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Background:The appropriate selection of empirical antibiotics based on the pattern of local antibiotic resistance can reduce the mortality rate and increase the rational use of antibiotics.Aims:We analyze the pattern of antibiotic use and the sensitivity patterns of antibiotics to support the rational use of antibiotics in patients with sepsis.Materials and Methods:A retrospective observational study was conducted in adult sepsis patient at one of Indonesian hospital during January-December 2011. Data were collected from the hospital medical record department. Descriptive analysis was used in the processing and interpretation of data.Results:A total of 76 patients were included as research subjects. Lung infection was the highest source of infection. In the 66.3% of clinical specimens that were culture positive for microbes, Klebsiella pneumoniae, Escherichia coli, Staphylococcus hominis were detected with the highest frequency. The six most frequently used antibiotics, levofloxacin, ceftazidime, ciprofloxacin, cefotaxime, ceftriaxone, and erythromycin, showed an average resistance above 50%.Conclusions:The high use of antibiotic with a high level resistance requires a policy to support its rational use. Local microbial pattern based on site infection and pattern of antibiotics sensitivity test can be used as supporting data to optimize appropriateness of empirical antibiotics therapy in sepsis patients.

Abstract.Prostate cancer has become a leading cause of mortality in humans. Previous studies have shown the potential anticancer properties of kaempferol-3-O-rhamnoside in breast cancer cell lines. In the present study, the anticancer potential of kaempferol-3-O-rhamnoside was investigated in LNCaP human prostate cancer cell lines. The inhibition of cell proliferation was investigated using MTT assays, whereas its ability to induce the caspase-cascade pathway was investigated by western blotting. The results showed that kaempferol-3-O-rhamnoside inhibits the proliferation of LNCaP cells in a dose-dependent manner by upregulating the expression of caspase-8, caspase-9, caspase-3 and poly (ADP-ribose) polymerase proteins. Although further studies are required, the results of the present study indicate the potential application of kaempferol-3-O-rhamnoside in cancer treatment. IntroductionCancer has become a significant disease for humans. In the USA alone, there were ~1.6 million new cases and 577,190 predicted mortalities in 2012. Among all types of cancer, prostate cancer is one of the top causes of male cancer fatalities worldwide (1). It is predicted that 233,000 new cases of prostate cancer will occur in America during 2014 (2).Several treatments are available for treatment of prostate cancer, by overcoming the aggressive tumor. These include surgery, radiation, radioactive implants and hormonal therapy. However, the treatment often impacts the quality of life due to side-effects or complications (3). Thus, numerous investigators have focused on discovering novel drugs or treatments. Among all the agents tested, natural products derived from medicinal plants are among the most favorable.In our previous study, kaempferol-3-O-rhamnoside, the major compound found in the ethyl acetate fractions of the Schima wallichii (S. wallichii) Korth. leaves, was isolated and its properties were investigated against breast cancer cell lines. The results indicated that kaempferol-3-O-rhamnoside was favorable for further exploration of its anticancer therapeutic potential (4). Therefore, in the present study the anticancer properties and mechanism of kaempferol-3-O-rhamnoside were investigated in prostate cancer cell lines. Materials and methodsPlant materials. S. wallichii Korth. leaves were collected from Lembang, West Java, Indonesia. The plant species was identified at the Department of Biology, Faculty of Mathematics and Natural Sciences, University of Padjadjaran (West Java, Indonesia).Extraction and isolation. The S. wallichii leaves were dried and extracted with 70% ethanol at room temperature three times for 24 h each. A concentrated extract was obtained in vacuo at 50˚C. The ethanol extract was partitioned into n-hexane, ethyl acetate and aqueous phases. Column chromatography on a Wakogel C 200 (Wako Pure Chemical Industries, Ltd., Osaka, Japan) column was performed to the ethyl acetate fraction, as it was previously reported as the most active fraction against cancer cell lines, using a mixture of n-hexane, ethyl ac...

Non-adherence to anti-tuberculosis (anti-TB) medication is a major risk factor for poor treatment outcomes. We therefore assessed the effectiveness of medication adherence enhancing interventions in TB patients. We report a systematic review of randomized controlled trials that included either latent tuberculosis infection (LTBI) or active TB patients. Outcomes of interest included adherence rate, completed treatment, defaulted treatment and treatment outcomes. We identified four LTBI and ten active TB studies. In active TB patients, directly observed treatment (DOT) by trained community workers, short messaging service combined with education, counselling, monthly TB vouchers, drug box reminders and combinations of those were found effective. In LTBI patients, shorter regimens and DOT effectively improved treatment completion. Interestingly, DOT showed variable effectiveness, highlighting that implementation, population and setting may play important roles. Since non-adherence factors are patient-specific, personalized interventions are required to enhance the impact of a programme to improve medication adherence in TB patients.

