamicin-cephtriaxone (31,58%) and aminophylline-dexamethasone (35,71%). Length of stay (LOS) for gentamicin patients was 6-8 days (36,84%) with gentamicin duration of 5 days (22,37%). Length of stay for aminophylline patients is 3-5 days (54,29%) with aminophylline duration of 3 days (32,68%). Laboratory data being monitored in the use of gentamicin are kidney (86,84%) and liver (73,68%) function. For aminophylline, examination of lung thorax (90%), electrocardiogram (81,43%), as well as liver function (85,71%) is done. The most factor based for switch therapy is change of drug forms/kinds as much as 28,95% (gentamicin) and 57,14% (aminophylline). While the cured clinical response is 78,95% gentamicin and 92,86% aminophylline patients. This research shows that for some cases TDM is needed. Therapeutic drug monitoring needs to be done to ensure that the use of these drugs are really within safe boundaries. Dose, side effects, drug interactions also needs to be monitored in the use of narrow therapeutic drugs.

Kata Kunci : Farmakoterapi,Obat Kisaran terapi Sempit,TDM, narrow therapeutic drugs, gentamicin, aminophylline, drug use evaluation