Professional Documents
Culture Documents
Student Project Pharmaceutical
Student Project Pharmaceutical
By:
Group SGD B1
Luh Putu Widya Amritha Dewi / 2002511002
Karina Sih Nityani Kumar / 2002511003
Dewa Ayu Fony Prema Shanti / 2002511004
Ni Putu Ratih Cahaya Dewi / 2002511005
Williem Alexander Hartanto / 2002511011
Darren Junior / 2002511012
Mira Amba Grace Wrycza / 2002511018
Gede Raka Sutha Abdi Samudra / 2002511023
Winnie Chandra / 2002511027
Putu Nindya Krisnadewi Rahadi / 2002511028
I Kadek Sadam Wibawa / 2002511032
Sendi Aprilio / 2002511034
First and foremost, we would like to express our highest gratitude to the
Almighty God for his blessing that has enabled us to finish this student project
entitled “Drugs Usage in Children with Enterobiasis” on time. This student project
was made to complete our final project for the Basic Pharmaceutical and Drug Ethics
block. On this occasion, we would also like to say thanks to:
1. Prof. Dr. dr. I Ketut Suyasa, Sp. B., Sp. OT(K) as the Dean of the
Medical Faculty, Udayana University.
2. Dr. dr. Komang Januartha Putra Pinatih, M.Kes as the Head of the
Undergraduate Medical and Medical Profession Study Program, Medical
Faculty, Udayana University.
3. Apt. Dr. Ida Ayu Alit Widhiartini, as the head of the Basic
Pharmaceutical and Drug Ethics block, our lecturer and the evaluator of
this paper for examining our project.
4. Prof. dr. Ketut Tirtayasa, MS., AIF as our group facilitator, for guiding us
and giving us supportive remarks along the making of this project.
We understand that this project is far from perfect and has many rooms for
improvements. Therefore, we hope all readers are able to give us constructive
critiques and suggestions for the betterment of our future projects. Lastly, we do hope
that this student project can be useful for the readers.
Writers
ii
TABLE OF CONTENTS
Page
FOREWORD......................................................................................................................ii
TABLE OF CONTENTS...................................................................................................iii
LIST OF FIGURES.............................................................................................................v
CHAPTER I INTRODUCTION.........................................................................................1
1.1 Background................................................................................................................1
1.3 Purpose......................................................................................................................2
1.4 Benefit.......................................................................................................................2
2.2.1 Mebendazole...................................................................................................4
2.2.2 Piperazine........................................................................................................5
2.2.4 Albendazole.....................................................................................................7
2.3.1 Mebendazole...................................................................................................8
2.3.2 Piperazine........................................................................................................9
2.3.4 Albendazole...................................................................................................10
REFERENCES..................................................................................................................14
iii
LIST OF FIGURES
Page
Tabel 2.1 Worm Count Before and After Treatment of Pirantel Pamoate..............7
iv
CHAPTER I
INTRODUCTION
1.1 Background
Indonesia is a country with tropical climate, fertile lands, various economic
statuses, dense settlements, knowledge of health, and many of those factors are in low
category. Those phenomena cause a high number of diseases, especially worm
diseases like enterobiasis. Enterobiasis or also known as pinworm infection is a
parasitic infection commonly found in children. This disease is caused by Enterobius
vermicularis (parasitic pinworm). The infection can be transmitted to other people
through direct contact with contaminated food or objects (Kusumasari, Rizqiani.
2019). Worm infection patients can experience malnutrition, anemia, and digestive
tract disorders which in turn result in the decrease of body resistance. The decreased
stamina of the body will reduce the ability to learn in children. Children who often
spend their time outdoors playing or crowding with other children, making direct
contact with water and soil which has higher potential to be infected with Enterobius
vermicularis (Anjarsari, 2018).
The incidence of enterobiasis tends to be higher in children aged 6-8 years
and is still an important health problem in primary school age children. Most of the
countries in Asia have a fairly high rate of enterobiasis. One of the countries with
high incidence of enterobiasis in Asia is Nepal. Enterobiasis in Nepal (South Asia) in
110 children 1-12 years in Barbhan Village, Tanahun District found 14 children, that
means around 12.72% of children were infected with enterobiasis. The highest
incidence occurred in children aged 5-8 years, which was about 5.45% of the total
incidence. Then, followed by 5 children aged 9-12 years, finally 3 children 1-4 years.
