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"Infeksi daerah operasi (IDO) merupakan infeksi pada sayatan atau organ yang terjadi setelah pembedahan. Upaya pencegahan terhadap infeksi ini menjadi semakin penting dengan jumlah operasi yang semakin meningkat. Pemberian antibiotik profilaksis seringkali dianggap sebagai pencegahan IDO yang paling mudah dilakukan. Namun ketidaktepatan dalam penggunaannya dapat menjadi faktor risiko penyebab terjadinya IDO. Tujuan penelitian ini adalah untuk menganalisis ketidaktepatan penggunaan antibiotik profilaksis pada pasien bedah di RSUD Kota Depok pada periode Januari-Maret 2020. Penelitian ini dilakukan secara observasional dengan disain penelitian deskriptif cross sectional dan pengambilan data dilakukan secara retrospektif. Analisis dilakukan pada sampel sebanyak 139 menggunakan metode Gyssens. Hasil analisis ketidaktepatan penggunaan antibiotik profilaksis dengan metode Gyssens yaitu pada kategori VI sebanyak 138 sampel (99,28%), kategori V sebanyak 83 sampel (60,14%) kategori IVa sebanyak 52 sampel (94,54%). Untuk kategori IVb sampai IIc memiliki nilai yang sama yaitu sebanyak 0 sampel. Kategori I semua sampel tidak tepat waktu pemberian sehingga analisa berakhir pada kategori I dengan jumlah 3 sampel.(100%). Sedangkan angka kejadian infeksi daerah operasi pada pasien bedah di RSUD Kota Depok periode 1 Januari -19 Maret 2020 sebanyak 2,87%. Faktor penyebab terjadinya infeksi daerah operasi karena ketidaktepatan penggunaan antibiotik profilaksis pada waktu pemberian, kepatuhan pasien dan penyakit penyerta (komorbid).

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Surgery area infection (SSI) is an infection of the incision or organ that occurs after surgery. prevention against this infection is becoming increasingly important with an increasing number of operations. Treatment of prophylactic antibiotics as the easiest prevention of SSIs. However, inaccuracy in its use can be a factor in causing SSI. The purpose of this study was to analyze the inaccuracy of prophylactic use in surgical patients at RSUD Kota Depok in the period January-March 2020. This study was conducted observational with a cross-sectional descriptive study and data collection was carried out retrospectively. The analysis was carried out on a sample of 139 using the Gyssens method. The results of the inaccuracy analysis of prophylactic antibiotics using the Gyssens method were 138 samples (99.28%) in category VI, 83 samples (60.14%) in category IVa as many as 52 samples (94.54%). For categories IVb to IIc, there are 0 samples. Category I all samples are not presented on time so that the analysis ends in category I with a total of 3 samples. (100%). Meanwhile, the incidence of infection in the surgical area in surgical patients at the Depok City Hospital for the period January 1-March 19 2020 was 2.87%. Factors causing regional infection due to inappropriate use of prophylactic antibiotics at the specified time, patient and comorbidities (comorbid)."

"ABSTRAKHubungan Ketidaktepatan Pemberian Antibiotika Profilaksis denganKejadian Infeksi Daerah Operasi Post Laparatomi di RSPADGatot Soebroto Tahun 2014-2017Pembimbing : dr. Asri C. Adisasmita MPH., M.Phil., Ph.DInfeksi Daerah Operasi IDO termasuk salah satu dari Healthcare AssociatedInfection rsquo;s HAI 39;s yang paling banyak ditemukan seiring dengan meningkatnya jumlahtindakan operasi. Laparatomi merupakan jenis tindakan operasi yang paling berisikountuk terjadinya infeksi. Salah satu upaya pencegahan infeksi daerah operasi denganpemberian antibiotika profilaksis yang diberikan sebelum, saat dan sampai 24 jam setelahoperasi pada kasus yang secara klinis tidak didapatkan tanda-tanda infeksi. Penelitian inibertujuan untuk mengetahui hubungan ketidaktepatan pemberian antibiotika profilaksisdengan kejadian infeksi daerah operasi post laparatomi di RSPAD Gatot Soebroto Tahun2014-2017. Desain penelitian menggunakan studi kasus kontrol dengan pengambilan datasecara retrospektif menggunakan 268 sampel dari data rekam medik pasien post operasilaparatomi di RSPAD Gatot Soebroto pada tahun 2014-2017, kasus yaitu 67 pasien yangterjadi IDO dan kontrol 201 pasien tidak terjadi IDO . Analisa data dengan uji regresilogistik dengan conditional matching. Hasil penelitian menunjukkan waktu pemberianantibiotika profilaksis pre operasi tidak tepat memiliki risiko 5.17 kali terhadap kejadianinfeksi daerah operasi OR= 5.17 ; 95 CI=1.85-14.40 setelah dikontrol dengan variabellain. Variabel kovariat yang berhubungan terhadap kejadian infeksi daerah operasi yaitudiagnosis operasi digestif OR=3.51; 95 CI=1.04-11.83 , kadar albumin OR= 3.83;95 CI= 1.30-11.25 dan penyakit penyerta OR = 4.05 ; 95 CI=1.40-11.66 . Hasilpenelitian ini dapat menjadi masukan bagi RSPAD Gatot Soebroto untuk lebihmeningkatkan kepatuhan penggunaan antibiotika profilaksis secara tepat waktu, jenis,dosis dan durasi pemberian sesuai panduan untuk mencegah kejadian infeksi daerahoperasi.Kata Kunci: Antibiotika Profilaksis, Infeksi daerah operasi, Laparatomi.

