Implementasi Pedoman

Antibiotika di Rumah Sakit

Hadi Sumarsono, S.Farm., Apt.

 Antibiotic Stewardship Programs

Suatu program yang saling melengkapi

untuk mengubah atau mengarahkan
penggunaan antimikroba di fasilitas
pelayanan kesehatan

Tujuan:
Mengoptimalkan penggunaan antimikroba
dalam rangka pengendalian resistensi

PerMenKes No 2406 Tahun 2011

Antibiotic Stewardship Programs
Infeksi Nosokomial Resistensi Antibiotika

Antibiogram

Kebijakan Antibiotika

Guideline Antibiotika

Prudent use of antibiotics

WHO, 2011
 Antibiotic Stewardship Programs

• Optimize the treatment of infections and reduce adverse

events associated with antibiotic use

• Improve the quality of patient care and improve patient

safety through increased infection cure rates

• Reduced treatment failures and increased frequency of

correct prescribing for therapy and prophylaxis

• Reduce antibiotic resistance

• Saving hospitals money

CDC, 2014
 Core Elements of Hospital
Antibiotic Stewardship Programs
1. Leadership Commitment

2. Accountability

3. Drug Expertise

4. Action

5. Tracking

6. Reporting

7. Education CDC, 2014

 Core Elements of Hospital
Antibiotic Stewardship Programs

1.Leadership Commitment
Dedicating necessary human, financial and information
technology resources

2.Accountability
Identify a single leader who will be responsible for
program outcomes  Physicians

3.Drug Expertise
Identify a single Pharmacy leader who will co-lead the
program

CDC, 2014
 Clinical Pharmacy
• Terlibat langsung dalam penyusunan Kebijakan, Panduan dan Pedoman
penggunaan Antibiotik

1. Kesesuaian Antibiotik dengan Formularium RS

2. Dosis umum - maksimal antibiotik
3. Dosis antibiotik pada anak
4. Dosis antibiotik pada kondisi khusus (Umumnya pada penurunan fungsi
ginjal, berdasarkan Creatinin Clearence Test (CCT)-nya)
5. Antibiotik yang menjadi kontraindikasi pada anak dan wanita menyusui
6. Pregnancy Category setiap antibiotik

• Pemantauan Terapi Obat (PTO) --> Antibiotik setiap pasien rawat inap
setiap hari

• Pelayanan Informasi Obat (PIO) bagi tenaga kesehatan lain (Pemilihan,

kombinasi antibiotik, Dosis, Stabilitas, Ketercampuran, Pemberian, dll)

• Evaluasi Penggunaan Obat (EPO) ~ antibiotik (Kuantitatif dan Kualitatif)

• Monitoring Efek Samping Obat (MESO) ~ Antibiotik

PerMenKes No 72 Tahun 2016
 Core Elements of Hospital
Antibiotic Stewardship Programs

Support of other key groups:

- Clinicians and department heads
- Infection preventionists and hospital epidemiologists
- Laboratory staff
- Information technology staff
- Nurses

CDC, 2014
 Core Elements of Hospital
Antibiotic Stewardship Programs
4.Action
- Implement policies that support optimal antibiotic use
-Avoid implementing too many policies and interventions
simultaneously

5.Tracking
Monitoring antibiotic prescribing and resistance patterns

6.Reporting
Regular reporting information on antibiotic use and resistance to
doctors, nurses and relevant staff

7.Education
Educating clinicians about resistance and optimal prescribing
CDC, 2014
Prinsip Penggunaan Antibiotik Bijak
(Prudent)

Pembatasan penggunaan antibiotik dapat

dilakukan dengan menerapkan pedoman
penggunaan antibiotik, penerapan
penggunaan antibiotik secara terbatas
(restricted), dan penerapan kewenangan
dalam penggunaan antibiotik tertentu
(reserved antibiotics)

PerMenKes No 2406 Tahun 2011

Restricted Antimicrobials  Human Control

Non-Restricted Antimicrobials  Guideline Control

Antimicrobial Stewardship Strategy, 2015

 Restricted Antimicrobials
the problems:

- Harus menghubungi orang yang diberi kewenangan

untuk memutuskan penggunaan antibiotik
 Potensial untuk sulit dihubungi
Potensial terjadi friksi antar orang yang diberi kewenangan

- Jika tidak ada keputusan, maka pemberian antibiotik

akan tertunda
 Tidak patient safety

- Harus menyusun daftar antibiotik yang akan direstriksi

 Sulit dalam implementasi
Antimicrobial Stewardship Strategy, 2015
 Restricted Antimicrobials

 Approved criteria
 Indications
 Prescribers
 Services or wards
 Patient populations
 Combination of these

Antimicrobial Stewardship Strategy, 2015

Pedoman Penggunaan Antibiotika
(Guideline)

Making Implementing Evaluation

 Making …

• Kebijakan Penggunaan Antibiotika

• Panduan Penggunaan Antibiotika
• Pedoman Penggunaan Antibiotika (Guideline)
 The Hospital Antibiotic Policy Based

• Host
– Special needs of individual patient groups

• Drug (Antibiotic)
– Spectrum of antibiotic activity
– Pharmacokinetics / pharmacodynamics
– Adverse effects
– Cost

• Microorganism
– Potential to select resistance

Antimicrobial Stewardship Strategy, 2015

Patient Risk Stratification

Disease Severity
Cunha, 2010
 Microorganism Pattern
• Setting
– Ward
– ICU

• Site of Infection
– Lung
– UTI
– SSTI
– cIAI
– BSI

• MIC
CDC, 2014
Implementing …
• Workshop

• Socialization

Antimicrobial Stewardship Strategy, 2015

Evaluation …

Kuantitatif Kualitatif

Defined Daily Doses (DDD) Gyssens

 Sebelum dan sesudah penerapan guideline

 Perbaharuan peta kuman di RS

 Perbaharuan guideline
PerMenKes No 2406 Tahun 2011