There were more boys infected by 9 people than 5 girls (Adrianto & Wartiningsih,
2019). Several studies have also found that the incidence of enterobiasis in several
regions in Indonesia is still quite high. Based on Yulianti's report, the Minister of
Health said that around 60% -80% of school-age children in Indonesia have worm
1
infections. Hendratno S also reported that several areas in Central Java still had a
fairly high pre-
2
2
1.3 Purpose
1. To give information about Enterobiasis vermicularis infection in general.
2. To give information about the profiles of different enterobiasis drugs.
3. To give information about enterobiasis drugs prescribed as therapy for
children.
1.4 Benefit
1. Give general information about Enterobiasis vermicularis infection,
especially in children.
2. Give general information about the profiles of different enterobiasis
drugs.
3. Give general information about enterobiasis drugs prescribed as therapy
for children.
CHAPTER II
LITERATURE REVIEW
3
the infection is severe, secondary bacterial infection may occur due to irritation and
sc-
4
4
ratching of the anal area. Enterobiasis patients usually also complain of insomnia due
to disturbed sleep (Fan et al., 2019; Wendt et al., 2019).
Diagnosis of enterobiasis is carried out in two ways: identifying eggs in feces
and by perianal swab. Stool examination with a saline smear immediately detects the
presence of eggs. Meanwhile, the perianal area is wiped with tape, then placed on a
glass slide and examined for eggs. Swab should be done in the morning before taking
a bath and defecating. Adult worms can sometimes be seen on the skin near the anus
or underwear about 2-3 hours after sleeping (Bharti et al., 2018).
To treat enterobiasis, it is necessary to provide therapy with appropriate
antihelminthic drugs. Medications that can be used include mebendazole, piperazine,
pyrantel pamoate, and albendazole. Enterobiasis can lead to recurrent infections, so if
an infection occurs in a cluster group, treatment is mandatory for all members of the
cluster, whether symptomatic or not (Wendt et al., 2019).
The most widely recognized antagonistic impacts going with mebendazole use
are loss of appetite, stomach torment, diarrhea, flatulence, sickness, retching, cerebral
pain, tinnitus, and raised liver compounds. Some patients may encounter spasms, and
some may have excessive touchiness responses like rash, urticaria, and angioedema.
Mebendazole harmful effect is typically restricted to gastrointestinal disorder, yet
there are reports of other genuine results including neutropenia (counting
agranulocytosis) and additionally thrombocytopenia, especially in patients who have
taken higher measurements or had a more delayed treatment course than normally
suggested.
Mebendazole is contraindicated in children beneath the age of 1 year old for
the mass treatment of single or blended gastrointestinal invasions as a result of the
danger of spasm, which has been accounted for during post promoting use. The FDA
arranged mebendazole as a C class medication, which states either concentrates in
creatures have shown unfriendly results on the hatchling, and there are no accessible
checked examinations in women. Mebendazole is available in breastmilk. In a
restricted case arrangement report utilizing mebendazole during lactation, no
antagonistic results related with the medication happened in nursing babies.
In the condition of overdose, gastrointestinal manifestations (e.g., queasiness,
the runs, heaving, and stomach torment) may happen. In occasions of harmfulness,
actuate regurgitating and cleansing utilizing initiated charcoal if late ingestion has
happened, and just if the patient can secure their aviation route. There is no particular
remedy for mebendazole glut. Treatment is for the most part effective. Liquids and
electrolytes are used in patients who experience huge loose bowels or potentially
retching (Thakur and Patel, 2020).
2.2.2 Piperazine
Piperazine is an anthelmintic drug that is used to treat parasitic infections
caused by worm infections. Piperazine is very effective against Ascaris lumbricoides
which caused Ascariasis and Enterobius vermicularis which caused Enterobiasis.