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ABSTRACT Correlation of Inappropriate Antibiotic Prophylaxis with PostLaparatomy Surgical Site Infection at Gatot Soebroto Army CentralHospital Year 2014 to 2017Counsellor dr. Asri C. Adisasmita MPH., MPhil., Ph.DSurgical Site Infection SSI is one of the most commonly infection foundHealthcare Associated Infection 39 s HAI 39 s type as surgery procedure increases.Laparotomy is the type of surgery that is the most at risk for infection. One of theprevention efforts of surgical site infection is antibiotic prophylaxis administrationbefore, during and up to 24 hours after surgery in cases of clinically missing signs ofinfection. This study aims to determine the correlation of inappropriate antibioticsprophylaxis with the post laparatomy surgical site infection in Army Central Hospital RSPAD Gatot Soebroto from 2014 to 2017. The research design was case controlstudy with retrospective data retrieval, using 268 samples from medical record data ofpost laparotomy patient at Army Central Hospital RSPAD Gatot Soebroto from 2014to 2017, cases of 67 patients with SSI and control of 201 patients without SSI . Datawas analyzed using regression logistic conditional matching test. The result of thestudy showed that the inappropriate timing of antibiotic administration in preoperativetreatment made a risk of 5.17 times higher on the incidence of surgical site infection OR 5.17 95 CI 1.85 14.40 after control of other variables. Covariate variables,related to the incidence of surgical site infection, was digestive operation diagnose OR 3.51 95 CI 1.04 11.83 , albumin level OR 3.83 95 CI 1.30 11.25 and comorbid disease OR 4.05 95 CI 1.40 11.66 . The results of this studyhopefully can be an input data for Army Central Hospital RSPAD Gatot Soebroto,to improve adherence of correct timing, type, dose and duration of antibioticsprophylaxis according to guidelines of surgical site infection prevention.Key words Antibiotic Prophylaxis, Surgical Site Infection, Laparatomy"

"ABSTRAKNama : Echa AisyahProgram Studi : Ilmu Kesehatan MasyarakatJudul : Evaluasi Ekonomi Penggunaan Antibiotika Profilaksis CefotaximeDan Ceftriaxone Pada Pasien Operasi Seksio Sesarea Di RumahSakit X Tahun 2017Pemberian antibiotik profilaksis pada operasi seksio sesarea sangat dianjurkan.Menurut pedoman umum penggunaan antibiotik obat dipilih atas dasar keamanan danefektivitas biaya. Evaluasi ekonomi ini menggunakan metode alongside observationalstudy, data dikumpulkan selama bulan April ndash;Mei 2017 secara prospektif mencakup 60pasien dengan operasi seksio sesarea yang mendapatkan antibiotik profilaksis,membandingkan efektivitas biaya antara Cefotaxime dan Ceftriaxone. Hasil ujistatistik menunjukkan bahwa tidak ada perbedaan karakteristik pada 60 pasien tersebut.Analisis menggunakan perspektif rumah sakit, dilaksanakan di rumah sakit milikPemerintah di Jawa Barat. Hasil Systematic Review menunjukkan bahwa tidak adaperbedaan efikasi pada penggunaan kedua obat tersebut. Hasil penelitian inimenkonfirmasi bahwa tidak ada perbedaan outcome klinis berupa infeksi luka operasibaik pada pasien yang mendapatkan antibiotik profilaksis Ceftriaxone maupunCefotaxime. Komponen biaya terbesar adalah biaya operasional 84,79 , diikutibiaya alokasi dari unit penunjang 13,68 , lalu biaya investasi 1,2 dan biayapemeliharaan 0,32 . Analisis memberikan hasil biaya inkremental sebesar Rp.342.535,00 pada satu episode rawat inap. Rumah sakit memiliki potensi untukmenghemat sebesar Rp. 317.529.945,00 setahun dengan memilih antibiotik profilaksisCefotaxime pada pasien operasi seksio sesarea.Kata Kunci : Antibiotik Profilaksis; Operasi Seksio Sesarea; Efektivitas Biaya.

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ABSTRACTName Echa AisyahProgram of Study Public HealthTitle Economic Evaluation on The Use of Prophylaxis AntibioticCefotaxime and Ceftriaxone in Caesarean Section SurgeryPatients at X Hospital in The Year 2017.Prophylactic antibiotic for patients with caesarean section surgery is highlyrecommended in the clinical guideline. The use of antibiotics is selected by usingcriteria safety and cost effectiveness. This economic evaluation was using alongsideobservational study method, prospective data was collected from April to May 2017covering 60 patients with cesarean section surgery who received prophylaxisantibiotics, comparing cost effectiveness between Cefotaxime and Ceftriaxone. Thestatistical test showed that there was no differences of characteristics in the 60 patients.The analysis based on hospital perspective, carried out in a public hospital in WestJava. The Systematic Review showed that there were no difference in the efficacy ofthe drugs. This study confirmed that there was no difference in clinical outcome onsurgical wound infections either in patient who received Ceftriaxone prophylaxis orCefotaxime. The greatest component of the cost was the operational cost 84,79 ,followed by the indirect cost 13,68 , investment cost 1,2 , and maintenance cost 0,32 . The analysis suggested the incremental cost was IDR 342.535 in one episodeof treatment. Hospital would save cost of IDR 317.529.945 a year by choosingCefotaxime prophylactic antibiotics for patients with cesarean section surgery.Keywords Prophylaxis Antibiotic Cesarean Section Surgery Cost Effectiveness"

