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Diabetes mellitus is a chronic disease that requires long-term pharmacological therapy, increasing the risk of Drug Related Problems (DRPs). DRPs can affect the success of therapy, increase the risk of complications, and reduce the patient's quality of life. This article aims to identify the use of antidiabetic drugs, the characteristics of DRPs, and their clinical implications. The method used was a literature review of articles from 2016-2026 that are relevant to the analysis of DRPs in diabetes mellitus patients. The results of the study indicate that metformin is the most widely used antidiabetic drug, both as a single therapy and in combination. The dominant types of DRPs include drug interactions, inappropriate drug selection, inappropriate dosages, omissions from therapy, and use of drugs without indications. These DRPs can cause hypoglycemia, failure to achieve glycemic control targets, an increased risk of complications, and increased duration and cost of treatment. Based on the results of the study, it is concluded that DRPs remain a challenge in the management of diabetes mellitus therapy, requiring more optimal monitoring and an active role of pharmacists through medication review to improve the safety, effectiveness, and quality of treatment.

Risk factors for melasma have been identified at several points such as the use of birth control pills, cosmetics, sun exposure, estrogen therapy, decreased thyroid and ovarian function, ovarian tumors, nutrition, drugs that are classified as phototoxic or photoallergic, and epilepsy drugs. This article aims to determine the incidence of melasma and its risk factors. This study uses articles collected from the Google Scholar database. The data collection step uses the keyword "Risk Factor Melasma" according to the title and keyword criteria. The articles used are publications in the 2018-2023 year range. The stages of analysis are carried out using VOSviewer software for visualization and trend analysis in the form of bibliometric maps. The bibliometric approach was applied to identify publication patterns, research developments, and relationships among topics related to melasma risk factors. Based on the visualization results, 100 selected documents were published within 5 years, from 2018 to 2023. The findings provide an overview of the main research trends and contribute to a better understanding of the incidence of melasma and the factors associated with its occurrence

Diarrhea has the potential to cause an Extraordinary Event (KLB) and is currently a leading cause of mortality in Indonesia, especially in children. Antibiotics are necessary for diarrhea caused by bacteria, but irrational antibiotic prescribing can increase the risk of antibiotic resistance. This literature review was conducted to provide an overview of the level of rationality of antibiotic use in pediatric patients with diarrhea in several Indonesian health facilities. The literature review was conducted by reviewing articles obtained through a Google Scholar search using the keywords "rationality of antibiotic use," "diarrhea," "children," and "evaluation of antibiotic use." Articles were selected using inclusion and exclusion criteria, resulting in 10 suitable articles. The study results indicate that the evaluation methods for antibiotic use include the Gyssens criteria, World Health Organization criteria, Ministry of Health Decree Standards, the 2012 World Gastroenterology Organization Guidelines, and the Rational Drug Use Module. Commonly used evaluation parameters include appropriate indication, appropriate drug, appropriate dose, and appropriate patient. Most parameters have obtained rational results, but there are several studies that are not rational in the appropriate indication, appropriate drug, and appropriate dose categories. Variations in the results of rational antibiotic use at each health facility are influenced by patient characteristics, policies at the health care facility, and the level of compliance of health workers with therapy guidelines.

Diarrhea has the potential to cause an Extraordinary Event (KLB) and is currently a leading cause of mortality in Indonesia, especially in children. Antibiotics are necessary for diarrhea caused by bacteria, but irrational antibiotic prescribing can increase the risk of antibiotic resistance. This literature review was conducted to provide an overview of the level of rationality of antibiotic use in pediatric patients with diarrhea in several Indonesian health facilities. The literature review was conducted by reviewing articles obtained through a Google Scholar search using the keywords "rationality of antibiotic use," "diarrhea," "children," and "evaluation of antibiotic use." Articles were selected using inclusion and exclusion criteria, resulting in 10 suitable articles. The study results indicate that the evaluation methods for antibiotic use include the Gyssens criteria, World Health Organization criteria, Ministry of Health Decree Standards, the 2012 World Gastroenterology Organization Guidelines, and the Rational Drug Use Module. Commonly used evaluation parameters include appropriate indication, appropriate drug, appropriate dose, and appropriate patient. Most parameters have obtained rational results, but there are several studies that are not rational in the appropriate indication, appropriate drug, and appropriate dose categories. Variations in the results of rational antibiotic use at each health facility are influenced by patient characteristics, policies at the health care facility, and the level of compliance of health workers with therapy guidelines.

