Abstract
Typhoid is a global health problem especially in developing countries, one of which is in Indonesia. The incidence of antibiotic resistance in typhoid therapy can occur due to inappropriate use of antibiotics. This study aims to determine patterns of antibiotic use as well as the quality and quantity of antibiotic use in typhoid therapy in one of the provincial government hospitals in Bali. This study was an observational study conducted retrospectively which was analyzed using the Gyssens and ATC/DDD methods. The research data were taken from the medical records of patients in the January-December 2019 period that met the inclusion criteria. The results showed that of the 40 total antibiotics prescribing, ceftriaxone was the most widely used antibiotic for typhoid therapy. The quality of antibiotic use as much as 40% is stated rational (category 0), while the other 60% is irrational (categories I-VI) which includes the use of antibiotics with incorrect interval of administration (IIB; 5%), the use of antibiotics that is too long (IIIA; 40%), the use of antibiotics that are too short (IIIB; 5%), there are other antibiotics that are more effective (IVA; 5%), and there are other antibiotics that are less toxic/safer (IVB; 5%). The quantity of antibiotic use was stated more than WHO standards which includes the use of ceftriaxone at 83.80 DDD/100 patient days; levofloxacin at 27.47 DDD/100 patient days; and azithromycin at 3.52 DDD/100 patient days. The results of this study are expected to be a consideration for the hospital as a material for evaluation and improvement in order to improve the rationality of antibiotic use.
Highlights
This study aims to determine patterns of antibiotic use as well as the quality and quantity of antibiotic use in typhoid therapy in one of the provincial government hospitals in Bali
The results showed that of the 40 total antibiotics prescribing, ceftriaxone was the most widely used antibiotic for typhoid therapy
The quality of antibiotic use as much as 40% is stated rational, while the other 60% is irrational which includes the use of antibiotics with incorrect interval of administration (IIB; 5%), the use of antibiotics that is too long (IIIA; 40%), the use of antibiotics that are too short (IIIB; 5%), there are other antibiotics that are more effective (IVA; 5%), and there are other antibiotics that are less toxic/safer (IVB; 5%)
Summary
Tifoid merupakan penyakit menular yang disebabkan oleh bakteri Salmonella typhi. Pasien tifoid memiliki gejala klinis yaitu demam yang diikuti dengan mual, muntah, anoreksia, dan diare (Adiputra dan Somia, 2017). Pilihan terapi yang tepat untuk tifoid yang disebabkan oleh bakteri Salmonella typhi adalah menggunakan antibiotik. Kasus resistensi bakteri ini juga terjadi pada tahun 1994 terhadap berbagai jenis antibiotik yaitu kloramfenikol, ampisilin, dan trimethoprim-sulfametoksazol, atau dikenal sebagai Multiple Drug Resistance (MDR) (Alam, 2011). Metode ini bertujuan untuk mengklasifikasi penggunaan antibiotik menurut Anatomical Therapeutic Chemical (ATC) dan mengukur jumlah penggunaan antibiotik dengan Defined Daily Dose (DDD/100 patient days berdasarkan standar yang ditetapkan oleh WHO (Kemenkes RI, 2015). Penelitian terkait evaluasi penggunaan antibiotik tifoid berdasarkan metode Gyssens maupun ATC/DDD belum pernah dilakukan di Provinsi Bali. Berdasarkan uraian di atas, maka perlu dilakukan suatu penelitian untuk mengevaluasi penggunaan antibiotik pada kasus tifoid dengan menggunakan metode Gyssens dan ATC/DDD. Dalam penelitian ini diharapkan agar hasil evaluasi penggunaan antibiotik dapat menjadi masukan dan alternatif pemilihan obat antibiotik yang efektif pada kasus tifoid
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