"Surgical site infections are the second most frequent nosocomial infection after catheter infection. They are associated with increase morbidity and mortality, iength of stay in hospital and cost of care. Antibiotic prophylaxis use is addressed to reduce incidence of surgical site infection. The aim of this research was to find out the pattern of antibiotic prophylaxis use; incidence of surgical site infection; association between antibiotic prophylaxis use and incidence of surgical site infection; and other factors that influence the incidence of surgical site infection. This research was carried out in Dr. Cipto Mangunkusumo Hospital Jakarta and it was a retrospective study with cross-sectional design. A total of 220 samples had been taken proportional randomly according to the type of surgery division from 1,841 medical records in 2005. The result showed that the most antibiotic prophylaxis frequently used was cephalosporin (first and third generation). followed by phosphomycin and metronidazole. Most of the patients were given antibiotic prophylaxis in inappropriate time and the duration of use was more than one day. This study found that the incidence of surgical site infection was 8.6% with the highest percentage occurred at orthopedic surgery (23.3%). Statistically, there was no relationship of class. Timing and duration of antibiotic prophylaxis use with incidence of surgical site infection. Adherence of antibiotic prophylaxis use to hospital guideline was not influenced the incidence of surgical site infection. Multivariate analysis with logistic regression analysis showed that the incidence of surgical site infection were influenced by the type of surgery (OR=2.6) and the use of antibiotics during hospitalization prior to surgery (OR=3.2). The conclusion of this research were the incidence of surgical site infection relatively high and class. timing, duration and adherence to hospital guideline of antibiotic prophylaxis use did not influence it. The wound contaminated and the use antibiotics during hospitalization prior to surgery were risk factors for surgical site infection. It was recommended that the hospital management revise the currently used surgical antibiotic prophylaxis guideline which is no longer relevant to the current situation."

"Angka kejadian bedah caesar di seluruh dunia terus meningkat setiap tahun. Namun, angka risiko kematian pasca bedah caesar sangat tinggi akibat infeksi. Pemakaian suatu jenis antibiotik profilaksis pada sebagian kasus bedah caesar telah terbukti dapat mengurangi kejadian infeksi luka operasi. Tujuan penelitian ini untuk mengetahui pola penggunaan antibiotik profilaksis serta kerasionalan antibiotik profilaksis yang digunakan pada pasien bedah caesar di RSUPN Dr. Cipto Mangunkusumo tahun 2015. Penelitian dilakukan secara observasional dengan menggunakan metode deskriptif dan data diperoleh dari rekam medis pasien secara retrospektif. Pengambilan data dilakukan dengan teknik purposive sampling. Evaluasi kerasionalan penggunaan antibiotik profilaksis dinilai dari ketepatan pasien, tepat indikasi, tepat obat, tepat dosis, tepat waktu pemberian dan tanpa infeksi luka operasi. Pasien yang memenuhi kriteria sebagai subjek penelitian sebanyak 245 pasien. Data yang diperoleh menunjukkan bahwa jenis antibiotik profilaksis yang paling banyak digunakan adalah sefazolin (72,66%). Pada penelitian terdapat pasien bedah caesar yang menerima antibiotik profilaksis 100% tepat pasien, 100% tepat indikasi, 98,78% tepat obat, 98,37% tepat dosis dan 72,24% tepat waktu pemberian, serta 98,37% tanpa infeksi luka operasi. Penggunaan antibiotik profilaksis pada pasien bedah sesar terbukti 72,24% pasien menunjukkan kerasionalan. The number of caesarean section in all over the world continue to increase each year. But the rate of post caesarean section risk of death is very high due to infection. The use of a type of antibiotics prophylaxis in some cases of caesarean section has been proven to reduce the occurrence of surgical site infection. The purpose of this study was to know the image of antibiotic prophylaxis and the rationality of antibiotic prophylaxis on caesarean section patients in RSUPN Dr. Cipto Mangunkusumo in 2015. This study was conducted in observation using descriptive method and the data is acquired from medical record investigation retrospectively. Data were collected using purposive sampling technique. Rational use of antibiotics assessed evaluation of the appropriate patient, appropriate indication, appropriate drug, appropriate dose, appropriate time and without the provision of surgical site infection. Eligible patients as subjects of research were 245 patients. Data obtained showed that the most common kind of antibiotic prophylaxis that being used is cefazoline (72.66%). In this study were caesarean patients who received antibiotic prophylaxis showed 100% appropriate patient, 100% appropriate indication, 98.78% appropriate drug, 98.37% appropriate dose, 72.24% appropriate time and 98.37% no surgical site infection. The usage of antibiotic prophylaxis in patients with proven 72.24% caesarean section patients showed rationality."

