Penyakit tonsilofaringitis termasuk dalam infeksi saluran pernafasan akut yang kasusnya banyak di masyarakat, mencapai 40 - 60 % kunjungan pasien ke Puskesmas. Dari Sistim Pencatatan dan Pelaporan Terpadu Puskesmas menunjukkan bahwa tonsilofaringitis adalah yang paling sering ditemui di lapangan.Dilain pihak pengobatan antibiotika irasional terus berlangsung, tidak terkecuali ISPA. Padahal menurut laporan WHO, kebanyakan penyakit ISPA disebabkan oleh virus bukan bakteri, hanya 10 % gejala ISPA yang memang betul-betul memerlukan antibiotika.Sementara DepKes RI mengeluarkan pedoman Pengobatan Dasar Berdasar Gejala bagi Puskesmas, dimana faringitis oleh infeksi kuman ditetapkan pilihan I amoksisilin, pilihan II ampisilin, pilihan III penisilin V dan terakhir pilihan IV eritromisinOleh karena itu perlu adanya evaluasi dengan cost effectiveness analysis antara amoksisilin dan eritromisin pada terapi tonsilofaringitis, agar diketahui pilihan yang tepat secara ekonomis di masyarakat.Penelitian dilakukan di daerah Jakarta Barat pada Puskesmas Tambora, mulai bulan Juni sampai dengan September 2002.Dalam evaluasi disertakan faktor-faktor yang berhubungan dengan kesembuhan terapi tonsilofaringitis mulai internal umur, jenis kelamin, pendidikan, status gizi, penghasilan keluarga, kepatuhan minum obat, adanya pengaruh minum obat simptomatis sebelumnya, ada tidaknya efek samping obat dan eksternal terpapar oleh polusi ditempat kerja, kepadatan hunian rumah serta kondisi lingkungan rumah.Desain penelitian kohort, perhitungan sampel uji beda dua mean. Jumlah sampel jadi 241 orang dengan rincian 120 orang menerima pengobatan dengan amoksisilin dan 121 orang menerima pengobatan dengan eritromisin. Jugs dilakukan pemeriksaan kultur kuman dan tes resistensi terhadap 75 spesimen swap, sebagai kontrol terhadap proses terapi yang rasional. Keduanya sensitif, namun eritromisin lebih sensitif dari amoksisilin.Hasil kesembuhan penderita tonsilofaringitis dari 120 orang penderita yang diterapi amoksisilin: 101 (84,2%) orang penderita yang sembuh dan dari 121 orang yang diterapi eritromisin 115 (95,0%) orang penderita yang sembuh. Dalam analisa statistik nilai p = 0,005 bermakna, yang berarti bahwa kesembuhan dipengaruhi oleh adanya perbedaan jenis antibiotika yang digunakan dan nilai RR = 8,007, yang berarti kesembuhan dengan terapi eritromisin lebih baik 8.007 kali dibanding amoksisilin.Berdasarkan perhitungan akhir, unit cost untuk amoksisilin Rp. 182.405,97, lebih murah dibanding eritromisin, yaitu Rp. 156.834,90. Maka terapi tonsilofaringitis yang menggunakan antibiotika eritromisin lebih cost effective dibanding dengan terapi yang menggunakan amoksisilin.
Cost Effectiveness Analysis Between Amoxicillin And erythromycin for The Tonsilopharyngftis Therapies at Puskesmas Tambora, West Jakarta 2002. Tonsilopharyngitis is one of the acute respiratory infection cases which frequently found in society. In fact, 40-60% patients who come to the Puskesmas are infected. The Integrated Reporting and Recording System of Puskesmas shows that tonsilopharyngitis is the most commonly case found in the society.On the other hand, the irrational antibiotic treatment, including ISPA, is continuously conducted. According to WHO, most of the ISPA diseases are mainly caused by virus rather than bacteria. Only 10 % of ISPA symptoms need antibiotic.Depkes RI has published a guidance of the basic treatment based on symptoms, which are given for the Puskesmas. It is stated that the pharyngitis caused by a germ infection determined as option 1 amoxicillin, option II ampicillin, and option III penicillin V and option IV erythromycin.The techniques of cost effectiveness analysis between the amoxicillin and erythromycin for the tonsilopharyngitis are done in order to know the right use of therapy in the society economically.The research is held at Puskesmas Tambora located in west Jakarta started from June until September 2002.It is included in the evaluation the factors which related to the convalescence of the tonsilopharyngitis therapy antibiotic. The internal factors, namely, education, nutrition status, family income, medicine consumption, the previous effect of the symptomatic medicine consumption, the existence of the side effect of the medicine, and the external factors are air pollution in the workplace, thickness of the habitation and the environment condition.Cohort research design is the sample test of the two different means. There are 241 patients for the sample. 120 of them are given with the amoxicillin therapy and the other 121 patients are given with the erythromycin therapy. The culture examination of the germ and the resistance test for the 785-swap specimen are also conducted as the control of the rational therapy. Both of the used antibiotics are still sensitive for the tonsilopharyngitis germ, and the erythromycin is more sensitive rather than amoxicillin.The tonsilopharyngitis healing result of the 120 patients who have given the amoxicillin therapy consists of 101 (84,2%) patients, and 115 (95%) out of the 121 patients who have given the erythromycin therapy are recuperated. In a statistic analysis, p= 0.005 is valuable. It means that the recuperation is influenced by the different kinds of antibiotic used, and RR = 8,007, which has a recovery meaning for the therapy is 8.007 times better than amoxicillin.Based on the final calculation, unit cost for the amoxicillin is Rp 182.405,97 and for the erythromycin is RP 156.834,90. Thus, tonsilopharyngitis therapy, which is using erythromycin, is more cost effective rather than the tonsilopharyngitis therapy using amoxicillin |
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