Antimicrobial resistance is a persistent threat to hospital care, particularly when empirical therapy relies on broad-spectrum antibiotics without continuous evaluation of local use and susceptibility patterns. This literature review aimed to synthesize evidence from four Indonesian hospital-based studies regarding antibiotic utilization, rationality assessment, and bacterial resistance profiles. A structured narrative review was conducted using four selected articles provided by the author. Data were extracted for study design, setting, population, antibiotic evaluation method, dominant antibiotic classes, rationality indicators, resistance profile, and stewardship implications. The four studies were descriptive and hospital-based, using retrospective records, concurrent observation, ATC/DDD with DU 90%, qualitative rationality criteria, and antibiogram data. The synthesis showed a consistent concentration of antibiotic use in broad-spectrum groups, especially third-generation cephalosporins, penicillins, quinolones, and macrolides. In a Bandung public hospital, total antibiotic consumption reached 95,719.01 DDD, with penicillins, cephalosporins, quinolones, macrolides, and sulfonamides included in the DU 90% segment. In intensive care, ceftriaxone was the most frequently used antibiotic and most rationality indicators were appropriate, although clinically significant drug interactions were still identified. In pediatric acute respiratory infection inpatients, cefotaxime and ceftriaxone dominated empirical therapy. Resistance mapping in Denpasar highlighted relevant Gram-positive and Gram-negative pathogens and recommended antibiotics according to susceptibility levels. Overall, the reviewed evidence supports an integrated antimicrobial stewardship model combining ATC/DDD-DU 90% surveillance, qualitative rationality evaluation, antibiogram-based empirical guidance, and periodic feedback to prescribers.

Drug-Related Problems (DRPs) are common in patients with type 2 Diabetes Mellitus (T2DM) who receive combination therapy involving oral antidiabetic agents and insulin. This literature review aims to identify the main types of DRPs and the factors contributing to their occurrence based on recent studies from PubMed, ScienceDirect, ResearchGate, and Google Scholar. The most frequently reported DRP is drug interaction, followed by underdosing, overdosing, therapy without indication, untreated indications, adverse drug reactions, and patient-related problems such as non-adherence. Several factors contribute to the occurrence of DRPs, including polypharmacy, inappropriate dosing, the presence of comorbidities, limited patient knowledge regarding therapy, and inadequate clinical monitoring. These conditions may increase the risk of poor glycemic control and treatment failure. Therefore, effective management of DRPs is essential to improve therapeutic outcomes. The findings of this review emphasize the important role of pharmacists in conducting medication reviews, identifying DRPs early, and implementing appropriate interventions to enhance patient safety and optimize treatment in T2DM patients.

Drug-Related Problems (DRPs) are common in patients with type 2 Diabetes Mellitus (T2DM) who receive combination therapy involving oral antidiabetic agents and insulin. This literature review aims to identify the main types of DRPs and the factors contributing to their occurrence based on recent studies from PubMed, ScienceDirect, ResearchGate, and Google Scholar. The most frequently reported DRP is drug interaction, followed by underdosing, overdosing, therapy without indication, untreated indications, adverse drug reactions, and patient-related problems such as non-adherence. Several factors contribute to the occurrence of DRPs, including polypharmacy, inappropriate dosing, the presence of comorbidities, limited patient knowledge regarding therapy, and inadequate clinical monitoring. These conditions may increase the risk of poor glycemic control and treatment failure. Therefore, effective management of DRPs is essential to improve therapeutic outcomes. The findings of this review emphasize the important role of pharmacists in conducting medication reviews, identifying DRPs early, and implementing appropriate interventions to enhance patient safety and optimize treatment in T2DM patients.