"Resistensi antibiotik yang terjadi secara global memunculkan kekhawatiran dalam keberhasilan terapi pengobatan infeksi bakteri, khususnya bakteri patogen. Bakteriosin adalah Peptida Anti Mikroba (PAM) yang diproduksi oleh bakteri di ribosom, sebagai fungsi pertahanan terhadap bakteri lain yang memiliki kekerabatan yang dekat dengan bakteri penghasilnya. Awalnya, bakteriosin dimanfaatkan sebagai pengawet makanan alami. Namun, bakteriosintelah diteliti lebih lanjut sebagai terapi pengobatan infeksi bakteri. Lysostaphin diketahui memiliki efek sinergis dalam kombinasi dengan antibiotik Polymixin B terhadap inhibisi bakteri Methicillin-Resistant Staphylococcus aureus (MRSA). Penelitian ini bertujuan utuk melihat adanya efek yang sinergis dari kombinasi antibiotik lain dengan BLIS yang dihasilkan bakteri Streptococcus macedonicus MBF 10-2 dan Weissella confusa MBF 8-1 terhadap bakteri multiresistensi MRSA.Uji aktivitas dilakukan dengan metode difusi sumur agar dengan menginjeksikan campuran masing - masing larutan BLIS dengan antibiotik ke dalam sumuran logam yang ditancapkan pada medium yang telah ditumbuhkan bakteri. Efek sinergis dilihat dari penambahan zona hambat yang dihasilkan dari masing - masing kombinasi BLIS dan antibiotik yaitu Kloramfenikol, Vankomisin, Ampisilin, dan Tetrasiklin.Peningkatan zona hambat diperoleh dari kombinasi BLIS dari Streptococcus macedonicus MBF 10-2dengan antibiotik Kloramfenikol dan Ampisilin dan dari BLIS dari Weissella confusa MBF 8-1 dengan Kloramfenikol.

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Antibiotic resistance, which happening globally, causes a big concern about the success of bacterial-infections treatment therapy, especially caused by pathogens. Bacteriocin is an Anti-microbial peptide (AMP) which produced by bacteria ribosomally as a defense mechanism against other bacteria, which is closely related with the bacteria producer. At the early introduction, bacteriocin wasfirstlyused as food preservatives. Furthermore, bacteriocin is investigated as an anti-microbial agent for infection therapy. Lysostaphin was known its synergistic effect towards inhibitory of Methicillin-Resistant Staphylococcus aureus (MRSA), when combined with antibiotic Polymixin B. The goal of this research was to get know the synergistic effect from combination between BLIS produced by Streptococcus macedonicus MBF 10-2 dan Weissella confusa MBF 8-1 with another antibiotics against multiresistance bacteria MRSA. Well Agar Diffusion Method was used for the activity test by injecting combination of each BLIS and antibiotics inside a well on a medium with bacteria. Synergistic effect was interpreted by the increasing of inhibition zone resulted from each combination between BLIS and antibiotics used which were Chloramphenicol, Vancomycin, Ampicillin, and Tetracycline. The increase of inhibition zone resulted from combination of BLIS from Streptococcus macedonicus MBF 10-2 with Chloramphenicol and Ampicilin and also of BLIS from Weissella confusa MBF 8-1 with Chloramphenicol."

"[Tingginya tingkat infeksi nosokomial di ICU menyebabkan penggunaan antibiotik ICU cenderung lebih tinggi dari ruang rawat yang lain. Penggunaan antibiotik ini sering kali tidak menunggu hasil uji kepekaan bakteri. Hal ini menyebabkan resistensi terhadap antibiotika semakin cepat terjadi. Tujuan penelitian ini adalah mengetahui jenis antibiotik yang banyak digunakan di ICU RSCM dan mengetahui jumlah penggunaan antibiotik berdasarkan perhitungan Defined Daily Dose (DDD) WHO di ICU RSCM periode Januari hingga Maret 2015. Penelitian ini merupakan penelitian deskriptif observasional dengan menggunakan rekam medis pasien. Dari 167 rekam medis yang diikutkan dalam penelitian ini, tiga antibiotik dengan frekuensi pemakaian terbanyak adalah meropenem (15.31%), seftriakson (14.43%), dan fosfomisin (11.57%). Hasil penilaian kuantitas penggunaan antibiotik berdasarkan metode DDD menunjukkan tiga antibiotik dengan DDD tertinggi adalah meropenem (433.51 DDD/1000 hari rawat), dilanjutkan dengan seftriakson (268.04 DDD/1000 hari rawat dan amikasin (180.41 DDD/1000 hari rawat). Hasil ini cukup tinggi jika dibandingkan dengan kuantitas penggunaan antibiotik rumah sakit lain, The high incidence nosocomial infection in Intensive Care Unit could increase the antibiotics administration. Furthermore, the administration of antibiotics often not based on the results of bacterial susceptibility test. This phenomenon cause the high level of bacterial resistance in ICU. The aim of this study was to determine the most frequent antibiotics used in ICU and to evaluate antibiotic consumption quantitatively using ACT/DDD method in ICU RSCM. This research is a descriptive-observasional study using medical record of the patient. From 167 medical records, three antibiotics with the highest frequency administration were meropenem (15.31%), ceftriaxone (14.43%), dan fosfomycin (11.57%). By using DDD method, three antibiotics with the highest DDD were meropenem (433.51 DDD/1000 bed days), ceftriaxone (268.04 DDD/1000 bed days), and amikacin (180.41 DDD/1000 bed days). This result is quite high when compared with antibiotic consumpsion in another hosp]"

