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Lampiran1. Contoh Standar Formularium RSU Budi Lestari untuk anti infeksi
Kode 08.01 Kelas Terapi Golongan Aminoglikosida Generik Gentamicin Sulfat Kanamycin Monosulfate Per ml inj: Amikasin Sulfat 250 mg Per ml inj: Amikasin Sulfat 500 mg Per ml inj: Gentamicin Sulfat 40 mg Per ml inj: Gentamicin Sulfat 20 mg Streptomycin Sulphat 08.02 Golongan Sefalosporin Cefadroxil Monohidrat Cefadroxil Monohidrat Cefadroxil Monohidrat Per ml oral drops: Cefadroxil 150 mg Per 5 ml syrup: Cefadroxil Monohidrat 125 mg Per 5 ml syrup: Cefadroxil Monohidrat 250 mg Per 5 ml syrup: Cefadroxil Monohidrat 125 mg Cefixime Trihydrat Nama obat Gentamicin cream Kanamycin Sulphate Meiji Mikasin Sediaan Cream 5 mg Vial 1 gram Vial 2 ml Nama Pabrik Kimia Farma Meiji Kalbe Farma

Mikasin

Vial 2 ml

Kalbe Farma

Gentamicin

Ampul 2 ml

Indofarma

Sagestam

Ampul 2 ml

Sanbe

Streptomycin Sulphat Meiji Cefadroxil Cefat Lapicef Renasistin

Vial 1 gram Kapsul 500 mg Kapsul 250 mg Kapsul 500 mg Kapsul 500 mg Oral Drops 15 ml

Meiji Kimia Farma Sanbe Lapi Fahrenheit

Cefat

Dry Syrup 60 ml

Sanbe

Cefat Forte

Dry Syrup forte 60 ml Syrup 60 ml

Sanbe

Lapicef

Lapi

Cefixime

Tablet 100 mg

Dexa Medica

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Per 5 ml syrup: Cefixime 100 mg Cefixime Trihydrat Per 5 ml syrup: Cefixime 100 mg Cefixime Trihydrat

Cefixime

Syrup 30 ml

Dexa Medica Interbat Interbat

Ceptik Ceptik

Kapsul 100 mg Syrup 30 ml

Cefilia

Kapsul 50 mg Kapsul 100 mg Kapsul 200 mg

Lapi

Cefixime Trihydrate Per 5 ml syrup: Cefixime Trihydrate 100 mg Per 5 ml syrup: Cefixime Trihydrate 100 mg Per 5 ml syrup: Cefixime Trihydrate 100 mg Cefotaxime Na Cefotaxime Na

Cefspan Cefilia Cefspan

Kapsul 50 mg Kapsul 100 mg Dry Syrup 30 ml

Kalbe Farma Lapi Kalbe

Sporetic

Dry syrup 60 ml

Sanbe

Tocef

Dry Syrup 30 ml

Bernofarm

Kalfoxim Cefotaxime Incetax Taxegram Lancef Lapixim

Vial 0,5 gram Vial 1 gram

Kalbe farma Indofarma Indofarma Sanbe Landson Lapi

Ceftriaxone Na

Ceftriaxone Incephin Ecotrixon Trijec Starxon Cefxon

Vial 1 gram

Indofarma Indofarma Bernofarm Landson Interbat Lapi

Cefuroxime Na Cephalexine

Celocid Cephalexin

Kaplet 500 mg Kapsul 500 mg

Dexa Medica Indofarma

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Ceftazidime pentahydrate Cefoperazone Na Per 5ml syrup: Cefaclor 125 mg Cefaclor Monohydrat 08.03 Golongan Kloramfenikol Chloramphenicol Chloramphenicol Chloramphenicol Per 5ml syrup: Chloramphenicol 125 mg Thiamphenicol Per 5 ml syrup: Thiamphenicol mg Per 5 ml syrup: Thiamphenicol mg Thiamphenicol Per 5 ml syrup: Thiamphenicol mg Thiamphenicol Azithromycin Azithromycine Per 5 ml syrup: Azithromycine mg Azithromycin Erythromycin Per 5 ml syrup: Erythromycin 200 mg

Pharodime Cefomax Cloracef

Vial 1 gram Vial 1 gram Dry syrup 60 ml

Pharos Simex Ethica

Cefaclor Chloramphenicol Colsancetine Colsancetine Colsancetine

Kapsul 250 mg Kapsul 500 mg Tablet 250 mg Inj: Vial 1g+ a..p.i 5 ml (amp) Kapsul 250 mg Syrup 60 ml

