Do pharmacists counsel customers on the disposal of unused or expired household medications? A national survey among 1,596 pharmacists in Indonesia.

Introduction: Pharmacists play a vital role in counseling customers on proper medication disposal, yet their consistency in providing such information is often lacking. This study aimed to assess pharmacists' awareness of appropriate disposal practices for unused and expired household medications. Additional objectives included evaluating whether pharmacists offer disposal information during counseling, measuring their willingness to receive medication waste from the public, and identifying associated factors. Methods: A national cross-sectional online survey employing convenience sampling was conducted among pharmacists working in hospitals, pharmacies, clinics, or community health centers (CHCs) in Indonesia, using a validated questionnaire to assess awareness, information provision, and willingness to receive medications for disposal. Binary logistic regression, with 95% confidence intervals (CI) and odds ratios (OR), explored potential associations between factors and outcomes. Results: This study involved 1,596 pharmacists across 37 Indonesian provinces. Most pharmacists were women (80.4 %), aged 31-40 years (49.3 %), with a pharmacist professional background (93.8 %), working in CHCs (41.2 %), and practicing for 1-5 years (51.0 %). More than half were unaware of guidelines for returning medications to health facilities. While 69.9 % never counseled customers on disposal practices, 64.9 % expressed willingness to receive unused and expired medication from the public. Pharmacists practicing for at least six years were more likely to provide disposal information during counseling (OR: 2.54; 95 % CI: 1.44-4.47). Conversely, those in clinics (OR: 2.16; 95 % CI: 1.29-3.62), CHCs (OR: 2.07; 95 % CI: 1.45-2.95), or hospitals (OR: 2.00; 95 % CI: 1.27-3.14) were more likely to be unwilling to receive expired and unused household medication. Conclusions: The study reveals that most pharmacists, particularly those with limited practice duration, lacked awareness regarding the importance of proper medication disposal and did not provide counseling on appropriate medication disposal to patients. To address this issue, there is a pressing need for intensified education intensified education at the undergraduate level, continuous training for pharmacists, and a clear policy and practical guidelines, particularly targeting pharmacists in clinics, CHCs, and hospitals, to facilitate the acceptance of unused and expired household medications.

Characteristics, knowledge, attitude, and practice of pharmacy personnel in supporting tuberculosis treatment: A multicentre cross-sectional study in a high-burden tuberculosis country.

BACKGROUND: Positive roles of community pharmacy in TB care have been widely reported. However, the actual practice of supporting TB treatment is not optimal yet. Therefore, we analyzed the current practice of community pharmacy personnel and its factors in supporting the successful treatment of TB patients in Indonesia, aiming to develop strategies for effective and sustainable TB practice models for the community pharmacy. METHODS: We performed a cross-sectional survey in three areas representing Indonesia's eastern, central, and western parts. Development and validation of the questionnaire were conducted to assess four domains, i.e., characteristics, knowledge, attitudes, and practice of community pharmacy personnel in supporting the successful treatment of TB patients. Data were collected with purposive convenience sampling using online and offline questionnaires. Descriptive analyses were used to summarize factors in each domain, while binary logistic regression was used to analyze the associated factors of the practice. RESULTS: Thirty-five questionnaire items indicated a valid instrument, and the study successfully included 844 participants who comprised pharmacists (n= 473, 56%) and pharmacy assistants (n= 371, 44%). Although most of the knowledge items were correctly answered by more than 60% of the participants, items related to TB signs, risk groups, drug regimens, and medicine uses were still less than 60%. This was in line with exposure to updated TB training in only 51% of the participants (n= 426). Most of the participants had a positive attitude toward their professional role (n= 736, 87%), capability (n= 646, 77%), and consequences (n= 655, 78%) in supporting TB treatment. However, this was not aligned with the actual practice of supporting TB treatment, intensively performed by only 1.3% of participants (n=11). We identified several factors associated with the practice, i.e., a pharmacy assistant background (p<0.05), short working time (p<0.05), experience in TB training (p<0.001), and a positive attitude (p<0.001). CONCLUSIONS: This study highlighted a limited number of community pharmacy personnel practising as TB treatment supporters in Indonesia. An interventional package considering the identified factors is needed to develop effective and sustainable practices in the real world.

Development and validation of assessment instrument for the perception and attitude toward tuberculosis among the general population in Indonesia: a Rasch analysis of psychometric properties.