"[ABSTRAKLatar Belakang : Pemberian kotrimoksazol diberikan sebagai standar pencegahan primer terhadap infeksi toksoplasmosis dan pneumonia Pneumocystis jirovecii (PCP) pada pasien HIV dengan CD4 kurang dari 200 sel/mm3 dan pasien tuberkulosis. Beberapa penelitian di luar negeri mendapatkan bahwa pemberian profilaksis kotrimoksazol belum sesuai dengan panduan nasional, sehingga perlu dilakukan penelitian untuk menilai kepatuhan dokter dalam meresepkan profilaksis primer kotrimoksazol.Tujuan : mengetahui pola peresepan dokter terutama dalam memulai, menghentikan, dosis obat, efek samping, durasi pemberian dan persentase lama pemberian profilaksis primer kotrimoksazol pada pasien HIVMetode : Studi ini merupakan studi kohort retrospektif dan mengambil data semua pasien HIV usia lebih dari 18 tahun yang berobat ke UPT HIV RSCM tahun 2004-2013 dan memenuhi kriteria pemberian profilaksis primer kotrimoksazol. Variabel yang diteliti adalah pola inisiasi peresepan, penghentian peresepan, dosis, durasi, persentase lama pemberian, serta ada tidaknya efek samping kotrimoksazolHasil : Sejumlah 3818 pasien mempunyai indikasi pemberian kotrimoksazol dengan nilai tengah usia pasien adalah 29 tahun, pria (79,1%), tuberkulosis (58,5%), stadium 3 dan 4 (86%). Nilai tengah CD4 saat awal adalah 51 sel/mm3 (RIK 101). Profilaksis primer kotrimoksazol sudah dimulai pada 83% pasien. Pemberian dosis kotrimoksazol sudah sesuai pedoman pada 99,8% pasien. Efek samping yang dari yang paling sering sampai yang jarang terjadi adalah peningkatan transaminase (38,1%), leukopenia (16,9%), anemia (16,5%), mual (15,4%), muntah (7,8%), trombositopenia (7,4%) dan alergi (5,3%). Efek samping yang menyebabkan penghentian peresepan adalah alergi (100%), anemia (2,4%), peningkatan transaminase (2,1%), muntah (0,8%) dan leukopenia (0,6%). Pola penghentian peresepan tidak sesuai pedoman pada 61,6% dengan nilai tengah persentase lama pemberian 87,5% (RIK 39) dan nilai tengah durasi pemberian profilaksis primer kotrimoksazol adalah 20 bulan (RIK 20). Durasi pada pasien dengan CD4≤100 sel/mm3 dan >100 sel/mm3 adalah 21 bulan (RIK 22) dan 12,5 bulan (RIK 14,75) dengan nilai p=0,000.Kesimpulan : walaupun pada saat awal 83% pasien HIV dewasa dilakukan pemberian profilaksis primer kotrimoksazol dengan pengaturan dosis yang sangat baik, namun 61,6% penghentian peresepan tidak sesuai pedoman.

