Profiles of Antibiotic Usage In Pneumonia Patients At Internal Medicine Ward, Cipto Mangunkusumo Hospital

Abstract

Background: Frequency of tropical infection in Indonesia are still high nowadays. This condition can cause high frequency of antibiotic usage and antibiotic resistance in the future. Aim of this study was to quantify the antibiotic usage in tropical infection patients in Cipto Mangunkusumo Hospital on June 2014-June 2015 using defined daily dose (DDD) method. The advantage of this method is easy to apply, used to compare between different medicine with same therapeutic group, have similar efficacy but different dose requirement, and also compare between institution or area. Methods: It was a descriptive, cross-sectional study, used medical record as data sources. All tropical infection patients in Internal Medicine Ward, on June 2014-June 2015 period, were included in our study. DDD formula is DDD/100 bed-days= (total amount of antibiotic in gram/DDD value from WHO) x (100 / length of stay of all patients with tropical infection diseases). One DDD mean average maintenance dose per day for a drug used for its main indication for adults. Results: We found 34 patients with tropical infection diagnosis and only 22 patients used antibiotic. The total length of stay for tropical infection patients was 314 days. Three antibiotics with highest DDD were ceftriaxone (54.46), levofloxacin (24.20) and meropenem (21.66). The highest DDD in typhoid fever subjects was ceftriaxone and in leptospirosis subjects were levofloxacin and meropenem. The antibiotic usage pattern could be difference between institutions or area, depends on the etiology and microbial resistance pattern. There were six patients with malaria and DHF treated with antibiotics, even though these diagnosis are not indication for antibiotic treatment. It might be due to bacterial infection as comorbid condition. Conclusions: Ceftriaxone, levofloxacin, and meropenem were antibiotics with the highest DDD unit. The usage of antibiotics for viral and parasite infection might be due to secondary infection.

Assessment of Antibiotic Use in ICU Patients with Pneumonia Using ATC/DDD as a Quantitative Analysis Method

“…In addition, the results of the culture and the clinical circumstances of the patients are taken into account while choosing a treatment. In a study conducted by Gayatri and Bestari (2017) at RSUPN Dr. Cipto Mangunkusumo Jakarta obtained data that azithromycin is the most widely used antibiotic by pneumonia patients, with total use of 62.5 DDD/100 patient days (Gayatri & Bestari, 2017).…”

Quantitative Study of Antibiotic Usage in Pneumonia Patients: Systematic Literature Review

“…The results of research conducted at RSUPN dr. Cipto Mangunkusumo Jakarta in the period 2008-2009 showed the class of generation III cephalosporins and macrolides as the most widely used antibiotics in CAP therapy, with the most widely used antibiotics being ceftriaxone and azithromycin (Rais et al, 2012). The results of studies in the same hospital in different periods (2015) showed similar results where the most widely used antibiotic classes in CAP therapy were generation III cephalosporins and macrolides, with the most widely used antibiotics being ceftriaxone (55.3 DDD / 100 bed days) and azithromycin (62.5 DDD / 100 bed days) (Gayatri &;Bestari, 2017) (Gayatri & Bestari, 2017). Generation III cephalosporins and macrolides are also one of the most commonly used antibiotic classes for CAP therapy where almost seven other journals cite these groups as well as ceftriaxone and azithromycin as the most widely used antibiotics (Connor et al, 2022;Hadiningrat et al, 2021;Kim et al, 2020;Matuz et al, 2015;Tan et al, 2017;Zavira et al, 2021;Zhukova et al, 2017).…”

“…The second most commonly used antibiotic is ceftriaxone, with an average use of 12.51 DDD/100 patient-days and 22.25 DDD/100 bed days. Other studies by Kunhikatta et al (2013) and Gayatri & Bestari (2017) indicated ceftriaxone as the second most used antibiotic in terms of DDD/100 bed days and its prevalence in CAP treatment (Gayatri & Bestari, 2017;Rais et al, 2012). The use of levofloxacin and ceftriaxone in pneumonia therapy is associated with fluoroquinolone and thirdgeneration cephalosporin classes, which have broad-spectrum activity against several pathogens causing CAP.…”

“…Based on a study conducted by Rais et al (2012) at Dr. Cipto Mangunkusumo Hospital, generation III cephalosporins are the most widely used class of antibiotics in HAP therapy, with the antibiotics used are ceftriaxone (Rais et al, 2012). The results of research in the same hospital in the 2015 period showed different results where cephalosporins generation IV (sefepim) were used as the most widely used antibiotic (Gayatri &;Bestari, 2017). The results of clinical studies suggest that sefepim can be used in first-line therapy for serious infections such as nosocomial pneumonia (HAP and VAP).…”

“…A study conducted at Dr. Cipto Mangunkusumo Hospital in Jakarta in 2015 on antibiotic usage in pneumonia patients using the DDD method showed the top three antibiotics with the highest DDD for Community-Acquired Pneumonia (CAP) were azithromycin (62.5), ceftriaxone (55.3), and meropenem (20.1). For Hospital-Acquired Pneumonia (HAP), the top three were cefepime (49.0), meropenem (41.2), and levofloxacin (27.87) (Gayatri & Bestari, 2017). Another study at Cempaka Putih Jakarta Islamic Hospital in 2017 on antibiotic usage in pneumonia patients in 2016 using the ATC/DDD method showed that the most widely used antibiotics were ceftriaxone (29.1%), cefixime (19.2%), and levofloxacin (18.7%) (Nahdira et al, 2016).…”