Terapi Antibiotik pada Infeksi Nosokomial

Antibiotik adalah senyawa kimia yang dalam kadar rendah mempunyai kemampuan untuk menghambat (bakteriostatik) atau menghancurkan (bakterisidal) bakteri atau mikrooganisme lain. Golongan antibiotik yang sering digunakan di rumah sakit meliputi aminoglikosida, fluorokuinolon, penisilin, sefalosporin. Penisilin, misalnya benzil penisilin mempunyai kemampuan untuk menghambat atau menghancurkan bakteri gram positif; sedangkan aminoglikosida, misalnya gentamisin mempunyai kemampuan untuk menghambat atau menghancurkan bakteri gram negatif. Resistensi bakteri terhadap antibiotik dapat terjadi secara alamiah (naturally resistance/intrinsic resistance) atau didapat (acquired resistance). Contoh resistensi alamiah adalah lapisan lipopolisakarida (LPS) yang terdapat di bagian terluar sel bakteri gram negatif sehingga secara alamiah bakteri gram negatif lebih kebal terhadap aktivitas antibiotik dibanding bakteri gram positif. Resistensi bakteri yang didapat (acquired resistance) biasanya terjadi karena penggunaan antibiotik yang tidak tepat. Resistensi bakteri merupakan masalah kesehatan yang penting. Penularan penyakit infeksi oleh bakteri resisten terjadi apabila bakteri resisten tersebut berpindah dari pasien yang satu ke pasien lain. dari pasien ke tenaga kesehatan, dari tenaga kesehatan ke pasien lain, dari tenaga kesehatan yang satu ke tenaga kesehatan yang lain, atau dari tenaga kesehatan ke anggota keluarga di rumah. Pasien yang terinfeksi bakteri resisten memerlukan antibiotik lini kedua atau ketiga. Penggunaan antibiotik yang berlebihan dapat meningkatkan risiko terjadinya reaksi obat yang tidak diinginkan (ROTD), kolonisasi bakteri, superinfeksi, resistensi bakteri, meningkatkan angka mortalitas dan meningkatkan biaya pengobatan. Oleh karena itu, prinsip penggunaan antibiotik di rumah sakit adalah sebagai berikut: (i) Mula-mula gunakan antibiotik spektrum luas dalam waktu singkat, (ii) kemudian gantikan dengan antibiotik spektrum sempit (sesuai dengan hasil kultur) secara oral setelah pemberian antibiotik intravena selama 48- 72 jam, dan (iii) total lama pemberian antibiotik secara oral maupun intravena adalah selama 5 hari (kecuali ada pertimbangan khusus).1-2 Dalam artikel “Infeksi Nosokomial” yang ditulis oleh dr. Ediyono disebutkan bahwa etiologi infeksi nosokomial dapat disebabkan oleh bakteri Staphylococcus aureus, Streptococcus, Eschericia coli, Klebsiella sp, Pseudomonas sp, dan Bacteriodes sp. Antibiotik empiris merupakan terapi awal Terapi Antibiotik pada Infeksi Nosokomial yang perlu diberikan pada pasien yang terkena infeksi nosokomia

Penyakit kardiovaskular: Seri pengobatan rasional

Buku Penyakit Kardiovaskular ini membahas secara holistik dari sudut pandang ahli, yaitu dokter, apoteker dan farmasi klinis. Buku ini membahas beberapa penyakit kardiovaskular, antara lain: hipertensi, dislipidemia, sidroma koroner akut dengan atau tanpa peningkatan segmen ST, stroke dan atrial fibrilasi. Setiap penyakit kardiovaskular pada buku ini dibahas secara detail mulai dari definisi penyakit, etiologi, tanda dan gejala, hingga pengobatan rasional yang berbasis bukti (evidence based). Selain itu perkembangan obat-obat kardiovaskular yang disertai bukti-bukti klinis dibahas dalam bagian akhir buku ini

Initiatives across countries to reduce antibiotic utilization and resistance patterns : impact and implications