Introduction: Tuberculosis (TB)-related knowledge is an important evaluation metric for health education interventions. Factor analysis is limited when used on ordinal scales and does not provide in-depth item function examinations, whereas Rasch analysis addresses these limitations and offers potential advantages such as generalizability, testing of unidimensionality, producing an ordered set of items, and identifying poorly functioning items. Therefore, this research aims to develop a reliable and valid measure of perception and attitude toward TB (PATT) for public application use Rasch Analysis. Methods: A questionnaire-based survey was conducted on the Indonesian general population using the Google Form platform. Rasch analysis was then employed to examine the psychometric properties and develop the final items of PATT. Results: Experts from across the TB community participated in the PATT development, producing an initial scale of 16 items. Up to 1,616 participants completed the PATT questionnaire, where 74.8% were female, and 5% had a TB history. The final unidimensional 16-item scale has an item reliability of 1.00 for the two components (perception and attitude), a person reliability index of 0.87 and 0.60, as well as a Cronbach's test reliability of 0.88 and 0.88 for perception and attitude, respectively. Conclusion: The PATT is a unidimensional scale with good construct validity and internal consistency. It has the potential to be useful for the assessment of TB perception and attitude in research and clinical practice.

The psychometric properties of the Indonesian version of the Willingness to use telemedicine questionnaire in pharmacy students

Backgound: The Willingness to Use Telemedicine Questionnaire (WTQ) was translated into Indonesian and cross-culturally adapted with the intention of analyzing the validity and reliability of the surveys. Our study aims to translate, cross-culturally adapt the Willingness to Use Telemedicine Questionnaire (WTQ) into the Indonesian version and analyze the questionnaires’ psychometric properties. Methods: In Yogyakarta province, 327 pharmacy students were conveniently recruited. Cronbach’s alpha coefficient was used to gauge internal consistency. Analyzing the results of 60 patients who were retested one week later allowed for the calculation of the test-retest reliability using the intraclass correlation coefficient. Results: Pearson’s correlation coefficient (r) was used to assess the construct validity. Additionally, an investigation of the WTQ’s exploratory factor analysis and internal consistency for subscores was done. The mean age was 21.68 ±2.43 years. The internal consistency of each item and the overall WTQ score were excellent (>0.80; ranged from 0.856 to 0.977). The test-retest reliability of all items and the WTQ’s overall score was between satisfactory and outstanding (0.856–0.977). Strong association (r = 0.923, P 0.001) existed between WTQ and WTPQ. The WTQ has high factor loading scores (0.621–0.843). Conclusion: The Indonesian WTQ is reliable and valid among university students. (AU)

Development and Validation of the Knowledge, Attitude, and Practice Questionnaire for Community Pharmacy Personnel in Tuberculosis Case Detection, Drug Monitoring, and Education: A Study from Indonesia.

Background: Validated and standardized structured questionnaires based on psychometric analysis are extremely limited, particularly for assessing community pharmacy personnel's knowledge, attitude, and practice (KAP) in tuberculosis (TB) case detection, drug monitoring, and education. We, therefore, developed and validated a questionnaire to assess the KAP of community pharmacy personnel in TB case detection, drug monitoring, and community education. Methods: This study was conducted in two phases. First, we developed the questionnaire, which included framework development, item generation, individual item content validity index (I-CVI), item screening, and pre-testing. Second, we validated the questionnaire with 400 participants using various analyses, including participant analysis, confirmatory factor analysis (CFA), adjusted goodness-of-fit index (AGFI), comparative fit index (CFI), non-normed fit index (NNFI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR). We determined the reliability test using Cronbach's alpha and test-retest reliability using Pearson's correlation. Results: In the development phase, we defined 63 items that comprised 18 sociodemographic, 18 knowledge, 18 attitude, and 9 practice items. Across the 63 items, the I-CVI scores of sociodemographic and KAP items were one each. The CFA model parameter values were X2/df= 2.28; AGFI = 0.95; CFI = 0.99; NNFI = 0.98; RMSEA = 0.06; and SRMR = 0.03 (p < 0.05 for all). Cronbach's alpha coefficients of KAP items were 0.75, 0.91, and 0.95, respectively. The test-retest reliability coefficients of KAP were 0.84, 0.55, and 0.91, respectively (p < 0.01). Conclusion: This study indicates that the developed questionnaire is a valid and reliable instrument for assessing the KAP of community pharmacy personnel for TB case detection, drug monitoring, and community education in Indonesia. Community pharmacy personnel can support TB notification and treatment by assessing their prospective roles in surveys using this questionnaire, enabling TB eradication in 2030.

