Evaluation of the Rationality of Antibiotic Use in the General

Hospital Dr. Zainoel Abidin 2018

Roziana

, Riza Sufriadi

Departement of Obstetric and Gynaecology Syiah Kuala University, Darussalam, Banda Aceh, Indonesia

Keywords: Antibiotics, Rationality, Defined Daily Dose, DDD

Abstract: Antibiotics are the most widely used class of drugs in the world related to the many occurrences of bacterial

infections. In general antibiotic prescribing is often suboptimal, not only in developing countries but also in

developed countries. Data related to the rationality of the use of antibiotic drugs in Indonesia is still limited.

In this study on May-June 2018 period, were 9 types of antibiotics used in Obstetric and Gynaecology ward

in General Dr. Zainoel Abidin Hospital. Total 588 DDD per 378 days of care. Phosphomicyn is the most

widely used antibiotic. Phosphomicyn is a broad-spectrum antibiotic whose resistance level is at the General

Hospital Dr. Zainoel Abidin is still low. Phosfomicyn is suitable for use especially in postoperative patients,

both Obstetrics and Gynecology. Followed by Cefazolin, Ceftriaxon as the top 3 antibiotic uses.

1. INTRODUCTION

Antibiotics are the most widely used class of drugs

in the world related to the many occurrences of

bacterial infections. About 10-40% of the world's

health budget is used to procure medical expenses.

Based on WHO data in 2004, almost half of

medicines including antibiotics were used

inappropriately, which worsened the economic

situation for poor and developing countries (WHO,

2007).

Generally, antibiotic prescribing is often

suboptimal, not only in developing countries but

also in developed countries. Widespread improper

use of antibiotics is a major issue in public health

and patient safety. Improper use of antibiotics can

cause various problems, including treatment will be

more expensive, side effects are more toxic,

widespread resistance and the incidence of

superinfection is difficult to treat (Gyssens, 2005;

Gerber et al, 2010).

Data related to the rationality of the use of

antibiotic drugs in Indonesia is still limited. The

Amrin team's research at two teaching hospitals in

Indonesia received only 21% of antibiotic

prescriptions that were classified as rational (Hadi et

al, 2008). Several pathogens studied in Indonesia are

known to be resistant to antibiotics (Lestari et al,

2008; Tjaniadi et al, 2003).

Studies conducted in Indonesia during 1990-

2010 regarding antibiotic resistance, resistance occur

in almost all important pathogenic bacteria. This is a

negative impact of irrational use of antibiotics, use

of antibiotics with unclear indications, inappropriate

dosages or duration of use, improper use, drug status

is unclear, and excessive use of antibiotics

(Febriana, 2012). Controlled use of antibiotics can

prevent the emergence of antimicrobial resistance

and save on antibiotic use, which in turn will reduce

the burden of patient care costs, shorten the length of

treatment, save for hospitals and increase hospital

services (Ministry of Health, 2011).

To ensure rational use of antibiotics, evaluation

is needed. One method that can be used to evaluate

antibiotic use is DDD (Defined Daily Dose). DDD

method is a quantitative drug use evaluation

technique. The quantity measurement data can be an

early prediction of the rationality of drug use

(Nouwen, 2006; Republic of Indonesia Ministry of

Health, 2011). Research on evaluating the rationality

of antibiotic use in in Dr. Zainoel Abidin General

Hospital has been evaluated in 2017 and an annual

evaluation is needed. Therefore, further research was

made in 2018 to evaluate the rationality of antibiotic

use in the in Obstetric

and Gynaecology ward of Dr. Zainoel Abidin

General Hospital.

138

Roziana, . and Sufriadi, R.

Evaluation of the Rationality of Antibiotic Use in the General Hospital Dr. Zainoel Abidin 2018.

DOI: 10.5220/0008789801380141

In Proceedings of the 2nd Syiah Kuala International Conference on Medicine and Health Sciences (SKIC-MHS 2018), pages 138-141

ISBN: 978-989-758-438-1

1.1.

Objective

1) Knowing the rationality of antibiotic use in

the Inpatient Room of General Hospital Dr. Zainoel

Abidin in 2018.