Chronic Coronary Syndrome (CCS) is a contemporary term that replaces stable coronary artery disease (CAD) and describes a spectrum of clinical conditions resulting from chronic abnormalities of the coronary arteries. This condition is characterized by a mismatch between myocardial oxygen supply and demand that is transient and reversible, commonly presenting as stable angina pectoris. CCS contributes significantly to global cardiovascular morbidity and mortality, including in Indonesia. The underlying pathophysiology primarily involves atherosclerosis and microvascular dysfunction leading to myocardial ischemia. Diagnosis is established through comprehensive history taking, physical examination, and both invasive and non-invasive investigations such as electrocardiography, stress testing, and cardiac imaging. Risk stratification using pre-test probability plays a crucial role in guiding further diagnostic evaluation. The management of CCS aims to relieve symptoms and prevent adverse cardiovascular events through pharmacological and non-pharmacological approaches, as well as revascularization when indicated. Pharmacological therapy includes antianginal agents, antiplatelet drugs, and lipid-lowering agents, while lifestyle modifications such as smoking cessation, healthy diet, and regular physical activity are essential in preventing disease progression. With accurate diagnosis and comprehensive management, the morbidity and mortality associated with CCS can be reduced.

Bacterial infections are diseases that can be transmitted by bacteria from sufferers to others, either directly or indirectly. Cases of bacterial infections are more common among children. The use of antibiotics is needed to treat life-threatening conditions caused by bacteria by killing bacteria or making it difficult for bacteria to grow and reproduce. Antibiotics are a type of drug given to prevent bacterial infections, or are drugs given to high-risk patients. This research method is a descriptive study by collecting medical record data to find out the description of bacterial infections and the use of antibiotics in pediatric inpatients at RSU Cut Meutia Aceh Utara in 2022. This research technique used purposive sampling with a sample size of 183 samples. The results of this study showed that 183 children suffered from bacterial infections and received injection antibiotic therapy, the majority were boys, namely 106 children (57%), the age group with the most number of sufferers, namely aged 0‒5 years, totaling 76 children (41%), the percentage of bacterial infections most commonly found in pediatric inpatient wards at RSU Cut Meutia Aceh Utara in 2022, namely typhoid fever as much as 33%, the class of antibiotics most commonly used at RSU Cut Meutia is cephalosporins (93%).

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an obligate intracellular bacterium that affects the skin, peripheral nerves, upper respiratory mucosa, and eyes. Type 2 diabetes mellitus (T2DM) is a comorbidity that can worsen the course of leprosy. The female patient, Mrs. D, aged 55 years came to the emergency room of Cut Meutia Hospital with the main complaint of red bumps accompanied by pain on the face, hands, chest, and back since 3 days ago and additional complaints such as fever, joint pain, and numbness and loss of feeling in the legs, weakness, frequent thirst, and frequent urination. Dermatologic status is obtained in the facial region in the form of erythema nodules with firm boundaries with numular size, multiple. Laboratory examination showed anemia and leukocytosis. The therapy given was MDT MB package, ferrous sulfate 1x325 mg and PRC transfusion 3 kolf. Complaints arose acutely after the patient resumed taking MDT (multidrug therapy) leprosy drugs which had previously been stopped for more than 3 months. Based on the time of onset of symptoms, history of leprosy treatment, and the manifestation of systemic inflammatory lesions with signs of neurotropism, it can be suspected that the patient is experiencing a type 2 leprosy reaction or Erythema Nodosum Leprosum (ENL).