Context:Irrational use of antibacterial drugs in Community Health-Care Centers (CHCs) may lead to increased resistance, morbidity, and mortality.Aims:The aim of this study was to determine patterns of antibacterial use at CHCs in a district of Indonesia and use this as data for an antibiotic policy.Settings and Design:The observational-descriptive study was conducted in a district of Indonesia to obtain antibacterial use from 2008 to 2010.Subjects and Methods:The data obtained from the report on the use of medicines were classified and processed using the anatomical therapeutic chemical (ATC) and defined daily doses (DDD) method, with DDD/1000 patients as a unit measurement. The number of patients was obtained from attending patients in that research period. The most abundant antibacterial drugs use segment was identified by the drug utilization 90% (DU90%) method.Statistical Analysis Used:Descriptive analysis were performed in this study.Results:Fourteen kinds of antibacterial drugs were used in 61 CHCs. The total of antibacterial drug use during the period 2008–2010 was 871.36 DDD/1000 patients/day. Declining antibacterial use was observed between 2008 and 2010. Six kinds of antibacterial drugs were the most commonly used. The data show that the average use per visit was as high as 24.41 DDD.Conclusions:Amoxicillin, sulfamethoxazole and trimethoprim are antibacterials that have to be reconsidered by physicians for use in the Bandung CHC. The high use of antibacterial drugs, as described in the study, can be used as reference to develop an antimicrobial stewardship program and increase awareness of resistance, adverse drug reaction and drug interaction of antibacterial drugs.

BACKGROUND: Despite considerable efforts to globally eradicate TB, and the availability of effective antibiotics, TB elimination goals are falling behind. While non-adherence to TB drug regimens may compromise effective treatment, its full impact is still unknown.OBJECTIVE: To determine the clinical and economic impact of non-adherence to TB medication on treatment outcomes in drug-susceptible TB patients (DS-TB).METHODS: A systematic review was performed using PubMed and Embase for studies published between 2009 and 2019 reporting associations between adherence and WHO-defined TB treatment outcomes and economic outcomes in DS-TB patients.RESULTS: A total of 14 studies were included. Eight focused on the association between non-adherence and death, 2 on treatment failure, 1 study on successful treatment outcome, 1 study on both successful and unsuccessful treatment outcomes and 2 on cost outcomes. Most studies (71.4%) were retrospective cohort or case-control studies. The results showed that non-adherence to TB drug regimens was associated with death, treatment failure and lower cure rates.CONCLUSION: Non-adherence to TB drugs has a profound impact on both clinical and economic TB outcomes. To reach WHO TB elimination goals, preventing non-adherence and the implementation of cost-effective intervention programmes should receive the highest priority.

Background Since in low incidence TB countries population migration and complex treatment of drug-resistant tuberculosis (DR-TB) patients are major issues, we aimed to analyse patient risk factors associated with the incidence of poor outcome of TB treatment among DR-TB patients in the Netherlands. Methods This retrospective cohort study included adult patients with confirmed DR-TB treated from 2005 to 2015. We obtained data from a nationwide exhaustive registry of tuberculosis patients in the Netherlands. Predictors for unsuccessful TB treatment (defaulted and failed treatment) and TB-associated mortality were analysed using multivariate logistic regression. Results Among 10,303 registered TB patients, 545 patients with DR-TB were analysed. Six types of DR-TB were identified from the included patients, i.e. isoniazid mono- or poly-resistance (68%); rifampicin mono- or poly-resistance (3.1%); pyrazinamide mono-resistance (8.3%); ethambutol mono-resistance (0.1%); multidrug-resistance (18.9%); and extensively drug-resistance (0.7%). The majority of patients were foreign-born (86%) and newly diagnosed TB (89%) patients. The cumulative incidence of unsuccessful treatment and mortality were 5 and 1%, respectively. Among all DR-TB cases, patients with Multi Drug-Resistant Tuberculosis (MDR-TB) (OR 4.43; 95%CI 1.70–11.60) were more likely to have unsuccessful treatment, while miliary and central nervous system TB (OR 15.60; 95%CI 2.18–111.52) may also be predictors for TB mortality. Additionally, patients with substance abuse and homelessness tend to have unsuccessful treatment. Conclusions In recent years, we identified a low incidence of DR-TB as well as the poor outcome of DR-TB treatment. The majority of cases were primary drug-resistant and foreign-born. To further improve treatment outcome, special attention should be given to the high-risk DR-TB patients. Electronic supplementary material The online version of this article (10.1186/s13756-019-0561-z) contains supplementary material, which is available to authorized users.

Objectives: We reviewed measures used to estimate adherence and persistence to multiple cardiometabolic medications from prescription data, particularly for blood pressure-lowering, lipid-lowering, and/or glucose-lowering medication, and give guidance on which measures to choose. Study Design and Setting: A literature search of Medline, Embase, and PsycINFO databases was conducted to identify studies assessing medication adherence and/or persistence for patients using multiple cardiometabolic medications. Two reviewers performed the study selection process independently. Results: From the 54 studies assessing adherence, only 36 (67%) clearly described the measures used. Five measures for adherence were identified, including adherence to ''all,'' to ''any,'' to ''both'' medication, ''average adherence,'' and ''highest/lowest adherence". From the 22 studies assessing persistence, only six (27%) clearly described the measures used. Three measures for persistence were identified, including persistence with ''all,'' with ''both,'' and with ''any'' medication. Less than half of the studies explicitly considered medication switches when relevant. Conclusion: From the identified measures, the ''any medication'' measure is most suitable for identifying patients in need of an intervention, whereas the ''all medication'' measure is useful for assessing the effect of interventions. More attention is needed for adequate measurement definitions when reporting on and interpreting adherence or persistence estimates to multiple medications.