Background: Deprescribing of preventive medication is recommended in older patients with polypharmacy, including people with type 2 diabetes (T2D). It seems that many patients in low-middle-income countries are not willing to have their medicines deprescribed. This study aims to assess attitudes of Indonesian patients with T2D towards deprescribing in general and regarding specific cardiometabolic medicines, and factors influencing their willingness to stop medicines. Methods: Primary care patients with T2D of ≥60 years in Indonesia completed the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire. Attitudes in general and for cardiometabolic medicines were reported descriptively. Proportions of patients willing to stop one or more medicines when recommended by different healthcare professionals were compared with Chi-square test. Multiple regression analysis was used to analyse the influence between patient-related factors and the willingness to stop medicines. Results: The survey was completed by 196 participants (median age 69 years, 73% female). The percentages willing to stop medicines were 69, 67, and 41%, when the general practitioner (GP), the specialist, or the pharmacist initiates the process (p-value < 0.001). Higher perceived burden of medicines (p-value = 0.03) and less concerns about stopping (p-value < 0.001) were associated with a higher willingness to stop medicines if proposed by the GP. Patients using multiple glucose-regulating medicines were less willing to stop (p-value = 0.02). Using complementary or alternative medicines was not associated with the willingness to stop. If proposed by their pharmacist, patients without substantial education were more willing to stop than educated patients. Conclusions: Only two-thirds of older people with T2D in Indonesia were willing to stop one or more of their medicines if the GP or specialist recommended this, and even less when the pharmacist proposed this. Attention should be given to concerns about stopping specific medicines, especially among patients using multiple glucose-lowering medicines, who may be more eligible but were less willing to accept deprescribing.

Breast cancer is the most prevalent cancer in women. Anthracyclines are commonly used as the first line of treatment, often combined with other agents, including trastuzumab. Despite their efficacy, both drugs pose a risk of cardiotoxicity, which may impair patients’ quality of life (QoL) and hinder treatment persistence. Anthracycline-induced cardiotoxicity is dose-dependent and generally irreversible, whereas trastuzumab is associated with potentially reversible cardiac dysfunction. This review discusses the risk factors and biological mechanisms underlying chemotherapy-induced cardiotoxicity in breast cancer and explores effective strategies for prevention and treatment. It has been demonstrated that several cardioprotective strategies, such as treatments with angiotensin-converting enzyme inhibitors (ACEis), angiotensin receptor blockers (ARBs), beta-blockers, and dexrazoxane, can help lessen cardiotoxic effects. A better understanding of cardioprotective strategies may help optimize cancer treatment without compromising cardiovascular function.

Antibiotics are frequently prescribed to coronavirus disease 2019 (COVID-19) patients, often without evidence of bacterial superinfection, increasing the risk of antibiotic resistance and posing a public health threat. The aim of this study was to evaluate antibiotic prescribing patterns in COVID-19 patients with suspected secondary infections and to assess the association between antibiotic use and clinical outcomes, particularly leukocyte count. The study analyzed 376 hospitalized COVID-19 patients from two hospitals in Bandung, Indonesia, between 2020 and 2022. All included patients were aged ≥17 years with confirmed COVID-19, leukocyte count >11,000 μg/L, and received antibiotic therapy. The Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) and drug utilization (DU) 90% were used to assess prescribing patterns. The patients’ demographic characteristics, clinical and culture results were also collected. Our data indicated that most patients received multiple antibiotics (>2), with prescribing patterns significantly associated with age, confirmed bacterial pathogen, length of hospital stay and having tuberculosis infection. The most frequently identified pathogens included Gram-positive bacteria Staphylococcus aureus, Staphylococcus haemolyticus and Gram-negative bacteria Klebsiella pneumoniae, Acinetobacter baumannii, and Escherichia coli. The most frequently prescribed antibiotics were azithromycin, levofloxacin, and ceftriaxone. No significant association was found between the number of antibiotics prescribed and clinical outcome (leukocyte normalization). Broad-spectrum antibiotics from the World Health Organization (WHO) AWaRe "Watch" category dominated the antibiotic prescriptions in the patients. While antibiotic selection was generally aligned with pathogen type and comorbidities, standardized guidelines remain crucial to optimizing antibiotic use, particularly in settings with limited pathogen testing.

