Most anticancer agents exhibit a narrow therapeutic index, i.e., a small change in plasma concentrations can lead to a less efficacious treatment or an unacceptable degree of toxicity. This study aimed at providing health professionals with a feasible and time-saving tool to adapt the dose of anticancer agents for patients with renal or hepatic dysfunction. A guideline for anticancer agents was developed based on a literature search. An algorithm was generated to enhance the efficiency of the dose adaptation process. Finally, the dosing guideline was converted into an easy-to-use ExcelTM tool. The concept was applied to a total of 105 adult patients at the Centre for Integrated Oncology, Bonn, Germany. In total, 392 recommendations for dose adaptation were made and 320 (81.6%) recommendations were responded to by the oncologists. 98.4% of the recommendations were accepted. The algorithm simplifies the decision and screening process for high-risk patients. Moreover, it provides the possibility to quickly decide which laboratory tests are required and whether a dose adjustment for a particular anticancer drug is needed. The ExcelTM tool provides a recommended individual dose for patients with renal or hepatic dysfunction. The effectiveness of this strategy to reduce toxicity should be investigated in further studies before being adopted for routine use.

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WHO estimated that >50% of medicines are used inappropriately. One that posess highest risk due to inappropriate use is beta-lactam antibiotic, espescially in pediatric patient since the organ function in pediatric patient has not fully developed as in adult yet. This cross-sectional study was performed to identify drug-related problems (DRPs) occurred during beta-lactam therapy in pediatric hospitalized in a secondary-care hospital in Cimahi. A predetermined medication-use criteria based on the current literatures was created as an assessment standard tools. Furthermore, identification of DRPs based on PCNE v6.2 classification was carried out concurrently (January-March 2015) to 351 patients. As many as 458 DRPs were found including 22 cases inappropriate drugs (category C1.1), 127 cases no indication for drug (C1.2), 42 cases inappropriate combination of drugs, or drugs and food (C1.4), 1 case of too many drugs prescibed for indication (C1.6), 137 cases drug dose too low (C3.1), 89 cases drug dose too high (C3.2), 39 cases duration of treatment too short (C4.1), and 1 case of duration of treatment too long (C4.2). The potential DRPs was estimated to be occured for approximately 1-2 DRPs per patient.Keywords: drug-related problems; beta-lactam antibiotic; pediatric; pharmaceutical care

Previous studies showed that counseling is able to improve patient adherence and reduce medication-related problems, leading to reach an optimal outcome therapy. The aims of this study were to identify patient's need, healthcare professional's support, pharmacist's readiness and step to be taken to meet standard for implementing patient medication counseling service. This cross-sectional questionnaire-based study was conducted in a tertiary-care eye hospital in Bandung. Questionnaires has been given to hospitalized-patient to identify the patient's need and to healthcare professionals in recognizing their supports, followed by survey of pharmacist's readiness. Gap analysis was then carried out to identify the additional resources to be provided for conducting the service. As many as 103 patients were enrolled and eager for drug counseling to be implemented with pharmacist as healthcare counselor. All nurses (n=54) and resident physician (n=25) who returned the questionnaire gave their support for pharmacist to provide the service; and all pharmacists (n=4) are ready to conduct patient medication counseling with minor adjustment. Gap analysis concluded that additional resources should be furnished, e.g. information module consist of standard information needed by the patient, standard operational procedure, and updated literatures. Due to lack of pharmacist, counseling service only be delivered to patient who has a complex antibiotic regimen therapy. Our data showed that patient medication counseling service in this center could be quickly implemented.