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ABSTRACTBack Ground : Cotrimoxazole was standard of primary prevention against toxoplasmosis infection and Pneumocystis jirovecii pneumonia (PCP) in patients with CD4 less than 200 cell/mm3 and tuberculosis. Some study found that prophylactic use cotrimoxazole in patients with HIV was inappropriate with national guideline. It was necessary to have research in order to know clinician adherence to prescribe primary cotrimoxazole prophylaxis.Objective : to know initiation, discontinuation, dosage, adverse events, duration and duration percentage of primary cotrimoxazole prophylaxis in HIV patientsMethods : This was cohort retrospective study and was done in UPT HIV RSCM and subject of study were all patients more than 18 years old from 2004 to 2013 and had indication of primary cotrimoxazole prophylaxis. Variable in this study were initiation, discontinuation, dosage, duration, duration percentage and adverse events of primary cotrimoxazole prophylaxis.Result : There were 3818 patients had indication of primary cotrimoxazole prophylaxis with median age of study subjects were 29 years old, 79,1% were male, 58,5% were tuberculosis, WHO clinical stage 3 and 4 were 86%. Median CD4 at beginning was 51 cell/mm3 (IQR 101). Initiation of primary cotrimoxazole prophylaxis was performed in 83% patients who met indication. 99,8% patients used appropriate dose of cotrimoxazole. Frequent adverse events were increasing hepatic transaminase (38,1%), leucopenia (16,9%), anemia (16,5%), nausea (15,4%), vomiting (7,8%), thrombocytopenia (7,4%) and hypersensitivity (5,3%). Adverse event causing discontinuation were hypersensitivity (100%), anemia (2,4%), increasing hepatic transaminase (2,1%), vomiting (0,8%) and leucopenia (0,6%). Inappropriate discontinuation of cotrimoxazole was 61,6% with median duration percentage was 87,5% (IQR 39) and median of duration was 20 month (IQR 20). Duration in patients with CD4≤100 cell/mm3 and >100 cell/mm3 was 21 month (IQR 22) and 12,5 month (IQR 14,75) p=0,000.Conclusion : although initiation of primary cotrimoxazole prophylaxis was done in 83% adult HIV patients with appropriate dosage, but 61,6% discontinuation was inappropriate with guideline;Back Ground : Cotrimoxazole was standard of primary prevention against toxoplasmosis infection and Pneumocystis jirovecii pneumonia (PCP) in patients with CD4 less than 200 cell/mm3 and tuberculosis. Some study found that prophylactic use cotrimoxazole in patients with HIV was inappropriate with national guideline. It was necessary to have research in order to know clinician adherence to prescribe primary cotrimoxazole prophylaxis.Objective : to know initiation, discontinuation, dosage, adverse events, duration and duration percentage of primary cotrimoxazole prophylaxis in HIV patientsMethods : This was cohort retrospective study and was done in UPT HIV RSCM and subject of study were all patients more than 18 years old from 2004 to 2013 and had indication of primary cotrimoxazole prophylaxis. Variable in this study were initiation, discontinuation, dosage, duration, duration percentage and adverse events of primary cotrimoxazole prophylaxis.Result : There were 3818 patients had indication of primary cotrimoxazole prophylaxis with median age of study subjects were 29 years old, 79,1% were male, 58,5% were tuberculosis, WHO clinical stage 3 and 4 were 86%. Median CD4 at beginning was 51 cell/mm3 (IQR 101). Initiation of primary cotrimoxazole prophylaxis was performed in 83% patients who met indication. 99,8% patients used appropriate dose of cotrimoxazole. Frequent adverse events were increasing hepatic transaminase (38,1%), leucopenia (16,9%), anemia (16,5%), nausea (15,4%), vomiting (7,8%), thrombocytopenia (7,4%) and hypersensitivity (5,3%). Adverse event causing discontinuation were hypersensitivity (100%), anemia (2,4%), increasing hepatic transaminase (2,1%), vomiting (0,8%) and leucopenia (0,6%). Inappropriate discontinuation of cotrimoxazole was 61,6% with median duration percentage was 87,5% (IQR 39) and median of duration was 20 month (IQR 20). Duration in patients with CD4≤100 cell/mm3 and >100 cell/mm3 was 21 month (IQR 22) and 12,5 month (IQR 14,75) p=0,000.Conclusion : although initiation of primary cotrimoxazole prophylaxis was done in 83% adult HIV patients with appropriate dosage, but 61,6% discontinuation was inappropriate with guideline;Back Ground : Cotrimoxazole was standard of primary prevention against toxoplasmosis infection and Pneumocystis jirovecii pneumonia (PCP) in patients with CD4 less than 200 cell/mm3 and tuberculosis. Some study found that prophylactic use cotrimoxazole in patients with HIV was inappropriate with national guideline. It was necessary to have research in order to know clinician adherence to prescribe primary cotrimoxazole prophylaxis.Objective : to know initiation, discontinuation, dosage, adverse events, duration and duration percentage of primary cotrimoxazole prophylaxis in HIV patientsMethods : This was cohort retrospective study and was done in UPT HIV RSCM and subject of study were all patients more than 18 years old from 2004 to 2013 and had indication of primary cotrimoxazole prophylaxis. Variable in this study were initiation, discontinuation, dosage, duration, duration percentage and adverse events of primary cotrimoxazole prophylaxis.Result : There were 3818 patients had indication of primary cotrimoxazole prophylaxis with median age of study subjects were 29 years old, 79,1% were male, 58,5% were tuberculosis, WHO clinical stage 3 and 4 were 86%. Median CD4 at beginning was 51 cell/mm3 (IQR 101). Initiation of primary cotrimoxazole prophylaxis was performed in 83% patients who met indication. 99,8% patients used appropriate dose of cotrimoxazole. Frequent adverse events were increasing hepatic transaminase (38,1%), leucopenia (16,9%), anemia (16,5%), nausea (15,4%), vomiting (7,8%), thrombocytopenia (7,4%) and hypersensitivity (5,3%). Adverse event causing discontinuation were hypersensitivity (100%), anemia (2,4%), increasing hepatic transaminase (2,1%), vomiting (0,8%) and leucopenia (0,6%). Inappropriate discontinuation of cotrimoxazole was 61,6% with median duration percentage was 87,5% (IQR 39) and median of duration was 20 month (IQR 20). Duration in patients with CD4≤100 cell/mm3 and >100 cell/mm3 was 21 month (IQR 22) and 12,5 month (IQR 14,75) p=0,000.Conclusion : although initiation of primary cotrimoxazole prophylaxis was done in 83% adult HIV patients with appropriate dosage, but 61,6% discontinuation was inappropriate with guideline, Back Ground : Cotrimoxazole was standard of primary prevention against toxoplasmosis infection and Pneumocystis jirovecii pneumonia (PCP) in patients with CD4 less than 200 cell/mm3 and tuberculosis. Some study found that prophylactic use cotrimoxazole in patients with HIV was inappropriate with national guideline. It was necessary to have research in order to know clinician adherence to prescribe primary cotrimoxazole prophylaxis.Objective : to know initiation, discontinuation, dosage, adverse events, duration and duration percentage of primary cotrimoxazole prophylaxis in HIV patientsMethods : This was cohort retrospective study and was done in UPT HIV RSCM and subject of study were all patients more than 18 years old from 2004 to 2013 and had indication of primary cotrimoxazole prophylaxis. Variable in this study were initiation, discontinuation, dosage, duration, duration percentage and adverse events of primary cotrimoxazole prophylaxis.Result : There were 3818 patients had indication of primary cotrimoxazole prophylaxis with median age of study subjects were 29 years old, 79,1% were male, 58,5% were tuberculosis, WHO clinical stage 3 and 4 were 86%. Median CD4 at beginning was 51 cell/mm3 (IQR 101). Initiation of primary cotrimoxazole prophylaxis was performed in 83% patients who met indication. 99,8% patients used appropriate dose of cotrimoxazole. Frequent adverse events were increasing hepatic transaminase (38,1%), leucopenia (16,9%), anemia (16,5%), nausea (15,4%), vomiting (7,8%), thrombocytopenia (7,4%) and hypersensitivity (5,3%). Adverse event causing discontinuation were hypersensitivity (100%), anemia (2,4%), increasing hepatic transaminase (2,1%), vomiting (0,8%) and leucopenia (0,6%). Inappropriate discontinuation of cotrimoxazole was 61,6% with median duration percentage was 87,5% (IQR 39) and median of duration was 20 month (IQR 20). Duration in patients with CD4≤100 cell/mm3 and >100 cell/mm3 was 21 month (IQR 22) and 12,5 month (IQR 14,75) p=0,000.Conclusion : although initiation of primary cotrimoxazole prophylaxis was done in 83% adult HIV patients with appropriate dosage, but 61,6% discontinuation was inappropriate with guideline]"