2) Knowing the relationship between the

rationality of antibiotic use and the outcomes of

inpatient clinics in the inpatients of the Obstetric and

Gynaecology ward in Dr. Zainoel Abidin General

Hospital in 2018.

1.2.

Target

The target to be achieved is that it can be used as

a guide to the use of antibiotics as well as a more

rational use of antibiotics so that it can prevent the

occurrence of antibiotic resistance in Dr. Zainoel

Abidin General Hospital.

2. METHODOLOGY

This research is a descriptive observational with

a cross sectional using retrospective study taken

from 100 patient”s medical records to assess the

quality of antibiotic use. The quality of antibiotics

was assessed using DDD (Defined Daily Dose)

category. The sampling method uses random

sampling. There are several inclusion and exclusion

criteria that must be fulfilled to become a research

sample, namely:

Inclusion criteria are:

1. Medical record of hospitalized patients in the

Obstetric and Gynaecology ward of Dr. Zainoel

Abidin General Hospital who uses antibiotics that

are treated in the Obstetric and Gynaecology ward of

Dr. Zainoel Abidin. General Hospital for the period

May - July 2018.

2. Medical records of hospitalized in Obstetric and

Gynaecology ward of Dr. Zainoel Abidin General

Hospital is clearly legible and complete.

Exclusion criteria are:

1. Patients who get antibiotics forcibly before the

patient's antibiotic program is completed

2. Patients undergoing chemotherapy

3. Immunocompromised patient

2.1. Setting

This research was conducted at the Medical Record

Installation of in Dr. Zainoel Abidin General

Hospital by examining the status of patients treated

in the Obgyn ward. Collecting data start from 1st

May 2018 until 31th July 2018.

2.2. Output

The output of this study is:

1. Knowing the rationality profile of antibiotic

use of inpatients in the ward of General Hospital Dr.

Zainoel Abidin in 2018.

2. The Result as consideration to arrange a

guidlines for the antibiotics use in hospitalized

patients in the inpatient unit of the Dr. Zainoel

Abidin.General Hospital

3. RESULT

Graph 1: Total Defined Daily Dose.

The results of the study 100 Patient was teated

in Obstetric and Gynaecology ward of Dr. Zainoel

Abidin General Hospital, with 378 days of care use

588 Define Daily Doses. There were 9 types of

antibiotics used in Dr. Zainoel Abidin General

Hospital. Total 588 DDD per 378 days of care.

Phosphomycin is the most widely prescribed

antibiotic with a total of 302 DDD. Followed by

Cefazolin, Ceftriaxon as the top 3 antibiotic uses.

The least antibiotic prescribes is Sulbactam.

0,00

50,00

100,00

150,00

200,00

250,00

300,00

350,00

Cefadroxil

Cefazolin

Cefixim

Ceftriaxone

Fosfomicin

Levofloxacin

Meropnenm

Metronidazole

Sulbactam

22,00

89,00

50,40

302,00

1,50

2,00

48,50

1,00

Evaluation of the Rationality of Antibiotic Use in the General Hospital Dr. Zainoel Abidin 2018

139

Graph 2: Quantitative Analysis of the Use of

Antibiotics in

Dr. Zainoel Abidin General

Hospital in 2018

From the distribution Quantitative analysis of the

use of antibiotics at Dr. Zainoel Abidin General

Hospital in 2018, there are 9 types of antibiotics

used in the May-June 2018 period. Among the 9

types of antibiotics, phosphomicyn is the most

widely used antibiotic in the Obstetrics and

Gynecology Ward of the General Hospital dr.

Zainoel Abidin. The use of Phosfomicyn antibiotics

exceeds more than half of the total number of

antibiotics used (51.33%). This makes the most

popular antibiotics used. This is because

phosphomicyn is a broad-spectrum antibiotic whose

resistance level is at the General Hospital Dr.

Zainoel Abidin is still low. Phosfomicyn is suitable

for use especially in postoperative patients, both

Obstetrics and Gynecology. The second most use is

cefazolin (15.3%), which is a class of second

generation Cefalosporin antibiotics. The least use is

Ampicillin Sulbactam which is only used as much as

0.17%.

