Evaluasi penggunaan antibiotik pada pasien penyakit ginjal kronik rawat inap di RSUD DR MOEWARDI Surakarta periode September - November 2007

YULIANTI, Tri, Prof. Dr. Likman Hakim, M.Sc., Apt

2008 | Tesis | S2 Farmasi Klinik

Latar Belakang : Evaluasi penggunaan obat khususnya antibiotik merupakan salah satu bentuk tanggung jawab farmasis di lingkungan rumah sakit dalam rangka mempromosikan penggunaan antibiotik yang rasional. Penyakit infeksi sering terjadi pada pasien penyakit ginjal kronik, sehingga penggunaan antibiotik pada populasi ini perlu mendapatkan perhatian. Tujuan : Penelitian ini bertujuan untuk memberi gambaran penggunaan antibiotik pada pasien penyakit ginjal kronik di RSUD Dr. Moewardi Surakarta yang meliputi aspek indikasi, ketepatan dosis dan durasi, hasil terapi, adverse drug reaction dan interaksi obat. Metode : Penelitian dilakukan dengan rancangan studi observasional menggunakan desain cross-sectional. Pengambilan data pasien penyakit ginjal kronik secara prospektif dilakukan pada populasi terbatas di ruang bangsal rawat inap dan HCU Melati I di RSUD Dr. Moewardi selama periode September – November 2007. Pengolahan data dilakukan secara analisis deskriptif. Hasil dan Pembahasan : Selama penelitian di rumah sakit ditemukan 103 pasien didiagnosis mempunyai penyakit ginjal kronik dan 48 pasien (46,6%) termasuk kriteria inklusi. Berdasarkan 48 pasien kriteria inklusi ditemukan 55 episode infeksi, yaitu mempunyai indikasi pada 52 episode infeksi terdiri atas pneumonia 21 (38,2%), infeksi saluran kemih 22 (40%), sepsis 4 (7,3%), profilaksis bedah 1 (1,8%), amoebiasis 2 (3,6%), gastroenteritis 1 (1,8%), dan tuberkulosis paru 1 (1,8%) serta terdapat 3 (5,5%) penggunaan antibiotik tanpa indikasi.Terdapat 45 (81,8%) episode infeksi yang tepat indikasi tepat obat, 6 (10,9%) tepat indikasi tidak tepat obat dan 1 (1,8%) kontraindikasi. Kontraindikasi pemberian antibiotik pada pasien penyakit ginjal kronik yaitu pemberian nitrofurantoin. Terdapat 16,1% dosis antibiotik yang belum disesuaikan untuk pasien penyakit ginjal kronik Berdasarkan hasil terapi pemberian antibiotik didapatkan 45,5% responnya baik. Adverse drug reaction (reaksi obat merugikan) sulit dinilai dalam penelitian ini. Interaksi obat potensial terjadi diantara pemberian antibiotik dengan obat lain. Kesimpulan : Penelitian ini menyimpulkan dari pemberian antibiotik pada pasien penyakit ginjal kronik hanya terdapat 25 episode infeksi (45,5%) yang memberikan hasil terapi baik.

Background : Drug used evaluation prior to antibiotic is one of pharmacist responsibility in hospital to promoting rational drug use of antibiotic. Infection disease often happened in patient with chronic kidney disease, so that the use of antibiotic in this population are require to get attention. Objective : This research aim is to describe the use of antibiotic at patient with chronic kidney disease at Dr. Moewardi Hospital covering indication aspect, accuracy of duration and dose, therapy outcome, adverse drug reactions and drug interactions. Method : Research conducted with observational study device and use crosssectional design. Intake of patient chronic kidney disease data done by prospective at limited population in ward and HCU Melati I Dr. Moewardi Hospital during September - November 2007 period. Data processing done descriptively analytic. Result : During research at hospital found 103 patient diagnosed to have chronic kidney disease and 48 patients (46,6%) including inclusion criteria. Pursuant to 48 patients have inclusion criteria found that 55 infection episode that is have indication at 52 infection episode consist of pneumonia 21 (38,2%), urinary tract infection 22 (40%), sepsis 4 (7,3%), prophylaxis surgery 1 (1,8%), amoebiasis 2 (3,6%), gastroenteritis 1 (1,8%), and tuberculosis 1 (1,8%) and also there are 3 cases (5,5%) use of antibiotic do not indication. There are 45 (81,8%) correct infection episode of precise indication of drug, 6 (10,9%) precisely imprecise indication of drug and 1 (1,8%) is contraindication. Contraindication the use of antibiotic in chronic kidney disease that is nitrofurantoin. There are 16,1% antibiotic dose which not yet been accommodated for the patient with chronic kidney disease and duration of antibiotic which not yet according to. Pursuant to outcome of therapy antibiotic got by 45,5% its good. Adverse drug reaction not yet earned to be assessed in this research. Potential drug interaction happened among some antibiotic with other drug. Conclusion : Conclusion of this study show that the use of antibiotic in patient chronic kidney disease there are only 25 infection episode (45,5%) giving good outcome.

Kata Kunci : Antibiotik,Penyakit ginjal kronik,Indikasi,Dosis,Reaksi obat merugikan,Interaksi obat, antibiotic, chronic kidney disease, indication, dosage, adverse drug reaction, drug interaction.