EVALUASI RASIONALITAS PENGGUNAAN ANTIBIOTIKA TERHADAP OUTCOME TERAPI PADA PASIEN PNEUMONIA ANAK DI BANGSAL RAWAT INAP RSUD KARDINAH TEGAL

NUR YULIASIH, Dr. Chairun W, M.kes, M.App.Sc., Apt, Dr. Ika Puspitasari, M.Si., Apt.

2016 | Tesis | S2 Ilmu Farmasi

Pneumonia merupakan penyakit infeksi yang menyebabkan peradangan akut parenkim paru, distal dari bronkiolus terminalis yang mencakup bronkiolus respiratorius, yang menimbulkan konsolidasi paru dan pengisian alveoli oleh eksudat, sel radang dan fibrin serta berkontribusi atas tingginya kematian pada balita di dunia. Antibiotika yang digunakan secara empiris pada terapi pneumonia bertujuan untuk eradikasi atau penghambatan penyebab infeksi sebelum data kultur diperoleh. Dilaporkan 40-62% antibiotika digunakan secara tidak tepat. Intensitas penggunaan antibiotika yang relatif tinggi menyebabkan ancaman global bagi kesehatan dalam bentuk resistensi terhadap antibiotika. Tujuan dari penelitian ini adalah untuk mengetahui rasionalitas penggunaan antibiotika, mengetahui outcome terapi penggunaan antibiotika yang tidak rasional dan rasional serta mengetahui hubungan rasionalitas penggunaan antibiotika terhadap outcome terapi. Penelitian ini merupakan penelitian non-eksperimental analitik retrospektif cohort dengan melakukan purposive sampling pada pasien pneumonia anak usia sampai dengan18 tahun pada periode Agustus 2013 - Agustus 2015. Data yang dikumpulkan adalah data rekam medik pasien pneumonia anak di rawat inap di RSUD Kardinah Tegal. Evaluasi rasionalitas penggunaan antibiotika dinilai berdasarkan diagram alur Gyssens. Outcome terapi yang diamati yaitu respiratory rate, retraksi dan suhu. Data dianalisa dengan uji Chi Square dengan interval kepercayaan (CI) sebesar 95% (alfa= 5%). Hasil penelitian menunjukkan antibiotika dinilai tidak rasional 53,2% dan rasional 46,8%. Antibiotika yang rasional memberikan outcome terapi (respiratory rate dan suhu) normal sekitar 60-70%, tetapi tidak ada perbedaan bermakna penggunaan antibiotika tidak rasional dan rasional pada parameter retraksi. Terdapat hubungan yang signifikan rasionalitas antibiotika terhadap nilai normal pada respiratory rate (p<0,05; RR =1,758; CI 95%= 1,265-2,444) dan suhu (p<0,05; RR= 1,804; CI 95%= 1,350-2,411).

Pneumonia is an infectious disease that causes acute inflammation of the lung parenchyma, distal to the terminal bronchioles include respiratory bronchioles, causing lung consolidation and filling alveoli by exudate, inflammatory cells and fibrin, and contributes as a cause of high mortality in young children worldwide. Antibiotics usage in the treatment of pneumonia empirically was aimed to eradicate or inhibit of infectious agents prior to the culture data obtained. Reported that 40-62% of antibiotics are used inappropriately. The intensity of antibiotics usage relatively high was becomes led to a global threat to health in antibiotics resistance. The aim of this study was to determine the rationality of the use of antibiotics, to know the outcome of the use of antibiotics rationally and irrationally, and to determine the relationship of the rationality of antibiotics usage for therapeutic outcome. This study was a non-experimental analytic retrospective cohort. Sample selected with purposive sampling in children patients with pneumonia aged up to 18 years during August 2013 - August 2015. The collected data was data inpatient medical records of pneumonia patients in Kardinah Hospital, Tegal children who have been in accordance with the inclusion and exclusion criteria. The rationality evaluation of the antibiotics usage assessed based on Gyssens flow chart. The observed therapy outcomes were respiratory rate, retractions and temperature. Data were analyzed by Chi Square test with confidence interval (CI= 95%; alfa = 5%). The results showed that there was irrationally antibiotics usage 53.2 % and rationally 46.8 %. Empirical antibiotic that considered rational has significant effect to normal value in respiratory rate and temperature were in range 60-70%, but no statistically significant effect of antibiotics usage irrationally and rationally on retraction. There was a significant relationship the rationality of the use of antibiotics toward the normal value in the respiratory rate (p <0.05; RR = 1.758; 95% CI = 1.265 to 2.444) and temperature (p <0.05; RR = 1.804; 95% CI = 1.350 to 2.411).

Kata Kunci : Anak, Pneumonia, Rasionalitas Antibiotika, Diagram Alur Gyssens