RESUME OF ANTIMICROBIAL USAGE INFORMATION AND CATEGORIZATION

Type of therapy :
ADE = Antimicrobial Drug Empiric therapy, ADET = Antimicrobial Drug Extended Empiric Therapy,Aa = Alternative agent,ADD = Antimicrobial Drug Documented therapy, ADP = Antimcrobial Drug P

NOTE :TIDAK BOLEH MERUBAH KOLOM

ADE = Antimicrobial Drug Empiric therapy, ADET = Antimicrobial Drug Extended Empiric Therapy,Aa = Alternative agent,ADD = Antimicrobial Drug
Documented therapy, ADP = Antimcrobial Drug Prophylaxis, ADU = Antimicrobial Drug Unknown therapy
 ANALISA KUALITATIF PENGGUNAAN ANTIBIOTIK DENGAN METODE GYSSENS PASIEN ICU RSUD Dr. MOEWARDI
PERIODE : SEPTEMBER 2019
1 No RM : 0145xxx Masuk RS : 25/8/2019 (09.34) Reviewer :
No reg : Masuk ICU :
Nama Pasien : Tn. S Keluar ICU :
Tanggal lahir : Keluar RS : 5/9/2019 (15.54)
Diagnosa : OA Genu S grade IV post TKR
A. Data penggunaan antibiotik/Metode Gyssens

Type of Unit Dose Start Stop Duration Total 0 I II III

Generic Freq (X) Route
therapy (mg) d/m/y d/m/y (day) (day)
A B C A
ADP Netilmycin 2x300 mg 2x300 mg IV 2/9/2019 2/9/2019 1 1 v
ADE Netilmycin 2x300 mg 2x300 mg IV 2/9/2019 4/9/2019 3 3 v
AD
Aa
AD … 0 0
Aa
AD … 0 0
Aa
AD … 0 0
Aa
AD … 0 0
Aa
B. Hasil kultur
Tanggal Spesimen Bakteri Antibiotik Sensitif Antibiotik Intermediate

C. Tanda-tanda vital D. Hasil laboratorium

Tanggal 6/9/1 7/9/1 8/9/1 9/9/19 Parameter
Tek. Darah 130/ 120/ 125/ 120/80 Leukosit (x10³/uL)
Suhu 36,7 37,2 36,9 37
Nadi 80 82 79 80
RR 18 16 22 18
E. Evaluasi
Diagnosa Organisme penyebab yang utama Antibiotik Dosis Antibiotik
OA Genu S grade IV post TKR Netilmicin OD : 6,5 mg per kg q24h Sanford Guid

ADE = Antimicrobial Drug Empiric therapy, ADET = Antimicrobial Drug Extended Empiric Therapy,Aa = Alternative agent,ADD = Antimicrobial Drug
Documented therapy, ADP = Antimcrobial Drug Prophylaxis, ADU = Antimicrobial Drug Unknown therapy
FORMATION AND CATEGORIZATION

nt,ADD = Antimicrobial Drug Documented therapy, ADP = Antimcrobial Drug Prophylaxis, ADU = Antimicrobial Drug Unknown therapy

ADE = Antimicrobial Drug Empiric therapy, ADET = Antimicrobial Drug Extended Empiric Therapy,Aa = Alternative agent,ADD = Antimicrobial Drug
Documented therapy, ADP = Antimcrobial Drug Prophylaxis, ADU = Antimicrobial Drug Unknown therapy
METODE GYSSENS PASIEN ICU RSUD Dr. MOEWARDI
MBER 2019
Reviewer : ……………………….

III IV V VI
B A B C D

v v V

Antibiotik Resisten

Literatur
Sanford Guidline

ADE = Antimicrobial Drug Empiric therapy, ADET = Antimicrobial Drug Extended Empiric Therapy,Aa = Alternative agent,ADD = Antimicrobial Drug
Documented therapy, ADP = Antimcrobial Drug Prophylaxis, ADU = Antimicrobial Drug Unknown therapy
 ANALISIS KUALITATIF PENGGUNAAN ANTIBIOTIK DI ICU RSDM
DENGAN METODE GYSSENS
Pebruari 2014

Kategori Deskripsi Jumlah %

0 Pengobatan sudah tepat
1 Tidak tepat saat pemberian Antibiotik (profilaksis)
2 A TIdak tepat dosis
B Tidak tepat interval
C Tidak tepat cara pemberian
3 A Tidak tepat karena terlalu lama
B Tidak tepat karena terlalu singkat
4 A Tidak tepat, ada obat lain yang lebih efektif
B Tidak tepat, ada yang kurang toksik/lebih aman
C Tidak tepat, ada yang lebih murah
D Tidak tepat, ada yang lebih spesifik
5 Tidak ada indikasi
6 Rekam medic tidak lengkap untuk dievaluasi
Total
 RESUME OF ANTIMICROBIAL USAGE INFORMATION AND CATEGORIZATION
Type of therapy :
ADE = Antimicrobial Drug Empiric therapy, ADET = Antimicrobial Drug Extended Empiric Therapy, Aa = Alternative agent
ADD = Antimicrobial Drug Documented therapy, ADP = Antimcrobial Drug Prophylaxis, ADU = Antimicrobial Drug Unknow therapy,

1 No reg :
Nama PX :
No RM :
Diagnosa :

A. Tanda-tanda vital
Tanggal
Tek. Darah
Suhu
Nadi
Respirasi

B. Gyssens
Unit Freq Start Stop Duration Total
Type of I II III
Generic Dose (x) Route d/m/y d/m/y (day) day
therapy
(mg) A B C A B
AD … 0 0
Aa
AD … 0 0
Aa
AD… 0 0
Aa
AD… 0 0
Aa
AD… 0 0

C. Evaluasi
Diagnosa Bakteri Antibiotik Keterangan
herapy,

IV V VI
A B C D

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