Greater accessibility to antibiotics has resulted in their excessive use, leading to increasing antimicrobial resistance (AMR) and strains on healthcare systems, with only a limited number of patients in ambulatory care treated according to guidelines. High rates of AMR are now seen across countries and continents, resulting in AMR becoming one of the most critical issues facing healthcare systems. It is estimated that AMR could potentially cause over 10 million deaths per year by 2050 unless addressed, resulting in appreciable economic consequences. There are also concerns with under-treatment especially if patients are forced to fund more expensive antibiotics as a result of AMR to first line antibiotics and do not have available funds. Over-prescribing of antibiotics is not helped by patient pressure even when physicians are aware of the issues. There is also extensive dispensing of antibiotics without a prescription; although this is now being addressed in some countries. Review interventions that have been instigated across continents and countries to reduce inappropriate antibiotic prescribing and dispensing, and associated AMR, to provide future guidance. Narrative case history approach. A number of successful activities have been instigated to reduce inappropriate prescribing and dispensing of antibiotics across sectors. These include the instigation of quality indicators, suggested activities of pharmacists as well as single and multiple interventions among all key stakeholder groups. Multiple inter-linking strategies are typically needed to enhance appropriate antibiotic prescribing and dispensing. The impact of ongoing activities need to be continually analysed to provide future direction if AMR rates, and their impact on subsequent morbidity, mortality and costs, are to be reduced

Pengaruh Antioksidan Hidrokuinon Dan t-Butilhidrokuinon Terhadap Laju Peruraian Prometasin Hidrokloridum Dalam Krim Vanishing Nonionik

Prometasin hidrokloridum merupakan antihistamin yang mempunyai efektivitas antialergi yang tinggi tetapi mudah mengalami oksidasi yang disebabkan oleh pengaruh cahaya, oksigen maupun adanya sesepora logam seperti Cu ( II ) dan Fe ( III ) sehingga dalam memformula sediaan krim prometasin hidrokloridum perlu ditambahkan antioksidan untuk mencegah peruraian prometasin bidrokloridum. Dalam penelitian ini ingin dilihat pengaruh antioksidan Hidrokuinon ( formula B ) dan t-Butilhidrokuinon ( formula C ) terhadap laju peruraian prometasin hidrokloridum dalam krim vanishing nonionik dibandingkan tanpa prometasin hidrokloridum dalam krim vanishing nonionik tanpa antioksidan ( fonnula A ). Parameter stabilitas yang diamati adalah penampilan, pH dan kadar. Penetapan kadar prometasin hidrokloridum dalam krim vanishing nonionik dilakukan dengan metode spektrofotometri sinar tampak dengan pereaksi palladium klorida. Profil peruraian prometasin hidrokloridum dalam krim vanishing nonionik mengikuti kinetika reaksi order satu Laju peruraian ( k ) dan waktu paruh ( t 1/2 ) prometasin hidrokloridum diolah secara statistik menggunakan metode analisis varian (ANAVA ). Dari hasi1 penelitian dapat ditarik kesimpulan bahwa antioksidan hidrokuinon dan t-butilhidrokuinon berpengaruh terhadap laju peruraian ( k ) dan waktu paruh( t 1/2 ) prometasin hidrokloridum dalam krim vanishing nonionik ( α = 0,05 ) tetapi tidak ada perbedaan laju peruraian ( k ) dan waktu paruh ( t 1/2 ) prometasin hidrokloridum dalam krim vanishing nonionik antara yang diberi antioksidan hidrokuinon dan antioksidan t-butilhidrokuinon ( α = 0,05 )