Practical Models of Pharmaceutical Care for Improving Tuberculosis Patient Detection and Treatment Outcomes: A Systematic Scoping Review.

Decreasing global tuberculosis (TB) notifications indicate problems related to TB patient detection and treatment outcomes. Pharmaceutical care (PC) has potential roles in managing these issues. However, PC practices have not yet become widespread in the real world. This systematic scoping review aimed to identify and analyze the current literature on practical models of pharmaceutical care for improving tuberculosis patient detection and treatment outcomes. We then discussed the present challenges and future considerations for the successful implementation of PC services in TB. A systematic scoping review was performed to identify the practice models of PC in TB. Systematic searches and screening were used to identify relevant articles in the PubMed and Cochrane databases. We then discussed the challenges and recommendations for successful implementation using a framework to improve professional healthcare practice. Our analysis included 14 of 201 eligible articles. We identified that the focuses in the PC of TB are on increasing patient detection (four articles) and improving TB treatment outcomes (ten articles). Practices cover services in the community and hospital settings, such as screening and referring people with presumptive TB, tuberculin test services, collaborative practices for treatment completion, directly observed treatment, the solution of drug-related problems, reporting and managing adverse drug reactions, and medication adherence programs. Although PC services positively increase TB patient detection and treatment outcomes, hidden challenges in the actual practice are analyzed. Several factors should be comprehensively considered in successful implementation, such as guidelines, individual pharmacy personnel, patient, professional interaction, organizational capacity, regulation, incentive, and resource factors. Hence, a collaborative PC program that involves all related stakeholders should be considered to create successful and sustainable PC services in TB.

Traditional medicine users in a treated chronic disease population: a cross-sectional study in Indonesia.

BACKGROUND: Traditional medicine (TM) is commonly used as a treatment in Indonesia. This raises the need for an analysis of its potential development and irrational use. Therefore, we analyze the proportion of TM users among chronic disease patients and its associated characteristics to optimize the use of TM in Indonesia. METHODS: A cross-sectional study of treated adult chronic disease patients was conducted using the fifth Indonesian Family Life Survey (IFLS-5) database. Descriptive analysis was used to identify the proportion of TM users, while a multivariate logistic regression was used to analyze their characteristics. RESULTS: This study included 4901 subjects and identified 27.1% as TM users. The highest TM use was in subjects with cancer (43.9%), liver issues (38.3%), cholesterol issues (34.3%), diabetes (33.6%), and stroke (31.7%). Characteristics associated with TM users were a perception of one's current health as unhealthy (OR 2.59, 95% CI 1.76-3.81), low medication adherence (OR 2.49, 95% CI 2.17-2.85), age above 65 years (OR 2.17, 95% CI 1.63-2.90), having higher education (OR 1.64, 95% CI 1.17-2.29), and residence outside of Java (OR 1.27, 95% CI 1.11-1.45). CONCLUSIONS: Low medication adherence among TM users highlights the potentially irrational use of treatment in chronic diseases. Nevertheless, the longstanding use of TM users indicates the potential for its development. Further studies and interventions are needed to optimize TM use in Indonesia.

Effect of Immunomodulating Extract and Some Isolates from Etlingera rubroloba A.D. Poulsen Fruits on Diabetic Patients with Tuberculosis.