Background/Objectives: The use of linezolid in drug-resistant tuberculosis has shown good effectiveness but has a high risk of adverse drug reactions (ADRs). Linezolid-related ADRs have been widely reported and may affect their therapeutic effect. This systematic review aimed to describe linezolid-related ADRs in drug-resistant tuberculosis. Methods: This literature review was conducted on PubMed, Scopus, ProQuest, and Sage without year limitation, up to June 2023. Study quality was assessed using the JBI checklist to evaluate method quality and risk of bias in the included articles. Inclusion criteria included studies assessing linezolid-correlated ADRs in drug-resistant tuberculosis patients with individual regimens, having access to the full text, and using the English or Indonesian language. Potential reporting bias was minimized by comprehensive database search and duplicate screening. Results: Initially, we identified 650 potential studies. Upon further assessment for relevance and eligibility, seven articles were selected for analysis. From seven articles, it was shown that all articles were reporting about linezolid-correlated ADRs. The three main ADRs are hematologic toxicity, peripheral neuropathy, and optic neuritis. In addition, gastrointestinal disorder and hyperlactatemia are reported as ADRs too. Varied doses of linezolid were used in the seven articles; they range from 300 mg to 1200 mg, with 600 mg/twice daily and 1200 mg/day being dominant. Conclusions: Linezolid-associated ADRs are dose- and duration-dependent. Hematological toxicity most commonly occurs at the beginning of treatment, while peripheral neuropathy and optic neuritis appear after long-term use. Therefore, intensive monitoring and therapeutic drug monitoring are essential to ensure the safety of linezolid therapy.

Background: The global burden of type 2 diabetes mellitus (T2DM) continues to rise, with Indonesia projected to reach over 28 million cases by 2045. Limited access to continuous education and follow-up care in low-resource primary care settings necessitates scalable digital health solutions to support self-management. Objective: This study aimed to evaluate the effectiveness of a mobile health (mHealth) application in reducing HbA1c levels among T2DM patients in Indonesian primary care. Methods: A quasi-experimental, two-arm study was conducted over 24 weeks across 10 public health centers (Puskesmas) in Bandung. One hundred patients with T2DM (HbA1c >8%) were assigned to either an intervention group (mHealth application supported by integrated pharmacist consultation) or a control group (standard care). The primary outcome was the change in HbA1c levels measured at baseline, 12, and 24 weeks. Results: The intervention group showed a significant reduction in HbA1c from 9.31% to 8.13% (p = 0.001), while the control group showed minimal change (from 8.99% to 8.96%, p = 0.021). Glycemic trends in the intervention group were consistent and progressive, indicating improved adherence and self-management. Boxplot analysis demonstrated reduced variability and tighter glycemic control in the intervention group. High usability and engagement were observed among older adults and participants with low educational backgrounds. Conclusion: The mHealth intervention significantly improved glycemic control and promoted consistent self-care among Indonesian T2DM patients. These findings suggest that scalable digital solutions may enhance diabetes management in primary care systems in low- and middle-income countries.

Background: The shifting from the old paradigm to the new paradigm with the philosophy of pharmaceutical care demands pharmacists to enhance the quality of pharmaceutical services. However, this role has not been optimally fulfilled, especially in the community setting.Objectives: This study aimed to identify the perceptions and expectations, the gap between expectations and reality, and public confidence as well as to analyze the relationship between sociodemographic factors and the perceptions, expectations, and public confidence in Bandung City regarding the role of pharmacists in pharmaceutical services.Methods: A cross-sectional study was conducted using a validated survey instrument with 440 respondents in Bandung, West Java, from March to April 2023. The survey data were analyzed descriptively and through inferential statistics.Results: The analysis showed that 58.41% of the community had a positive perception, 56.82% had high expectations, the average gap between expectations and reality was 14.04%, and more than 51.36% had a high level of public confidence in pharmacists. Sociodemographic factors influencing perceptions were age and the highest level of education (p = 0.005; p = 0.003), factors influencing public confidence were age, the highest level of education, residence address according to ID card (KTP), and occupation (p < 0.001; p = 0.034; p = 0.001; p = 0.001), and the factor influencing expectations was the residence address according to ID card (KTP) (p = 0.043). A correlation was found between the dimensions of perceptions, expectations, and public confidence.Conclusion: Most participants held a positive perception, had high expectations, and shown high confidence in the pharmacist's position, despite the existence of a disparity between expectations and the actual provision of pharmacy services. The elements of perception, expectations, and confidence are interrelated.