• NASUTION AZIZAH Fakultas Farmasi, Universitas Sumatera Utara


Objective: Provision of antibiotics to patients with chronic kidney disease (CKD) without dosage adjustment could result in complicated problems including progression of kidney damage. This study analyzed utilization and dose rationality of antibiotics administered to stage 4 and 5 CKD patients in Haji Adam Malik (HAM) hospital, Indonesia.

Methods: This retrospective cohort study was conducted on six-month JAMKESMAS database (n=80). Inclusion criteria were in-patients received antibiotics and GFR of ≤30 mL/min/1.73 m2. Exclusion criteria were patients with cancer and Human Immunodeficiency Virus and below 18 years old. Characteristics of the study population were descriptively analyzed. Antibiotics utilization was determined by assessing unit numbers of the provided antibiotics. Dose rationality of the antibiotics was analyzed by referring to dose recommended in literatures based on the patients'creatinine clearance. Proportion of the patients received irrational doses was analyzed applying frequency analysis. All statistical analyses were performed using SPSS program version 19.

Results: Mean age of the CKD patients was 47.08 (SD = 13.80) years.  There were more male patients (66%) compared to female, p = 0.003. There were more patients with CKD stage 5 (83%) compared to CKD stage 4, p = <0.001. Eleven classes of antibiotics were provided to CKD patients of which 9 had irrational doses received by 34% of the patients. Ceftriaxone, ciprofloxacin, ceftazidime, cefadroxyl, and amoxicillin had the highest irrational dose incidence.

Conclusion: Incidence of irrational antibiotics dosage provided to the CKD patients was still high.  

Keywords: CKD, Infection, Antibiotics dosing


1. Barsoum RS. Chronic kidney disease in the developing world. New England Journal of Medicine. 2006;354(10):997-9.
2. Prodjosudjadi W. Incidence, prevalence, treatment and cost of end-stage renal disease in Indonesia. Ethnicity and disease. 2006;16(2):2.
3. Collins AJ, Foley RN, Herzog C, Chavers BM, Gilbertson D, Ishani A, et al. Excerpts from
the US renal data system 2009 annual data report. American journal of kidney diseases: the official journal of the National Kidney Foundation. 2010;55(1 Suppl 1):S1.
4. Naqvi SB, Collins AJ. Infectious complications in chronic kidney disease. Advances in Chronic Kidney Disease. 2006;13(3):199-204.
5. Sarnak MJ, Jaber BL. Mortality caused by sepsis in patients with end-stage renal disease compared with the general population. Kidney International. 2000;58(4):1758-64.
6. Ishani A, Collins AJ, Herzog CA, Foley RN. Septicemia, access and cardiovascular disease in dialysis patients: The USRDS Wave 2 Study1. Kidney International. 2005;68(1):311-8.
7. Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Annals of Internal Medicine. 2003 July 15, 2003;139(2):137-47.
8. Long CL, Raebel MA, Price DW, Magid DJ. Compliance with dosing guidelines in patients with chronic kidney disease. The Annals Of Pharmacotherapy. 2004;38(5):853-8.
9. Manley HJ, Cannella CA, Bailie GR, St. Peter WL. Medication-Related Problems in Ambulatory Hemodialysis Patients: A Pooled Analysis. American Journal of Kidney Diseases. 2005;46(4):669-80.
10. Stemer G, Lemmens-Gruber R. Clinical pharmacy activities in chronic kidney disease and end-stage renal disease patients: a systematic literature review. BMC Nephrology. 2011.
11. Utomo B, Sucahya PK, Utami, F.R. Priorities and realities: addressing the rich-poor gaps in health status and service access in Indonesia. International Journal for Equity in Health. 2011;10:47.
12. Pandey M, Sarita GP, Devi N, Thomas BC, Hussain BM, Krishnan R. Distress, anxiety, and depression in cancer patients undergoing chemotherapy. World J Surg Oncol. 2006;4:68.
13. Haase A. Population biology of HIV-1 infection: viral and CD4+ T cell demographics and dynamics in lymphatic tissues. Annual review of immunology. 1999;17(1):625-56.
14. Levey A, Greene T, Kusek J, Beck G, Group MS. A simplified equation to predict glomerular filtration rate from serum creatinine. J Am Soc Nephrol. 2000;11(9):155A.
15. Anderson PO, Knoben JE, Troutman WG. Handbook of clinical drug data. Tenth ed: McGraw-Hill Medical; 2002.
16. Dynamed. Evidence-based clinical reference. 2012; Available from: https://dynamed.ebscohost.com/.
17. Arora P. Chronic kidney disease. Medscape Reference Available online at: http://emedicine 2011;2011(Twenty seventh October).
18. Lueangarun S, Leelarasamee A. Impact of Inappropriate Empiric Antimicrobial Therapy on Mortality of Septic Patients with Bacteremia: A Retrospective Study. Interdisciplinary Perspectives on Infectious Diseases. 2012;2012.
19. Burton ME, Shaw LM, Schentag JJ, Evans WE. Applied pharmacokinetics and pharmacodynamics: principles of therapeutic drug monitoring: Lippincott Williams & Wilkins; 2006.
20. Rowland M, Tozer TN. Clinical pharmacokinetics/pharmacodynamics. 4th ed: Lippincott Williams and Wilkins; 2011.
21. United States Pharmacopoeia. Ceftriaxone for injection. USP. 2009 [cited 2013 23th June]; Available from: dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid.
22. Kumar A, Ellis P, Arabi Y, Roberts D, Light B, Parrillo JE, et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. CHEST Journal. 2009;136(5):1237-48.
23. Department of health Indonesia. Pedoman pelaksanaan Jamkesmas. 2008 [cited 2013 2nd July]; Available from: hukum.unsrat.ac.id/men/menkes2008_125_lamp.pdf‎.
24. Leung E, Weil DE, Raviglione M, Nakatani H. The WHO policy package to combat antimicrobial resistance. Bulletin of the World Health Organization. 2011;89(5):390-2.
25. Laing R, Hogerzeil H, Ross-Degnan D. Ten recommendations to improve use of medicines in developing countries. Health policy and planning. 2001;16(1):13-20.
26. Vlieghe E. The First Global Forum on Bacterial Infections calls for urgent action to contain antibiotic resistance. Expert review of anti-infective therapy. 2012;10(2):145-8.
27. Krähenbühl J-M, Kremer B, Guignard B, Bugnon O. Practical evaluation of the drug-related problem management process in Swiss community pharmacies. Pharmacy World & Science. 2008;30(6):777-86.
28. Blix HS, Viktil KK, Moger TA, Reikvam A. Risk of drug-related problems for various antibiotics in hospital: assessment by use of a novel method. Pharmacoepidemiology and drug safety. 2008;17(8):834-41.
29. Viktil KK, Blix HS. The Impact of Clinical Pharmacists on Drug‐Related Problems and Clinical Outcomes. Basic & clinical pharmacology & toxicology. 2008;102(3):275-80.
30. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive care medicine. 2008;34(1):17-60.
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How to Cite
AZIZAH, N., S. S. S. AZHAR, and S. A. AKMAL. “EVALUATION OF ANTIBIOTICS UTILIZATION AND DOSING FOR MANAGEMENT OF PATIENTS WITH CHRONIC KIDNEY DISEASE IN AN INDONESIAN HOSPITAL”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 8, no. 1, Jan. 2015, pp. 299-02, https://innovareacademics.in/journals/index.php/ajpcr/article/view/2958.
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