4. CONCLUSION

From 100 Patient was teated in Obstetric and

Gynaecology ward of Dr. Zainoel Abidin General

Hospital, we got 378 days of care use 588 Define

Daily Doses. Phosphomycin is the most widely

prescribed antibiotic with a total of 302 DDD

(51.33%) of 9 types of antibiotics in period May

until July.

REFERENCES

Bisht, R., Katiyar, A., Singh, R., & Mittal, P. (2009).

Antibiotic resistance - A global issue of concern. Asian

Journal of Pharmaceutical and Clinical Research

(Vol. 2).

Choudhury, R., Panda, S. and Singh, D.

(2018), Emergence and dissemination of antibiotic

resistance: A global problem. [online] Ijmm.org.

Available at:

http://www.ijmm.org/article.asp?issn=0255-

0857;year=2012;volume=30;issue=4;spage=384;epage

=390;aulast=Choudhury.

Gaash, B. (2008), Irrational use of antibiotics. Indian

Journal for the Practising Doctor, 5. - References -

Scientific Research Publishing

Gerber, J. S., Newland, J. G., Coffin, S. E., Hall, M.,

Thurm, C., Prasad, P. A., … Zaoutis, T. E. (2010).

Variability in antibiotic use at children’s hospitals.

Pediatrics, 126(6), 1067–1073.

https://doi.org/10.1542/peds.2010-1275

Gyssens, I.C., 2005, Audits for Monitoring the Quality of

Antimicrobial Prescriptions, in Gould, I.M., Meer,

J.W.M. van der (Eds.), Antibiotic Policies, Springer

US, 197–226.

Kristiansson, C., Grape, M., Gotuzzo, E., Samalvides, F.,

Chauca, J., Larsson, M., … Petzold, M. (2009),

Socioeconomic factors and antibiotic use in relation to

antimicrobial resistance in the Amazonian area of

Peru. Scandinavian Journal of Infectious Diseases,

41(4), 303–312.

https://doi.org/10.1080/00365540902783301

Lestari, E. S., Severin, J. A., Filius, P. M. G., Kuntaman,

K., Duerink, D. O., Hadi, U., … Verbrugh, H. A.

(2008). Antimicrobial resistance among commensal

isolates of Escherichia coli and Staphylococcus

aureus in the Indonesian population inside and outside

hospitals. European Journal of Clinical Microbiology

& Infectious Diseases : Official Publication of the

European Society of Clinical Microbiology, 27(1), 45–

51. https://doi.org/10.1007/s10096-007-0396-z

Mettler, J., Simcock, M., Sendi, P., Widmer, A. F.,

Bingisser, R., Battegay, M., … Bassetti, S. (2007).

Empirical use of antibiotics and adjustment of

empirical antibiotic therapies in a university hospital:

a prospective observational study. BMC Infectious

Diseases, 7, 21. https://doi.org/10.1186/1471-2334-7-

Tjaniadi, P., Lesmana, M., Subekti, D., Machpud, N.,

Komalarini, S., Santoso, W., … Oyofo, B. A. (2003).

Antimicrobial resistance of bacterial pathogens

associated with diarrheal patients in Indonesia. The

American Journal of Tropical Medicine and Hygiene,

68(6), 666–670.

Van der Meer, J. W., & Gyssens, I. C. (2001), Quality of

antimicrobial drug prescription in hospital. Clinical

Microbiology and Infection : The Official Publication

of the European Society of Clinical Microbiology and

Infectious Diseases, 7 Suppl 6, 12–15.

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15,13

8,57

12,24

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SKIC-MHS 2018 - The 2nd Syiah Kuala International Conference on Medicine and Health Sciences

140

World Health Organization. (2007), The World Health

Report 2007: A Safer Future. Global Public

Health,96.

https://doi.org/10.1080/13623690801957232

Evaluation of the Rationality of Antibiotic Use in the General Hospital Dr. Zainoel Abidin 2018

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