"[Antibiotik merupakan salah satu obat yang paling banyak digunakan dan diresepkan di rumah sakit, salah satunya di Instalasi Gawat Darurat. Tingginya frekuensi penggunaan antibiotik tidak dapat dipisahkan dari risiko meningkatnya resistensi bakteri terhadap antibiotik, sehingga dapat menimbulkan kegagalan terapi antibiotik. Pemakaian antibiotik di suatu fasilitas kesehatan harus selalu di evaluasi agar dapat menghindari hal tersebut. Metode Defined Daily Dose merupakan salah satu metode evaluasi pemakaian obat secara kuantitatif yang sudah terstandardisasi oleh WHO. Penelitian ini menghitung estimasi jumlah pemakaian antibiotik di Instalasi Gawat Darurat RSCM pada bulan Januari-Maret 2015. Penelitian menggunakan 109 sampel rekam medik pasien IGD RSCM yang mendapatkan terapi antibiotik. Hasil perhitungan menunjukkan kuantitas pemakaian antibiotik di IGD RSCM diperkirakan sangat tinggi dengan tiga antibiotik yang paling sering digunakan yaitu ampisilin-sulbaktam (33,59 DDD/1000 kunjungan pasien), sefiksim (20,02 DDD/1000 kunjungan pasien), dan seftriakson (14,44 DDD/1000 kunjungan pasien, The antibiotic is one of the most frequently drug that prescribed in the hospital, especially in the emergency room. High frequency of antibiotic usage is related to the risk of antibiotic resistance that can impact to therapy failure. Antibiotic usage in health care facility must be evaluated in order to prevent that problem. Defined Daily Dose is a method to evaluate antibiotic usage quantitatively which is standardized by WHO. This study calculates estimation amount of antibiotic usage in Emergency Room RSCM on January-March 2015. This study includes 109 medical records from patients of emergency room RSCM that got antibiotic therapy. The result showed that the quantity of antibiotics usage in Emergency Department of RSCM is estimated to be very high with the three most frequently used are ampicillin-sulbactam (33,59 DDD/1000 patients visit), cefixime (20,02 DDD/1000 patients visit), and ceftriaxone (14,44 DDD/1000 patients visit).]"

