Pengaruh Faktor Risiko terhadap Waktu Timbulnya Efek Samping Kanamisin pada Tuberkulosis Resistan Obat
Abstract
Kanamisin adalah obat untuk terapi tuberkulosis resistan obat (TB RO) yang menimbulkan efek samping gangguan pendengaran, gangguan fungsi ginjal, dan gangguan elektrolit terutama hipokalemia. Penelitian bertujuan menilai kesintasan waktu timbulnya efek samping dan pengaruh faktor risiko usia, riwayat terapi streptomisin serta berat badan terhadap efek samping akibat pemberian kanamisin pasien TB RO. Penelitian kohort retrospektif dari data rekam medis pasien TB RO dari Januari 2011 sampai April 2017 di RSUD Dr. Moewardi Surakarta. Analisis pengaruh faktor risiko terhadap efek samping menggunakan uji cox regression. Dari 238 pasien didapatkan gangguan pendengaran 143 pasien, gangguan fungsi ginjal 147 pasien, dan hipokalemia 169 pasien. Usia lebih dari 40 tahun hazard ratio (HR) 2,419 (IK: 95%; 1,716–3,409; p= 0,000) dan jenis kelamin perempuan HR: 1,549 (IK: 95%; 1,089–2,202; p= 0,015) berisiko terjadi gangguan pendengaran. Usia lebih dari 40 tahun HR: 1,892 (IK: 95%; 1,353–2,646; p= 0,000) dan jenis kelamin perempuan HR: 1,667 (IK: 95%; 1,179–2,357; p= 0,004) berisiko terjadi gangguan fungsi ginjal. Riwayat streptomisin sebelumnya dan indeks massa tubuh (IMT) tidak berisiko timbul efek samping akibat pemberian kanamisin. Pengawasan ketat timbulnya efek samping gangguan pendengaran dan gangguan fungsi ginjal pasien usia lebih dari 40 tahun dan perempuan pada pengobatan TB RO.
Kata kunci: Efek samping, gangguan fungsi ginjal, gangguan pendengaran, kanamisin, TB resistan obat
Effects of Risk Factors on the Onset of Kanamycin’s Adverse Events in Drug Resistant Tuberculosis
Kanamycin is a therapy for drug-resistant tuberculosis (TB) which may cause hearing loss, impaired kidney function, and electrolyte disorders, especially hypokalemia. The objective of this study was to assess patient survival and the effects of risk factors such as age, previous history of streptomycin therapy, and weight on adverse events due to kanamycin administration in patients with drug resistant TB. A retrospective cohort study was conducted in TB patients by using medical records from January 2011 to April 2017 in Dr. Moewardi Hospital Surakarta. Cox regression analysis was used to analyze the relation between risk factors and adverse events. Of 238 patients, 143 patients experienced hearing loss, 147 patients experienced impaired kidney function, and 169 patients had hypokalemia. Age over 40 and female gender had higher risks for hearing loss and impaired kidney function (HR: 2.419 (95% CI: 1.716–3.409; p= 0,000) and HR: 1,892 (95% CI: 1.353–2.646; p=0,000); HR: 1.549 (95%CI: 1.089–2.202; p=0,015), and HR: 1.667 (95% CI: 1.179–2.357; p=0.004)), respectively. History of streptomycin and body mass index (BMI) were not risk factors for kanamycin’s adverse events. Therefore, closed monitoring on hearing loss and impaired kidney function is necessary for drug resistant TB patients aged over 40, and female patients.
Key words: Adverse events, drug resistant tuberculosis, hearing loss, impaired kidney function, kanamycin
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DOI: https://doi.org/10.15395/mkb.v50n2.1297
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