Evaluasi penggunaan antibiotik pada pasien sepsis di bangsal rawat inap penyakit dalam RSUP DR. Sardjito Yogyakarta periode September-November 2008

PRADIPTA, Ivan Surya, dr. I Dewa P. Pramantara S., SpPD., K-Ger

2009 | Tesis | S2 Farmasi Klinik

Latar Belakang : Sepsis merupakan penyakit infeksi sistemik yang berpeluang besar mengancam jiwa manusia. Ketepatan terapi antibiotik dapat menurunkan angka kematian yang signifikan, namun penggunaan antibiotik perlu dilakukan secara sistematis dan tepat untuk mencegah adanya efek-efek yang merugikan. Tujuan : Untuk mengetahui pola penggunaan antibiotik, kejadian Drug Related Problems (DRPs) dan outcome klinik pada pasien sepsis di RSUP Dr. Sardjito, Yogyakarta. Metode : Penelitian dilakukan secara observasional selama periode September hingga November 2008 di bangsal rawat inap penyakit dalam RSUP Dr. Sardjito, Yogyakarta. Pengumpulan data dilakukan secara prospektif dengan populasi pasien dewasa yang terdiagnosa sepsis. Pengolahan data dilakukan secara deskriptif. Hasil : Dari 42 pasien yang terdiagnosa sepsis, didapatkan 26 pasien memenuhi kriteria inklusi dan 16 pasien memenuhi kriteria eksklusi. Antibiotik yang digunakan sebanyak 25 jenis, dengan 78 kali frekuensi pemberian antibiotik yang meliputi seftriakson 17 (21,8%), seftazidim 8 (10,3%), siprofloksasin 8 (10,3%), kotrimoksasol 5 (6,4%), metronidazol 5 (6,4%), azitromisin 3 (3,8%), levofloksasin 3 (3,8%), meropenem 3(3,8%), sefepim 1 (1,3%), amikasin 1 (1,3%), sefotaksim 1 (1,3%), klindamisin 1 (1,3%), gentamisin 1(1,3%), kanamisin1 (1,3%), sefiksim 1(1,3%), sefoperazon 1 (1,3%), ampisilin sulbaktam 1 (1,3%), fosfomisin 1 (1,3%), klaritromisin 1 (1,3%), INH 4 (5,1%), rifampisin 2 (2,5%), pirazinamid 1 (1,3%), etambutol 4 (5,1%), streptomisin 1 (1,3%) dan FDC 3 (3,8%). Kesimpulan : Didapatkan 23 subyek penelitian (88,4%) mengalami DRPs dan 3 subyek penelitian (11,5%) tidak mengalami DRPs, dengan jumlah kejadian DRPs yang ditemukan, antara lain kebutuhan antibiotik 35 episode (38,4%), ketidaktepatan antibiotik 26 episode (28,6%), ketidaktepatan dosis 6 episode (6,7%), interaksi antibiotik 24 episode (26,4%). Terdapat hubungan yang signifikan antara peningkatan jumlah DRPs terhadap perburukan outcome klinik (p < 0,05).Outcome yang didapatkan, antara lain meninggal > 48 jam 5 pasien (19,2%), meninggal < 48 jam 1 pasien (3,8%), belum sembuh 5 pasien (19,2%), membaik 13 pasien (50%), sembuh 2 pasien (7,7%).

Background : The appropriate of antibiotic therapy can be decreasing significant of mortality rate, but the using of antibiotic therapy need to use with the appropriate and systematic approach to prevent resistance and adverse effect of antibiotic. Objective : This study was aimed at knowing pattern of antibiotic utilization and antibiotic drug related problems in sepsis patient at RSUP Dr. Sardjito, Yogyakarta. Method : This study was carried out in ward of internal disease at RSUP Dr. Sardjito, Yogyakarta, during September- November 2008. Data were collected with the prospective study in adult population who had sepsis diagnostic. Data processing done descriptively. Result: Out of 42 sepsis patients, as many as 26 fulfilled inclusion criteria and 16 fulfilled exclusion criteria. The presume of source infection which lead to sepsis were lungs 12 (24,5 %), unknown source 12 (24,5%), urinary track 11 (22,4%), opportunistic infection 9 (18,4%), ulcus diabetic 3 (6,1%), intra abdomen 2 (4,1%). There were 25 agents of antibiotic used and 78 episode utilization in study periods, there were ceftriaxone 21,8%, ceftazidime 10,3%, ciprofloxacin 10,3%, cotrim 6,4%, metronidazole 6,4%, ethambutol 5,1%, isoniazid 5,1%, azithromycin 3,8%, levofloxacin 3,8%, meropenem 3,8%, FDC 3,8%, rifampicin 2,5%, cefepime 1,3%, amikacin 1,3%, cefotaxime 1,3%, clindamycin 1,3%, gentamycin 1,3%, kanamycin 1,3%, cefixime 1,3%, cefoperazon 1,3%, ampicillin-sulbactam 1,3%, fosfomycin 1,3%, clarithromycin 1,3%, pyrazinamide 1,3%, streptomycin 1,3%. Conclusion : 23 patients had DRPs and 3 patients did not have DRPs. The proportion incident of DRPs were antibiotic needed 35 episode (38,4%), inappropriate antibiotic 26 episode (28,6%), inappropriate antibiotic dose 6 episode (6,7%), antibiotic interaction 24 (26,4%). Have a relationship between increasing number of DRPs and bad clinical outcomes (p < 0,05). The Clinical outcomes of research subject were died with more than 48 hours 5 patients (19,2%), died less than 48 hours 1 patients (3,8%), not yet cure 5 patients (19,2%), clinical improvement 13 patients (50%), cure 2 patients (7,7%).

Kata Kunci : Antibiotik,Drug related problems,Infeksi,Sepsis,antibiotic,drug related problems,infection,sepsis