"lnstalasi farmasi di Rumah sakit pcrlu mendapatkan pengelolaan yang baik, karena instalasi ini bcrperan penting dalam menenlukan baik tidaknya pclayanan Rumah Sakit dan juga pengeluaran Rumah Sakit unluk lnstalasi ini cukup besar. Di Rumah Sakit Umum Daerah Pemerintah Kota Bekasi pengeluaran unmk Instalasi Faxmasi Tahun 2008 sebesar 36,24 % dari total pengeluaran Rumah Sakil, dan dari jumlah tersebut 46,19 % adalah untuk obat, sedangkan jumlah item obat adalah 11733. Dcngan jumlah investasi yang sangat besar tersebut (Rp. 8.000.000.000,-) dengan jumlah item obat yang cukup banyak memerlukan suatu sistem perencanaan yang akurat. Pengawasan obat dengan jumlah item yang banyak akan lebih mudah dilakukan apabila dibuat pengelompokkan obat tcrsebut menurut tingkat pemakaian, tingkat invcstasi dan tingkat kckritisannya. Sedangkan perencanaan dapat dilakukan dengan melakukan forecasiing menggunakan data tahun yang lalu. Penelitian ini dilakukan di Instalasi Farmasi Rumah Sakit Umum Daerah Pemerintah Kota Bckasi dan merupakan penelitian kualitatif dan kuantitatif dengan operation research. Melalui pendekatan kualitatif diharapkan diperoleh informasi tentang Manajemen Farmasi, khususnya perencanaan. Sedangkan dengan operation research didapatkan bahwa dengan suatujumlah persedian yang optimal akan mengcluarkan biaya yang lebih rendah dan sekaligus dapat mengoptimalkan pelayanan. Objek yang akan cliteliti adalah obat golongan antibiotik, karena obat golongan ini banyak dipakai 30,55 % dari total pemakaian obat dan investasi umuk obat ini cukup besar yaitu 24,05 % dari total investasi obat selama tahun 2008. Dilakukan Analisis ABC indeks kritis untuk obat golongan ini dan dihitung prakiraanjumlah kebutuhan bulan januari, Februari dan Maret 2009 untuk antibiotik kelompok A dalam analisis ABC indeks kritis dengan metodc Sinynle Exponenfial Smoothing dengan dengan 0. = 0,3 dan patokan perhitungan adalah MAD. Selanjutnya dibandingkan dengan perencanaan yang dilakukan Rumah Sakit dengan uji peringkat bertanda Wilcoxon. Untuk antibiotik kelompok Ajuga dilakukan perhitunganjumlah pemesanan optimal. Hasil yang dipcrolch dari pcnclitian ini dikctahui bahwa lnstalasi Farmasi Rumah Sakit Umum Daerah Pemerintah Kota Bekasi. Dalam melakukan perencanaan memakai metode Moving Average dan pemesanan dengan Order Cyrcle Sysrem namun tidak diperolch alasan yang jelas mcngcnai pcmilihan metode ini. Dari analisis ABC indeks kritis diperoleh I2 item antibiotik yang termasuk kelompok A, 50 kelompok B dan 222 kelompok C. Ke-I2 item antibiotik yang termasuk kelompok A tersebut merupakan 51,99 % dari total pemakaian dan 20,73 % dari total invcstasi. Hasil jzrecastmg terhadap kelompok A setelah dibandingkan dengan perencanaan yang dibuat Rumah Sakit ternyata tidak ada perbedaan yang bermakna. Mengacu pada hasil penelitian ini menunjukkan bahwa dengan melakukan pengelompokan antibiotik menurut analisis ABC indeks kritis dapat mcmpcmwdah pcngawasan karena dapat ditentukannya prioritas pengawasan, untuk itu disarankan kepada Rumah Sakit Umum Daerah Pemerintah Kota Bekasi untuk membuat pengelompokkan semua obat menurut analisis ABC indeks kritis untuk mcmudahkan pcngawasan. Dari hasil _/brecasiing yang dilakukan dan setelah diuji ternyala tidak ada pcrbedaan yang bermakna dengan yang telah dilakukan Rumah Sakit, artinya metode perencanaan yang dilakukan Rumah Sakit telah cukup baik, disarankan untuk dipcrtahankan.

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Pharmacy unit should have good management in relation to its role in detemmining the quality of service in the hospital and the cost of this unit is quite high indeed. In Bekasi Public Hospital City 2008, the cost of this unit is about 36,24 % of total cost ofthe hospital from such amount 46,19 % is paid for |.733 items of medicine. Referring a large amount of such invest beside a large number of medicine (Rp. 8.000.000.000,-), the accurate planning is required. Managing of large number of medicine could be simplified by grouping the medicine according to level of use, level of invest and level of critical point. Therefore, the planning could be done by forecasting using the last data.

This reseach was conducted in pharmacy unit of Bekasi Public Hospital City by qualitative and quantitative approach with operation research. By quantitative approach, we expect the information about pharmaceutical management especially planning. More over, operation research could be define that optimal amount of stock would cost less even optimize the sen/ice. Object the research are antibiobics, because the using of this kind of medicine is 30.55 % of total number of all kind of medicine and the invest of antibiotics is quite large number, namely 24.05 % of total invest all kind of medicine a long 2008. Critical index ABC analysis is carried out. Requirement in January, February and March 2009 have been estimated for A group of antibiotics by this analysis using Simple Exponential Smoothing method with U. = 0.3 and calculation point is MAD. Futhennore, the value were compared with the data of planning which done by the hospital by wilcoxon signed ranks test.

The result showed that phamiaceutical instalation in Bekasi Public Hospital City, planning was carried out by Moving Average Method, meanwhile ordering was carried out by Order Cycle System, unfortunately there are no definitive reason in choosing these methods. Critical index ABC analyses found that I2 items of antibiotics were belonging A groups, 50 were belonging B groups and 222 were belonging C groups. All of I2 items of antibiotics belonging A groups were 35.90 % of total using and 28.46 % of total invest. The result of forecasting to A groups compared with planning carried out by hospital showed no significant difference.

The data showed that grouping the antibiotics according to critical index ABC analyses could simply the controlling because the priority of controlling could be determined. Therefore, it could be adviced to the Bekasi Public Hospital City to grouping all the medicine according to the critical index ABC analyses. The result of foreecasting and test showed no significant difference with those carried out by the hospital. It meaned that planning method carried out by hospital is good enough and could be continue."