Diabetes mellitus (DM) is a disease easily complicated by tuberculosis (TB) due to impaired function of the innate immune response. The successes of the discovery of immunomodulatory compounds needs to be continued to introduce new insights into the innate immune response. In previous studies, plant compounds of Etlingera rubroloba A.D. Poulsen (E.rubroloba) were demonstrated to have potential as an immunomodulators. This study aims to isolate and identify the structure of the compounds of E.rubroloba fruit that could effectively improve the function of the innate immune response in individuals with DM infected with TB. The isolation and purification of the compounds of the E.rubroloba extract were carried out by radial chromatography (RC) and thin-layer chromatography (TLC). Identification of the isolated compound structures was determined by measuring the proton (1H) and carbon (13C) nuclear magnetic resonance (NMR). In vitro testing was performed on the immunomodulating activity of the extracts and isolated compounds on DM model macrophages infected with TB antigens. This study succeeded at isolating and identifying the structures of two isolate compounds, namely Sinaphyl alcohol diacetat (BER-1), and Ergosterol peroxide (BER-6). The two isolates were more effective as immunomodulators than the positive controls were, which differed significantly (* p < 0.05) at the reducing interleukin-12 (IL-12) levels and Toll-like receptor-2 (TLR-2) protein expression and increasing the human leucocyte antigen-DR (HLA-DR) protein expression in DM infected with TB. The isolated compound was discovered in E. rubroloba fruits, which has been reported to have the potential to be developed as an immunomodulatory agent. Follow-up testing to determine the mechanism and effectiveness of these compounds as immunomodulators for DM patients is required so that they are not susceptible to TB infection.

The development of the national tuberculosis research priority in Indonesia: A comprehensive mixed-method approach.

Ranked second in global tuberculosis (TB) incidence, Indonesia has developed a National Strategy for TB Prevention and Control 2020-2024 to accelerate the TB elimination program. Research and innovation are key pillars to support the program and need to be prioritised. This study aimed to develop updated national TB research priorities in Indonesia. This study was a mixed-methods study consisting of an open survey, a published literature survey, and Delphi survey. The open survey invited all related TB stakeholders to answer (a) the main barriers of the TB program and (b) the need for studies to support TB elimination. The published literature survey retrieved scientific articles published in national and international journals between 2015 and 2020 to identify gaps between published research and the current national strategy for TB control. The online survey and literature survey informed a panel of TB experts in a two-phase Delphi Survey to select the top 10 priority research topics. We identified 322 articles and analysed 1143 open survey responses. Through two-phases Delphi surveys, top ten research categories were listed: early TB detection; diagnosis and treatment of DR-TB; contact investigation; case detection and treatment of child TB; TB preventive therapy; government policy; laboratory for drug-sensitive- and drug-resistant-TB diagnosis; treatment adherence; diagnostic tool development; and community empowerment. This study also found the gap between stakeholders' interests and the importance of translating research into policy and practice. TB research priorities have been identified through the involvement of various stakeholders. The combination of an online survey, a published literature survey, and a Delphi survey was a rigorous methodology and was fit to build a systematic consensus about the priority of TB research.

Patients' Perspectives of Interprofessional Collaboration in Breast Cancer Unit.

Interprofessional teamwork provides significant benefits for patients. However, qualitative research on interprofessional collaboration in the breast cancer unit is uncommon. Therefore, a qualitative study was conducted to assess the perceptions of outpatient breast cancer patients regarding interprofessional collaboration in the breast care unit of an Indonesian referral center hospital. The teamwork involved in the interprofessional collaboration included breast cancer specialists, pharmacists, and nurses. In this study, in-depth interviews were performed with nine breast cancer outpatients. All interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. The findings were divided into two categories to gather breast cancer patients' viewpoints on interprofessional collaboration: (1) obstacle components to interprofessional collaboration: incompleteness of health personnel, no justification from health personnel, no knowledge of patients about health professionals, no involvement of patients in the therapy decision making; (2) enabling elements: patient-oriented, patient expectations, collaboration among healthcare personnel, patient participation in interprofessional collaboration, health personnel responsibilities, comprehensive hospital services. Respondents assumed interprofessional collaboration positively. However, several obstacles must be overcome to implement interprofessional collaboration in a breast care setting effectively. The research findings can be utilized to establish interprofessional collaborations aimed at improving quality healthcare in breast cancer units.

Development and validation of a structured questionnaire for assessing risk factors of medication non-adherence among pulmonary tuberculosis patients in Indonesia.