Pneumonia caused by extensively drug-resistant (XDR) Pseudomonas aeruginosa is still  clinicaly chalenging, particularly among geriatric patients with neurological comorbidities such as stroke. This report presents a case of XDR P. aeruginosa pneumonia complicated by sepsis in a 73-year-old patient, characterized by persistent leukocytosis until the tenth day of hospitalization despite empirical meropenem therapy. This evidence-based case report aims to analyze clinical outcomes, specifically 28-day and 30-day mortality rates, and to identify mortality predictors in the adult population through a systematic literature search of the PubMed and Google Scholar databases for the 2019–2026 period. Synthesized evidence from six core studies indicates that XDR P. aeruginosa infections carry a profoundly high 28-day mortality rate, ranging from 41% to 51% in cohorts receiving antibiotic monotherapy. Key mortality predictors identified include the presence of sepsis or septic shock, a delay in initiating adequate therapy exceeding 52 hours, advanced age, and the requirement for Intensive Care Unit (ICU) admission. The phenomenon of persistent or worsening leukocytosis during treatment, as observed in this case, serves as a critical clinical indicator associated with antimicrobial response failure and a dismal prognosis. Ultimately, XDR P. aeruginosa pneumonia is associated with poor clinical outcomes, where therapeutic success is strictly contingent upon the timely administration of antibiotic regimens with proven activity against these highly resistant isolates.

This study aims to analyze the potential of eupatorin found in Cat’s Whiskers (Orthosiphon stamineus) as an anticancer agent using in silico methods. Eupatorin was selected due to its promising biological activity reported in previous literature. The research employed compound structure data registered in PubChem, analyzed through PASS Online for pharmacological activity prediction, ProTox-II for toxicity evaluation, and pkCSM for ADMET parameters. The results indicated that eupatorin has a high probability of inhibiting cancer cell proliferation with significant pharmacological activity values. Toxicity predictions showed a safe profile with an LD50 supporting its potential therapeutic use. ADMET analysis demonstrated that eupatorin possesses good bioavailability, adequate absorption and distribution, and minimal metabolic interactions, supporting its efficacy as an anticancer compound. These findings suggest that eupatorin could be an important candidate for herbalbased drug development, particularly for cancer therapy, and provide opportunities for further research through in vitro and in vivo experiments to validate anticancer activity comprehensively.

Medical personnel compliance in prescribing drugs according to the National Formulary (ForNas) is essential to ensure rational therapy, improve service quality, and enhance efficiency in health financing at government health facilities. However, compliance remains a challenge at Johar Baru Regional General Hospital, Central Jakarta. This study aimed to analyze factors influencing medical personnel compliance with ForNas-based prescribing, including drug availability, management policies, and the knowledge, attitudes, norms, and perceptions of medical staff.A qualitative approach was used through in-depth interviews with medical personnel, heads of supporting service sections, and pharmacy unit leaders. The study also involved observation and review of hospital formulary documents, minimum service standards reports for 2024, and monitoring and evaluation reports on prescribing compliance for 2024 and January June 2025. Data were analyzed using thematic analysis supported by NVivo software.The findings indicate that compliance is influenced by medical personnel’s understanding of ForNas policies, clinical experience, and professional attitudes toward prescribing standards. Management factors such as supervision, technological support, and procurement systems also play important roles. Limited drug stocks and suboptimal control systems were identified as major obstacles.The hospital is recommended to strengthen compliance by updating clinical practice guidelines, developing a ForNas-based hospital formulary, improving management support, optimizing information technology systems, ensuring drug availability, and proposing additional ForNas drugs to the Ministry of Health.

