PROCEEDING
The 3rdInternational Conference on
Pharmacy And Advanced Pharmaceutical Sciences June 18 19, 2013 Yogyakarta, Indonesia
Book 2: Clinical Pharmacy
Editors:
EFFICACY OF SINGLE DOSE AZITHROMYCIN ON PEDIATRIC STREPTOCOCCAL TONSILLOPHARYNGITIS
Rasmaya Niruri1*, Rini Noviyani1, A.A. Agustia Sinta Dewi1, FS.Suherman2, I Putu Tri Yasa3
1Dept. of Pharmacy, Faculty of Math and Science,Udayana University,
Jimbaran, Bali.
2Siloam Hospital, Kuta, Badung, Bali.
3Pediatric Depatment, Sanjiwani Hospital, Gianyar, Bali.
*Corresponding author: Rasmaya Niruri Email : rasmaya@yahoo.com
Abstract
Azithromycin, which is indicated for streptococcal
tonsillopharyngitis, can be given in single dose regimen, but the dose size is not established for pediatric tonsillopharyngitis. Therefore the drug dose for otitis media is used, which is 30,0 mg/kg weight. The aim of this study is to provide data of efficacy azithromycin 30,0 mg/kg weight in tonsillopharyngitis pediatric patients.
on Rapid Step Test (RST), was conducted in Clinic T, Gianyar, Bali from March November 2012. Patients pharynx and tonsils on day 1 and day 4 were monitored to determine the efficacy of single dose azithromycin. Adverse effects of azithromycin were monitored in three consecutive days.
Results:Eighteen from 124 children with tonsillopharyngitis were fit to sample-criteria. In first visit (day 1), all 18 patients took single dose azithromycin (on the range of 29,6-30,0 mg/kg weight). On day 4, all patients showed no swell and inflammation on the pharynx and tonsils. Two of 18 patients suffered from nausea.
Conclusion: Single dose azithromycin (29,6-30,0 mg/kg weight) was effective on 18 streptococcal tonsillopharyngitis pediatric patients and it had minimal adverse effect.
Keywords:azithromicin, single dose, pediatric, tonsillopharingitis
INTRODUCTION
pediatric patients with steptococal tonsillopharingitis were found in Denpasar. Different finding was in Clinic T, Gianyar, where this study was conducted.
Azithromycin is indicated for streptococcal tonsillopharyngitis. This antibiotic can be given in single dose regimen. However the dose is not established for pediatric with tonsillopharyngitis, so the drug dose for otitis media is used, which is 30,0 mg/kg weight (Charles, F.L., 2005). To provide data of the efficacy azithromycin 30,0 mg/kg weight in tonsillopharyngitis, this study was conducted by monitoring the condition of pharynx and tonsils.
MATERIAL AND METHODS
azithromycin). Azithromycin was effective when the pharynx and the tonsils were not swollen and inflamed. Daily monitoring were conducted in monitoring adverse effects through asking the patients directly (on day 1 and 4) and indirectly by using telephone communication (on day 2 dan 3 : around 24 and 48 hours after receiving azithromycin syrup).
RESULT AND DISCUSSION
From 124 tonsillopharyngitis patients during this study between March-October 2012, only 18 patients were fit to inclusion and exclusion criteria. It was difficult to get patients with steptococcal tonsillopharyngitis. It might be due to low prevalence in Indonesia. It was reported that a prevalence of 6.1 % in Jakarta (Gitawati, R., Isnawati, A., 2009), 10,2% in Yogyakarta (Jurianti, A., 2008), and 7,9% in Denpasar (Malino,I.Y., 2008), but there was no data available in Gianyar.
Patients Characteristic
of normal adult value. It attains adult value by age of 4-6 years (Weemaes, C., 2003).