Background: Medication non-adherence is a significant concern in tuberculosis (TB) treatment, requiring a precise understanding of the associated risk factors. However, there is a lack of appropriate means to assess the risk factors among TB patients in Indonesia, leading to the development and validation of a structured questionnaire for this purpose. Method: This study unfolded in two distinct phases, namely, the first included questionnaire construction through framework development, item generation, item screening, and pretesting (in 50 patients). The second comprised questionnaire validation with 346 participants using confirmatory factor analysis (CFA) and structural equation modeling-partial least squares (SEM-PLS). Additionally, reliability testing was conducted using Cronbach's alpha and composite reliability statistical techniques. Results: In the development phase, 168 items were defined, consisting of sociodemographic characteristics (8 items) and risk factors for medication non-adherence (160 items). Expert evaluation reduced the number of items to 60, which decreased to 22 after performing a pilot study. Subsequent SEM-PLS modeling resulted in the identification of 14 valid items, representing five major risk factors, namely, socioeconomics (4 items), healthcare team (4 items), condition (3 items), therapy (2 items), and patient (1 item). Only condition-related factors were found to influence non-adherence, and all constructs showed good reliability based on Cronbach's alpha (>0.6) and composite reliability (0.7) values. Conclusion: The final 22 items that emerged from this rigorous process indicated a valid and robust questionnaire for assessing risk factors of medication non-adherence among pulmonary tuberculosis patients in Indonesia. The developed questionnaire was positioned to be a valuable tool for healthcare professionals, policymakers, and scientists in creating patient-centered strategies and interventions to address non-adherence.

Depression is Associated with the Increase Risk of Multimorbidity Among the General Population in Indonesia.

Purpose: Depression is common among patients with chronic disease. However, little is known about the association between depression and the risk of developing multimorbidity. This study aims to identify the association between depression and the incidence of multimorbidity among the general population in Indonesia. Patients and Methods: The national cross-sectional population-based survey used publicly available data from the Indonesian Family Life Survey (IFLS-5) for 2014 among respondents aged ≥15 years. Depression was assessed using the Center for Epidemiologic Studies-Depression (CES-D) scale. The number of chronic diseases and amount of sociodemographic information were obtained from self-reported data. A logistic regression analysis was used to assess the association between depression and multimorbidity, adjusting for confounders. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Results: The study recruited 2222 respondents; the majority of them were male (68.0%) and aged 55-64 years (34.7%). Of the total number of respondents, 69.6% have depression and 36.5% have multimorbidity. The prevalence of depression in respondents increases with age. Depressive symptoms were more likely to report multimorbidity (OR 2.05, 95% CI: 1.66-2.52). Conclusion: Depression is associated with the increased risk of multimorbidity among the general population in Indonesia. Therefore, screening for and treatment of depression for those at risk of developing multimorbidity are urgently needed.

Knowledge, attitude and practice of community pharmacy personnel in tuberculosis patient detection: a multicentre cross-sectional study in a high-burden tuberculosis setting.

INTRODUCTION: Control of tuberculosis (TB) is hampered by suboptimal case detection and subsequent delays in treatment, which is worsened by the COVID-19 pandemic. The community pharmacy is reported as the place for first aid medication among patients with TB. We, therefore, analysed knowledge, attitude and practice (KAP) on TB patient detection (TBPD) of community pharmacy personnel, aiming to find innovative strategies to engage community pharmacies in TBPD. METHODS: A multicentre cross-sectional study was performed in four areas of Indonesia's eastern, central and western parts. Pharmacists and pharmacy technicians who worked in community pharmacies were assessed for their characteristics and KAP related to TBPD. Descriptive analysis was used to assess participant characteristics and their KAP, while multivariable regression analyses were used to analyse factors associated with the KAP on TBPD. RESULTS: A total of 1129 participants from 979 pharmacies, comprising pharmacists (56.6%) and pharmacy technicians (43.4%), were included. Most participants knew about TB. However, knowledge related to TB symptoms, populations at risk and medication for TB were still suboptimal. Most participants showed a positive attitude towards TBPD. They believed in their professional role (75.1%), capacity in TB screening (65.4%) and responsibility for TBPD (67.4%). Nevertheless, a lack of TBPD practice was identified in most participants. Several factors significantly associated with performing the TBPD practice (p<0.05), such as TB training experience (p<0.001), provision of a drug consultation service (p<0.001), male gender (p<0.05), a positive attitude towards TBPD (p<0.001), short working hours (p<0.001) and central city location of the pharmacy (p<0.05). CONCLUSIONS: Most participants had good knowledge and attitude, which did not translate into actual TBPD practice. We identified that TB educational programmes are essential in improving the KAP. A comprehensive assessment is needed to develop effective strategies to engage the community pharmacy in TBPD activities.

Interprofessional collaboration in the breast cancer unit: how do healthcare workers see it?