Piperazine is an alternative treatment for Ascariasis with a cure rate for more than
90% if taken for 2 days but not recommended for other worm infections. However,
6
pamoate is divided into two dosages depending on its package, such as tablets of 720
mg (normally 250 mg) and as a suspension of 144 mg/mL (normally 50 mg/mL) in an
official drug’s brand name Pin-X or Anthelmintic agents/Antiminth. Otherwise the
dosage in both children and adults is 0,1 up to 1 g per kg as a single dose and used in
two weeks constantly (Shen et al., 2019). If the dosage does not work, consider
treating either family or relatives. Adverse effects are unusual, such as GI
(gastrointestinal) disorder, fatigue, and headache (Wijaya, 2017).
Figure 2.1
Worm count before and after treatment of pyrantel pamoate
(Sapulete et al., 2020)
b. For 2 to 8 years of age: 1.2 grams every six hours for a total of two doses in
one day.
c. For 8 to 14 years of age: 1.2 grams every four hours for a total of three
doses in one day.
For tablet dosage form, the dosage is based on body weight and must be
determined by the patient’s doctor. However, the usual dose is 65 mg (piperazine
hexahydrate) per kilogram (29.5 mg per pound) of body weight per day for seven
days in a row. The treatment may need to be repeated in one week (Mayoclinic,
2021).
If the child misses a dose of piperazine, it is advised to take it as soon as
possible. However, if it is almost time for the next dose, skip the missed dose and
directly go back to the regular dosing schedule. Do not let the child take double doses
(Mayoclinic, 2021).
2.3.3 Pyrantel Pamoate
Pyrantel pamoate is the therapy of choice besides albendazole and
mebendazole, works by blocking neuromuscular depolarization, inhibiting
cholinesterase, and causing spastic paralysis in worms (Ryan, 2018). Pyrantel
pamoate is the most widely used drug, is easily available, and is available at health
centers where patients seek treatment. This drug is known by the wider community in
Indonesia, as well as in several other countries, such as in Australia, Canada and
Europe, under the trade name Combantrin®. In case of enterobiasis, the treatment can
be repeated after a time interval of 2 weeks (Wendt et al., 2019).
Pyrantel pamoate is mainly used to treat ascaris lumbricoides, enterobius
vermicularis and ancylostoma duodenale. The recommended single dose is 10
mg/KgBW. Actually all products to treat intestinal worms in humans can only be
used to immobilize adult worms that are in the intestine when the drug is consumed.
These medicines do not disable eggs or immature worms and will not protect children
from recurring enterobius vermicularis infections. Therefore, it is advisable to check
yourself approximately 2-4 weeks after the initial dose of the drug is consumed, to
determine whether a second dose is needed or not (Friesen et al., 2019).
11
2.3.4 Albendazole
Albendazole is one of many kind of drug that has a role as anthelmintic, that
can be used against many infections such as ascariasis, enterobiasis, tricuriasis,
strongyloidiasis, trichinellosis, and also hook worm infection caused by Ancylostoma
Duodenale and Necator Americanus (Melyer, 2016). However, the use of
Albendazole to cure enterobiasis also need guidance such as dosage, duration, and
frequency to ensure that the patient will get the therapeutic benefit from the drug. For
children under 6 months and adult, a 400 mg dose with single frequency need to be
administered, however, for children over 6 months but have weight under 10 kg, need
to be given 200 mg with single dose (WHO, 2021). The time span between the first
and second dose need to be at least 2 to 4 weeks in the event of using this drug to cure
enterobiasis (WHO, 2021).
CHAPTER III
SUMMARY
12
tablet. The dosage for each form is based on the child's age/ body weight and the
treatment
13
13
may need to be repeated in one to two weeks. For pyrantel pamoate drug single dose
is 10 mg / Kg BW, but it only kills the adult worms in the intestines not the immature
eggs or worms hence it will not protect children from recurring enterobiasis.
Albendazole therapeutic treatment for children can be given in age under and over 6
months. For children under 6 months take a single dose of 400 mg and for children
over 6 months with weighing less than 10 kg need to take 200 mg in a single dose.
REFERENCES
14
M.,
et al. (2019), “Detection of Enterobius vermicularis in greater Berlin, 2007–
2017: seasonality and increased frequency of detection”, European Journal of
Clinical Microbiology and Infectious Diseases, Vol. 38 No. 4, available
at:https://doi.org/10.1007/s10096-019-03495-1.
Health Products Regulatory Authority. (2018), Publicly Available Assessment Report
for a Veterinary Medicinal Product.
