Pemantauan Efektivitas Gentamisin Dosis Berganda Intravenus terhadap Pasien Pneumonia Komuniti (Community Aquired Pneumonia) di Rumah Sakit Umum Pusat H.Adam Malik Medan

Abstract

It has been carried out a monitoring study on the effect of gentamycin multi dose of intravenous toward 3 patients of community aquired pneumonia disease at Pulmonology and Respiratory Department RSUP H. Adam Malik Medan. The Gentamycin is given bolus intravenously dose 80 mg every 12 hours. Concentration in the patient blood by using aliquot serum is done as much as 3 times that is 30 minutes after the first dose in steady state, and called as maximum concentration (Cmax). The second aliquot is taken on 6 hours after injection of the first dose to find out clinical maniftation, and the third aliquot is taken 5 minutes before injection of the second dose called as minimum concentration (Cmin). Before and during gentamycin therapeutic, the patient undergo laboratory examination covering complete blood, kidney faal (BUN and serum creatinin) and microba sensitivity culture test. Based on the examination of gentamycin concentration in blood by using Chemistry Autoanalyzer COBAS INTEGRA 400 Roche, it is found the result that DI, the first patient has Cmax = 8,41 mcg/ml, C6hours = 6,83 mcg/ml and Cmin = 2,41 cmg/ml; RS, the second patient hasCmax = 6,72 mcg/ml, C6hours = 2,0 mcg/ml and Cmin = 1,1 mcg/ml; SS, the third patient has Cmax = 4,32 mcg/ml, C6hours = 1,35 mcg/ml and Cmin = 0,9 mcg/ml. Individual dose is determined based on steady state method and it is found that the dose need by DI patient is 60 mg, RS patient is 100 mg and SS patient is 150 mg so that Cmax is in therapeutic range to be affect to face infection cause with minimal side effect. Based on this study, it can be conclude that the giving of gentamycin dose 80 mg every 12 hours without considering the body weight and kidney fuction cause big variability toward the achievement of therapeutic concentration.

Telah dilakukan studi pemantauan efektivitas gentamisin dosis berganda intravenus terhadap 3 orang pasien pneumonia komuniti (community aquired pneumonia) di rumah sakit H. Adam Malik Medan Departemen Pulmunologi dan Saluran Pernafasan. Gentamisin diberikan secara intravenus bolus dosis 80 mg tiap 12 jam. Pengamatan kadar gentamisin dalam darah dilakukan dengan mengumpulkan cuplikan serum sebanyak 3 kali, yaitu 30 menit setelah injeksi pertama saat steady state untuk menentukan konsentrasi maksimum, 6 jam setelah injeksi untuk menentukan manifestasi klinis dan 5 menit sebelum injeksi berikutnya untuk menentukan konsentrasi minimum. Sebelum dan selama terapi gentamisin, penderita menjalani pemeriksaan darah lengkap, faal ginjal (BUN dan serum kreatinin) dan uji sensitivitas mikroba. Berdasarkan hasil pengujian konsentrasi gentamisin dalam darah menggunakan Chemistry Autoanalyzer COBAS INTEGRA 400 Roche diperoleh data bahwa pasien DI mempunyai Cmaks = 8,41 mcg/ml, C6jam = 6,83 mcg/ml dan Cmin = 2,41 cmg/ml; pasien RS mempunyai Cmaks = 6,72 mcg/ml, C6jam = 2,0 mcg/ml dan Cmin = 1,1 mcg/ml; pasien SS mempunyai Cmaks = 4,32 mcg/ml, C6jam = 1,35 mcg/ml dan Cmin = 0,9 mcg/ml. Dosis individu ditetapkan berdasarkan metode keadaan mantap dan diperoleh dosis untuk pasien DI adalah 60 mg, RS sebesar 100 mg dan SS sebesar 150 mg sehingga Cmaks berada dalam range terapi sehingga efektif melawan penyebab infeksi dengan efek samping yang minimal. Berdasarkan studi ini dapat disimpulkan bahwa pemberian gentamisin dosis 80 mg tiap 12 jam tanpa mempertimbangkan berat badan dan fungsi ginjal akan menyebabkan variabilitas yang besar dalam pencapaian konsentrasi terapetik