Table 1. Patients characteristic (N=18)
Patients characteristic N
Efficacy of Single Dose Azithromycin
used, which was 30,0 mg/kg weight, maximum: 1500 mg (Charles F.L, 2005). Patients took azithromycin syrup (200mg/5ml) on the first visits (after diagnosing with tonsillopharingitis and showing positive result on RST). Oral syringe was used as an administration device to quantify the desired dose of azithromycin syrup, because it provides the most accurate measurement (Koda-Kimble, M.A, et.all., 2009). Patients received azithromycin syrup in the dose range of 29,6 30,0 mg/kg weight (Table 2) due to limitation number scale on the syringe, which showed desired results (:the pharynx and the tonsils were not swollen and inflamed) in all 18 patients after three days of azithomicyn therapy.
tonsillopharingitis need to be conducted in order to determine the appropriate dose.
Tabel 2. Azithomicin Dose Size in Single Dose Administration and Patients Response
E 10 28,5 850 21,25 29,8 855 21,37 30,0 Good
N 5 25,0 750 18,75 30,0 750 18,75 30,0 Good
O 2 12,0 360 9,00 30,0 360 9,00 30,0 Good
P 2 13,0 390 9,75 30,0 390 9,75 30,0 Good
Q 3 13,5 400 10,00 29,6 400 10,00 30,0 Good
R 2 12,0 360 9,00 30,0 360 9,00 30,0 Good
Adverse effects
Commonly adverse effects of single dose azithromicin are gastrointestinal complaints (17,2%) and diarrhea (11-12%) (Amrol, D., 2007). On this study, only 2 patients suffered from nausea during this monitoring time period. Gastrointestinal problems can be minimized by taking azithromycin on an empty stomach (One hour before or 2 hours after a meal) (Amrol , D., 2007)
CONCLUSION
Single dose azithromycin (29,6-30,0 mg/kg weight) was effective to cure 18 streptococcal tonsillopharyngitis pediatric patients and it had minimal adverse effect.
ACKNOWLEDGMENT
REFERENCES
Amrol, D. 2007. Single-Dose Azithromycin Microsphere Formulation: A Novel Delivery System For Antibiotics. Int J Nanomedicine. March: 2(1): 9 12.
Charles, F.L. 2005. Charles F.L, 2005. Drug Information Handbook, 11th
Edition. Lexi Company
Craig W.A. 2012. Does the Does matter. CID oxford journal. CID 2001:33 (Suppl 3).
Gitawati R, Isnawati A. 2009. Pola sensitivitas kuman dari isolat hasil usap tenggorok penderita tonsilofaringitis akut terhadap beberapa antimikroba betalaktam di Puskesmas Jakarta Pusat. Cermin Dunia Kedokteran. 144:20-3.
Jurianti A. 2008. Faringitis Grup-A -Hemolitik Streptokokus pada anak-anak: klinis dan kultur usap tenggorok. Thesis. Universitas Gajah Mada .Yogyakarta.
Kementerian Kesehatan Republik Indonesia. 2009. Profil Kesehatan Indonesia Tahun 2009. Departemen Kesehatam RI. Jakarta. Koda-Kimble, M.A, et.all. 2009. Applied Therapeutics: The Clinical Use Of
Mackinnon, L.T., et.all. 1993. Decreased salivary immunoglobulin A secretion rate after intense interval exercise in elite kayakers. Eur J Appl Physiol Occup Physiol. ;67(2):180-4.
Malino, I.Y., et.all. 2008. Diagnostic Test of McIsaac Criteria on Group-A -Hemolitik Steptococcus Acute Pharingitis. Thesis. Universitas Gajah Mada. Yogyakarta. Indonesia.
Pichichero,M.E., 1995. Group A Streptococcal Tonsillopharyngitis: Cost-Effective Diagnosis and Treatment. Annals of Emergency Medicine Volume 25, Issue 3, March, Pages 390 403.
Topan, A. 2008. Profil Penggunaan dan Gambaran Biaya Antibiotika pada Terapi ISPA. Skripsi. Universitas Udayana. Denpasar. Indonesia Weemaes, C., et all., 2003. Development of Immunoglobulin A in Infacy