Hong, S.T. (2018), “Albendazole and praziquantel: Review and safety monitoring in
Korea”, Infection and Chemotherapy, Korean Society of Infectious Diseases,
Korean Society for Chemotherapy, 1 March.
Kang, W.-H. & Jee, S.-C. (2019), “ Enterobius vermicularis (Pinworm) Infection ”,
New England Journal of Medicine, Vol. 381 No. 1, p. e1.
Katzung, B.G. (2018), Basic & Clinical Pharmacology.
Kusumasari, Rizqiani. (2019), “Penyakit Enterobiasis – Parasitologi Kedokteran
UGM”. (n.d.). , available at: https://parasito.fkkmk.ugm.ac.id/penyakit-
enterobiasis/ (accessed 2 May 2021).
Lubis, S.M., Pasaribu, S. & Lubis, C.P. (2016), “Enterobiasis pada Anak”, Sari
Pediatri, Vol. 9 No. 5, p. 314.
Mayoclinic.org. 2021. Piperazine (Oral Route) Proper Use - Mayo Clinic. [online]
Available at: <https://www.mayoclinic.org/drugs-supplements/piperazine-
oral-route/proper-use/drg-20065522> [Accessed 10 May 2021].
Melyer, S. (2016), “Albendazole - an overview | ScienceDirect Topics”, available at:
https://www.sciencedirect.com/topics/pharmacology-toxicology-and-
pharmaceutical-science/albendazole (accessed 4 May 2021).
MIMS. (2021), “Piperazine”, available at:
https://www.mims.com/indonesia/drug/info/piperazine?mtype=generic
Nurhasanah & Murlina, N. (2020), “Perbandingan Efektivitas Pirantel Pamoat
Dengan Albendazol Terhadap Infeksi Soil Transmitted Helminth pada Siswa
SD Tahun 2018”, Jurnal Pandu Husada, Vol. 4 No. 1, pp. 226–232.
Raza, A., Rand, J., Qamar, A.G., Jabbar, A. & Kopp, S. (2018), “Gastrointestinal
15
parasites in shelter dogs: Occurrence, pathology, treatment and risk to shelter
workers”, Animals, Vol. 8 No. 108, pp. 1–23.
Sapulete, E.J.J., Utama, I.M.G.D.L., Putra, I.G.N.S., Wati, D.K., Arimbawa, I.M. &
Gustawan, I.W. (2020), “Efficacy of Albendazole-Pyrantel Pamoate
Compared to Albendazole Alone for Trichuris trichiura Infection in Children:
A Double Blind Randomised Controlled Trial”, Malaysian Journal of
Medical Sciences, Vol. 27 No. 3, pp. 67–74.
Shen, C., Li, M., Zhao, X. & Cui, L. (2019), “An Ocular Myasthenia Gravis Attack
after Oral Pyrantel Pamoate: An Unusual Case Report”, Medicine, Vol. 98
No. 27, pp. 1–3.
Thakur, R. K., & Patel, S. P. (2020). Mebendazole. In StatPearls. StatPearls Publish.
Wendt, S., Trawinski, H., Schubert, S., Rodloff, A.C., Mössner, J. & Lübbert, C.
(2019), “Diagnostik und Therapie des Madenwurmbefalls”, Deutsches
Arzteblatt International, Vol. 116 No. 13, pp. 213–219.
Wendt, S., Trawinski, H., Schubert, S., Rodloff, A.C., Mössner, J. & Lübbert, C.
(2019), “The Diagnosis and Treatment of Pinworm Infection”, Deutsches
Aerzteblatt Online, available at:https://doi.org/10.3238/arztebl.2019.0213.
WHO. (2021), “WHO | Deworming in children”, available at:
https://www.who.int/elena/titles/guidance_summaries/deworming-children/
en/ (accessed 4 May 2021).
Wijaya, J.S. (2017), “Perbandingan Efektivitas dan Efek Samping Albendazole
dengan Kombinasi Mebendazole-Pyrantel Pamoat untuk Terapi Soil-
transmitted Helminthiasis Anak Sekolah Dasar di Kecamatan Medan
Tembung”, Cermin Dunia Kedokteran, Vol. 44 No. 6, pp. 381–385.
16
15