Childhood tuberculosis remains a significant public health challenge, particularly in developing countries where malnutrition and limited diagnostic resources increase disease severity and mortality. Children are at high risk of rapid progression from latent infection to active disease due to immature immune systems. We report a case of a 1-year-old girl presenting with cough, fever, shortness of breath, and poor growth. Chest radiograph showed consolidation and infiltrates in the right paracardial area consistent with pulmonary tuberculosis. The patient was treated with first-line anti-tuberculosis drugs, including rifampicin and pyrazinamide, along with nutritional support, resulting in significant clinical improvement and discharge on day eight. This case emphasizes the importance of early recognition and management of tuberculosis in young children with risk factors such as malnutrition and incomplete immunization. Preventive strategies such as BCG vaccination, contact screening, family education, and access to tuberculosis preventive therapy are essential to reduce morbidity and mortality in childhood TB.

Hypertensive disorders of pregnancy remain a leading cause of maternal and perinatal morbidity and mortality worldwide. Nifedipine and labetalol are commonly recommended as first-line antihypertensive agents during pregnancy; however, evidence regarding their comparative effectiveness and safety is still evolving. This systematic review aimed to evaluate and compare the effectiveness and safety of nifedipine versus labetalol in the management of gestational hypertension, chronic hypertension, and preeclampsia. The review was conducted according to PRISMA 2020 guidelines. A comprehensive literature search was performed in PubMed, ScienceDirect, and Google Scholar for randomized controlled trials published between 2016 and December 2025. Studies comparing nifedipine monotherapy with labetalol monotherapy and reporting systolic and/or diastolic blood pressure outcomes were included. Six RCTs involving 2,806 pregnant women met the inclusion criteria. Both drugs were effective in reducing blood pressure. Nifedipine demonstrated a faster onset of blood pressure reduction, particularly in acute hypertensive emergencies, with mean differences ranging from 12 to 17 minutes compared with labetalol. No significant differences were observed in long-term blood pressure control or neonatal outcomes. Maternal adverse effects were generally mild and comparable. Overall, both agents exhibit similar efficacy and safety profiles, with nifedipine offering advantages in rapid blood pressure control in acute settings.

Hypertension is a major modifiable risk factor contributing to the development of Acute Coronary Syndrome (ACS), which includes STEMI, NSTEMI, and unstable angina. The increasing prevalence of hypertension worldwide raises concern regarding its impact on cardiovascular outcomes. This study aimed to describe the profile of ACS patients with hypertension receiving angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) therapy in the Intensive Coronary Care Unit (ICCU) of RSUD Dr. Soetomo Surabaya. Using a descriptive cross-sectional method, data from 91 patients treated between July 2021 and October 2024 were analyzed. Variables included demographic characteristics, clinical classification of ACS, hypertension degree, comorbidities, types and doses of ACEI/ARB administered. The results showed that most patients were male (73%) and aged over 65 years (40%). Chi-square analysis revealed no significant relationship between hypertension degree, ACS classification, or most comorbidities with drug selection or dosage (p>0.05), except for a significant association between coronary heart disease comorbidity and ARB selection. These findings suggest that in hypertensive ACS patients, the choice between ACEI and ARB therapy is predominantly based on individual comorbidity profiles rather than blood pressure severity or ACS type. The study highlights the importance of personalized treatment approaches considering patient comorbidities to optimize cardiovascular outcomes.

Tuberculosis (TB) remains one of the leading infectious causes of death worldwide and continues to pose a major public health challenge. The disease is caused by Mycobacterium tuberculosis and is transmitted through airborne droplets when infected individuals cough or speak. Without treatment, TB has a mortality rate of approximately 50%; however, about 85% of patients can be successfully treated with anti-tuberculosis drugs administered for 4–6 months according to standard guidelines. Indonesia is among the eight countries contributing the highest number of TB cases globally, yet national treatment adherence remains suboptimal. This study aimed to analyze factors associated with medication regularity among pulmonary TB patients in Indonesia using data from the 2023 Indonesian Health Survey. A cross-sectional design was applied using secondary data from respondents aged ≥15 years who had been diagnosed with TB and received treatment, with a weighted sample of 667,421 individuals. Data were analyzed using univariate, bivariate (Rao-Scott Chi-Square), and multivariate logistic regression with backward elimination. The prevalence of regular medication intake was 72.21%. Education level, residence, presence of a treatment supervisor (PMO), type of therapy, and comorbidities were significantly associated with medication regularity. Multivariate analysis identified the presence of a PMO as the most dominant factor, followed by higher education and absence of comorbidities. Strengthening treatment supervision and implementing Health Belief Model–based health education are essential to support the 2030 TB elimination target in Indonesia.  