Influence of penicillin allergy on antibiotic prescribing patterns and costs

The first part of this research was undertaken to assess the impact of documented penicillin allergy on the choice of antibiotics and the clinical and financial consequences of changes in prescribing patterns in an Australian teaching hospital. The medical records of all patients aged >/= 18 years admitted with community-acquired pneumonia (CAP) to Sir Charles Gairdner Hospital (SGGH) over a 15-week period were reviewed prospectively. The severity of patients' penicillin allergies was assessed using a structured questionnaire. The antibiotic cost was calculated using acquisition, delivery (labour and equipment) and laboratory monitoring costs. The appropriateness of antibiotic prescribing was assessed using the Therapeutic Guidelines: Antibiotic (TG:A). The antimicrobial selections and costs were then compared for those patients with (Group A) and without (Group B) penicillin allergy. 155 patients were reviewed (males 71, females 84) with an average age of 68 ± 18 years. Of these, 27 (17.4%) had documented penicillin allergies; of which 12 were classified as Severity I (e.g. anaphylaxis, urticaria), 12 as Severity II (e.g. rash, itch) and three as intolerance (e.g. GI upset). The current TG:A recommends cephalothin or cephazolin as the drugs of choice for mild to moderate CAP patients with a history of penicillin allergy. However, combinations of cephalothin intravenously and azithromycin orally were the most commonly prescribed antimicrobials for such patients. The TG:A recommends erythromycin plus cefotaxime or ceftriaxone as the first-line therapy for severe CAP patients with a documented penicillin allergy. Yet, combinations of intravenous cephalothin, erythromycin and gentamicin were the most frequently prescribed antimicrobials for such patients.A history of penicillin allergy significantly (p<0.05) increased the cost of antibiotic treatment and total cost of admission. The adherence of antibiotic prescribing to the TG:A for patients with penicillin allergies is variable. Patients with labelled penicillin allergies had greater antibiotic costs and total cost of admission. Identifying patients with intolerance rather than allergies would reduce the total inpatient costs at SCGH by A$463.01 a year for mild to moderate CAP patients and A$ 39 614.54 a year for severe CAP patients. The second part of the project was a prospective study of patients admitted to SCGH who had a history of penicillin allergy, but were not suffering from CAP. This study was conducted in order to ensure that the pattern of penicillin allergies of patients admitted to the hospital could be adequately characterised. Over a 5-week period, all adult patients admitted without CAP to SCGH who claimed to have a history of penicillin allergy were interviewed with regard to their penicillin allergies. The standard of allergy documentation was also assessed for each patient. Of the 140 patients assessed (males 63, females 77, average age 61 ± 17 years), 108 (77.1%) were classified as allergic: 61 (56.5%) as Severity I and 47 (43.5%) as Severity 11, 26 (18.6%) as intolerant and the remaining six (4.3%) as not substantiated.The standard documentation of the patients' penicillin allergies was poor - only 40 (38.6%) of either medical records or drug charts had the type of reaction and only five (3.6%) had the date of reaction. In general, penicillin allergies were poorly documented in both patients' medical records and on drug charts. Inadequate detail of reported reactions often made it difficult to assess their clinical significance. These findings prompted a recommendation that pharmacists should help to ensure accurate allergy documentation by evaluating patients and educating both patients and health care professionals

Influence of penicillin allergy on antibiotic prescribing patterns and costs

Antibiotic treatment for patients with community- acquired pneumonia (CAP) and previous history of penicillin allergy varies widely and can be more costly than for those with no history of penicillin allergy. Aim: To assess the influence of documented penicillin allergy on antibiotic prescribing for patients with CAP in an Australian hospital, and the clinical and financial consequences arising from changes to prescribing patterns. Method: The medical records of all patients 18 years and older admitted with CAP over a 15 week period were reviewed. The severity of patients' penicillin allergies was assessed through interview using a structured questionnaire and two groups formed: those with and without penicillin allergy. The antibiotic selections and treatment costs (drug plus accommodation costs) were then compared for the two groups. Results: 155 patients were reviewed (84 females, 71 males) with a mean age of 68 years (SD 18). Of these, 27 (17%) had documented penicillin allergies, of which 12 were classified as Severity 1 (anaphylaxis, urticaria), 12 as Severity 2 (rash, itch) and 3 as intolerance (gastrointestinal upset). Patients with a penicillin allergy were more likely to receive a cephalosporin, a macrolide and/or an aminoglycoside. This approach was in accordance with the recommendations of the Therapeutic Guidelines: Antibiotic (published in 2000), however the choice of cephalosporin in all cases was not. A history of penicillin allergy increased length of stay (p=0.054) and total cost of admission (p=0.051). Conclusion: Adherence of antibiotic prescribing to the Therapeutic Guidelines: Antibiotic for patients with penicillin allergies is variable. Patients labelled with penicillin allergy had greater drug costs and total admission costs. Thorough history taking to identify patients with true allergy versus intolerance may increase appropriate use of penicillins and reduce the use of more costly and potentially toxic alternative antibiotics