BACKGROUND: Interprofessional collaboration has an important role in health care for breast cancer patients who are undergoing treatment at the hospital. Interprofessional collaboration has been reported to provide significant benefits for patients. However, qualitative research on interprofessional collaboration in the breast cancer department is rarely done, therefore, a study was conducted to determine the perception of health practitioners about interprofessional collaboration in the breast care unit at a referral centre hospital in West Java, Indonesia. METHODS: A qualitative study was carried out using in-depth interviews and focus group discussions (FGDs) with 15 healthcare personnel using total sampling. Participants were chosen among healthcare professionals who treat and in charge for outpatient breast cancer, but were not resident physicians. The FGD approach was used for nurses and pharmacists, and interviews were used for oncologists. The audio recordings of all interviews and FGDs were transcribed verbatim and evaluated using thematic analysis. RESULT: The findings were categorized into two categories to obtain health care workers' perspectives on interprofessional collaboration: (1) impediment factors: personality, lack of leadership, seniority, healthcare workers with double positions, the need for a clinical meeting, hospital bureaucracy, national health insurance implementation, issues with patients, hospital infrastructure, and evaluation and synchronisation; (2) existing supportive elements: effective cooperation, effective communication, clear job description, interpersonal relationships, Standard Operational Procedure (SOP) for cancer therapy, legality for inter-discipline cancer team, professional responsibility, integrated clinical pathway, patient centred care, and comprehensive health services. CONCLUSIONS: Interprofessional collaboration was seen positively by the respondents. However, there are several hurdles that must be overcome to apply interprofessional collaboration works effectively. The findings of this study can be used to build interprofessional collaborations targeted at enhancing quality health care in breast cancer units.

Risk factors of multidrug-resistant tuberculosis: A global systematic review and meta-analysis.

OBJECTIVES: Since the risk of multidrug-resistant tuberculosis (MDR-TB) may depend on the setting, we aimed to determine the associations of risk factors of MDR-TB across different regions. METHODS: A systematic review and meta-analysis was performed with Pubmed and Embase databases. Information was retrieved on 37 pre-defined risk factors of MDR-TB. We estimated overall Mantel-Haenszel odds ratio as a measure of the association. RESULTS: Factors of previous TB disease and treatment are the most important risk factors associated with MDR-TB. There was also a trend towards increased risk of MDR-TB for patients 40 years and older, unemployed, lacking health insurance, smear positive, with non-completion and failure of TB treatment, showing adverse drug reaction, non-adherent, HIV positive, with COPD and with M. Tuberculosis Beijing infection. Effect modification by geographical area was identified for several risk factors such as male gender, married patients, urban domicile, homelessness and history of imprisonment. CONCLUSIONS: Assessment of risk factors of MDR-TB should be conducted regionally to develop the most effective strategy for MDR-TB control. Across all regions, factors associated with previous TB disease and treatment are essential risk factors, indicating the appropriateness of diagnosis, treatment and monitoring are an important requirements.

Antibiotic resistance in sepsis patients: evaluation and recommendation of antibiotic use.

BACKGROUND: The appropriate selection of empirical antibiotics based on the pattern of local antibiotic resistance can reduce the mortality rate and increase the rational use of antibiotics. AIMS: We analyze the pattern of antibiotic use and the sensitivity patterns of antibiotics to support the rational use of antibiotics in patients with sepsis. MATERIALS AND METHODS: A retrospective observational study was conducted in adult sepsis patient at one of Indonesian hospital during January-December 2011. Data were collected from the hospital medical record department. Descriptive analysis was used in the processing and interpretation of data. RESULTS: A total of 76 patients were included as research subjects. Lung infection was the highest source of infection. In the 66.3% of clinical specimens that were culture positive for microbes, Klebsiella pneumoniae, Escherichia coli, Staphylococcus hominis were detected with the highest frequency. The six most frequently used antibiotics, levofloxacin, ceftazidime, ciprofloxacin, cefotaxime, ceftriaxone, and erythromycin, showed an average resistance above 50%. CONCLUSIONS: The high use of antibiotic with a high level resistance requires a policy to support its rational use. Local microbial pattern based on site infection and pattern of antibiotics sensitivity test can be used as supporting data to optimize appropriateness of empirical antibiotics therapy in sepsis patients.