Type 2 Diabetes Mellitus is a chronic disease with an increasing prevalence and requires long-term therapy, resulting in a significant economic burden on healthcare systems. This study aimed to analyze the cost-effectiveness of antidiabetic drug use among Type 2 Diabetes Mellitus patients in the inpatient unit of Dr. R. Hardjanto Hospital, Balikpapan. This research employed an observational analytic design with a cross-sectional approach and retrospective data collection from medical records and administrative data for the period January–December 2023. A total of 54 patients who met the inclusion criteria were included as study samples. Therapeutic effectiveness was assessed based on the achievement of random blood glucose levels ≤200 mg/dL, while the analysis focused on direct medical costs. Cost-effectiveness was evaluated using the Average Cost-Effectiveness Ratio (ACER) and Incremental Cost-Effectiveness Ratio (ICER). The results showed that Metformin–Apidra therapy achieved higher clinical effectiveness (92%) with an average cost of IDR 3,636,721 and an ACER value of IDR 39,529. Meanwhile, Glimepiride–Sansulin therapy demonstrated 81% effectiveness with a lower average cost of IDR 2,519,259 and an ACER value of IDR 31,101. The ICER value of IDR 10,158 indicates the additional cost required to achieve a 1% increase in effectiveness. In conclusion, Metformin–Apidra therapy is more clinically effective, whereas Glimepiride–Sansulin therapy is more cost-effective economically.

Canker sores are an inflammation of the oral tissues, generally caused by bacterial and fungal infections. They can cause pain and discomfort and reduce the sufferer's quality of life. Treatment for canker sores has been dominated by synthetic drugs, but they are less popular among the public, especially children, due to discomfort and concerns about side effects. Therefore, we need safer and more easily accepted alternative treatments based on culturally derived materials. This study is to investigate the potential of pineapple and melon stems formulated in the form of gummy candy nanosimplicia as a complementary therapy in the treatment of canker sores. The research method was carried out through a literature review by collecting scientific articles from the PubMed, ScienceDirect, and Google Scholar databases, then analyzed using VOSviewer software to map emerging research trends and potential. The analysis results indicate that there are approximately 600 articles discussing the active metabolite content in pineapple and melon stems that have antibacterial and antifungal activity, as well as the development of innovative preparations such as gummy candy as a delivery medium for bioactive compounds. The implications of this study indicate that the combination of pineapple stem and melon nanosimplisia has the potential to be developed as a safe, attractive, and effective natural herbal candy product for the prevention and treatment of mouth ulcers, especially in children.

Tuberculosis (TB) is a chronic, infectious disease caused by the bacterium Mycobacterium tuberculosis. Primary infection occurs upon first exposure to bacillary tuberculosis, which often occurs in childhood, hence the term "childhood TB." The diagnosis of TB is usually made through a history that includes complaints of persistent cough, weight loss, fever, and weakness, along with a chest X-ray that shows typical abnormalities of pulmonary TB. In this case, a 21-month-old girl presented with a worsening, persistent cough accompanied by weight loss. The patient's mother reported that her child frequently had fevers and appeared weak. After a physical examination and supporting tests, the patient was diagnosed with TB. The patient was given pharmacological therapy in the form of anti-tuberculosis drugs (OAT), and parents were educated about the importance of adherence to TB treatment as prescribed by the doctor. Furthermore, providing a balanced, nutritious diet is recommended to support successful treatment.