Nun Zairina
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C-REACTIVE PROTEIN (CRP) AS A SUPPORTING MARKER OF ANTIBIOTIC EFFECTIVENESS ON CENTRAL NERVOUS SYSTEM (CNS) INFECTIONS Melawati Olevianingrum; Yulistiani Yulistiani; Darto Saharso; Nun Zairina
Folia Medica Indonesiana Vol. 51 No. 3 (2015): July - September 2015
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (87.093 KB) | DOI: 10.20473/fmi.v51i3.2821

Abstract

Infection of the central nervous system in pediatric patients have a high mortality as well as acute and chronic neurological sequelae. Signs of the disease are unclear, so cerebrospinal fluid (CSF) test is used as a gold standard for diagnosis, but the investigation has faced many obtacles. Empiric antibiotic therapy is the key factor in reducing morbidity and mortality. Microbiological culture result is obtained within 5-7 days. The effectiveness of empirical antibiotic use is questionable. Therefore, other investigations are conducted to determine the effectiveness of antibiotics by using one marker, the CRP. This study was to analyze CRP level in supporting antibiotic therapy effectiveness in pediatric patients with central nervous system (CNS) infections. A prospective cohort study was conducted to determine the relationship of CRP with other parameters, including clinical, microbiological and laboratory, in pediatric patients with central nervous system infections. Patients meeting blood samples criteria were taken before (H0), the third day (H3) and the fifth day (H5) after antibiotics administration. This study involved 10 patients with central nervous system infections (meningoencephalitis, encephalitis and encephalitis with cerebral edema). Six patients were male, with ages less than a year. Antibiotic treatment effectiveness was associated with improved condition of the patients' CRP level. It was 3.558 ±3.196 before (H0), 3.878±2.813 on the third day (H3) and 3.891±2.204 on the fifth day (H5) after antibiotic administration. Leukocyte levels were 13.680±1.660 before (H0), 17.832±7.213 on the third day (H5), and 10.546±3.671 on the fifth day (H5) after antibiotic administration. Pearson's correlation test analysis performed on CRP and WBC parameters showed H0 p=0.981, CRP and WBC H3 p=0.621, while CRP and WBC H5 obtained significance p=0.644. There was no significant correlation observed between CRP and WBC parameters before and after antibiotic administration. In conclusion, there was no correlation of CRP levels with clinical, laboratory and micobiological parameters in patients with central nervous system infections.
ANALYSIS OF ANTIBIOTICS USE IN PEDIATRIC PNEUMONIA PATIENTS AGED 3 MONTHS - 5 YEARS Dhita Evi Aryani; Didik Hasmono; Nun Zairina; Landia Setiawan
Folia Medica Indonesiana Vol. 52 No. 2 (2016): APRIL - JUNE 2016
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (211.198 KB) | DOI: 10.20473/fmi.v52i2.5224

Abstract

Pneumonia is an infectious disease that causes acute inflammation of the lung parenchyma and compaction exudate in the lung tissue. In addition to causing significant morbidity and mortality, pneumonia is also difficult to diagnose, treatments are less precise and less taken seriously. Pneumonia caused the death of 14% of children under five in Indonesia, with a mortality rate of 83 children per day. The difficulty of diagnosis, the selection of a less appropriate antibiotics, side effects, differences in pharmacokinetics and pharmacodynamics of the drug in infants and antibiotics resistance is to be a problem in itself. Therefore it is necessary to study the analysis of the use of antibiotics in patients with pneumonia of children aged 3 months till 5 years. The aim of this research to analyze antibiotics therapy in patients with pneumonia of children aged 3 months till 5 years. Method: an observational cohort analysis was carried out in the Pediatrics Respirology Division Dr. Soetomo Hospital Surabaya. Data was collected from February to May 2014. Patients who met the inclusion criteria were observed prospectively and the quantity and quality of antibiotics usage assessed with Gyssens category. Result: from February to May 2014 period, prospectively, the antibiotics usage quantitative evaluation used DDD/patient days shows that ampicillin 34.39DDD/100 patient days. Qualitative evaluation using Gyssens category on 75 antibiotics therapy shows that 32% considered appropriate. So, this study showed that ampicillin is most widely and qualitative analysis, only 32% of rational use of antibiotics.
METHOTREXATE USE IS SAFE IN CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA Febriansyah Nur Utomo; Yulistiani Yulistiani; Nun Zairina; Bambang Permono
Folia Medica Indonesiana Vol. 53 No. 2 (2017): JUNE 2017
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (261.006 KB) | DOI: 10.20473/fmi.v53i2.6431

Abstract

Monitoring level of methotrexate is not only aimed at monitoring effectiveness, but also safety aspects of the administration of high-dose methotrexate because the use of high-dose methotrexate is one of the problems associated with toxicity in various organs.  In the use of high-dose methotrexate, measurement of methotrexate is important to identify patients with a high risk of toxicity, particularly nephrotoxicity as well as for dosing guidelines for leucovorin therapy. The aim of this study was to analyze the safety of high-dose methotrexate on kidney function during chemotherapy consolidation phase in children with acute lymphoblastic leukemia. This was a longitudinal, observational prospective study conducted to determine the safety profile of high-dose methotrexate on kidney function during chemotherapy consolidation phase in children with acute lymphoblastic leukemia. Patients who met the inclusion criteria were given high-dose methotrexate according to the 2013 Indonesian ALL Chemotherapy Protocol. Measurement of methotrexate level and kidney function was done 3 times on each cycle of chemotherapy consolidation phase. Measurements were made on the 0, 24 and 48 hours after the first drop of high-dose methotrexate. This study had been reviewed by Ethics Committee of Dr. Soetomo Hospital Surabaya. There were 12 patients who met inclusion criteria and 6 patients among them had finished their chemotherapy consolidation phase completely. There was no significant change in kidney function after the administration of high-dose methotrexate compared to baseline (p>0.05) and there was no significant correlation between serum level of methotrexate versus creatinine clearance. In conclusion, methotrexate was safe to use in children with acute lymphoblastic leukemia.