Ethica Indofarma Sanbe Sanbe Sanbe

Thiamphenicol Thiamycin 125

Kapsul 500 mg Syrup 60 ml

Indofarma Interbat

Thiamycin forte 250 Thiamycin Biothicol 125

Syrup Forte 60 ml

Interbat

Kapsul 500 mg Dry Syrup 60 ml

Interbat Sanbe

08.04

Golongan Makrolida

Biothicol Azithromycin Zibramax Zibramax 200

Kapsul 500 mg Kaplet 500 mg Tablet 500 mg Dry syrup 15 ml

Sanbe Kimia Farma Guardian Guardian

Zistic Erythromycin Erythromycin

Kaplet 500 mg Kaplet 500 mg Kaplet 250 mg Syrup 60 ml

Bernofarm Kimia Farma Kimia Farma

Erythromycin

Erysanbe

Kaplet salut selaput 500 gram

Sanbe

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Per 5 ml syrup: Erythromycin 200 mg

Erysanbe

Dry Syrup 60 ml

Sanbe

Spramycine Spiramycine Per 5 ml syrup: Spiramycine 125 mg 08.05 Golongan Penisilin Amoxycillin Trihydrat

Spiramycine Spirasin Rovadin

Kapsul 500 mg Tablet 500 mg Syrup 60 ml

Indofarma Sanbe Otto

Amoxsan Pehamoxil Kalmoxillin

Vial 1000 mg

Sanbe Phapros Kalbe

Amoxycillin Trihydrat Amoxycillin Trihydrat Amoxycillin Trihydrat Per 5 ml syr: Amoxycillin Trihydrat 125 mg

Amoxsan Intermoxil Wiamox Lapimox Amoxycillin Amoxycillin Amoxsan Lapimox

Kapsul 500 mg Kaplet 500 mg Tablet 500 mg Dry Syrup 60 ml

Sanbe Interbat Landson lapi Kimia Farma Kimia Farma Sanbe Lapi

Per 5 ml syr forte: Amoxycillin Trihydrat 250 mg Per ml drops: Amoxicillin Trihydrat 100 mg Per tablet Amoxycillin 500 mg, Clavulanic acid 125 mg

Amoxsan Forte Lapimox Forte

Syrup Forte 60 ml

Sanbe Lapi

Amoxsan

Drops 15 ml

Sanbe

Co Amoxyclav Clobat Claneksi Palentin

Tablet 625 mg

Indofarma Interbat Sanbe Phapros

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Per 5 ml syr: Amoxicillin Trihydrate 125 mg, K.Clavulanate 31,25 mg Per 5 ml syr: Amoxycillin 250 mg, Clav acid 62,5 mg, Amoxycillin 1 g, Clavulanic Acid 200 mg Sulbactam Ampicillin Sulbactam Ampicillin Sulbactam Ampicillin Sulbactam disodium Ciprofloxacin Ciprofloxacin Ciprofloxacin Per 100 ml lar.infus: Ciprofloxacin 200 mg Levofloxacin

Clabat Claneksi

Dry Syrup 60 ml

Interbat Sanbe

Claneksi Clabat

Dry Syrup Forte 60 ml

Sanbe Interbat

Claneksi

Vial 1000 mg

Sanbe

Bactesyn Pycin Pycin Kedacillin Ciprofloxacin Wiaflox Baquinor Lapiflox Ciprofloxacin Levofloxacin Lexa

Tablet 375 mg Vial 1,5 gram Vial 0,75 gram Vial 1 gram Tablet 500 mg Tablet Film Coated 500 mg Kaplet 500 mg Lar. Infus 100 ml Tablet 500 mg

Kalbe Farma Bernofarm Bernofarm Takeda Indofarma Landson Sanbe Lapi Dexa Kimia Farma Landson

08.06

Golongan Quinolon

Levofloxacin Per 100 ml lar.infus: Levofloxacin 500 mg Per 100 ml lar.infus: Levofloxacin 500 mg Ofloxacin Ofloxacin

Levovid Levofloxacin Lexa Ofloxacin Akilen

Tablet Salut 500 mg Lar. Infus 100 ml Lar. Infis 100 ml Tablet 200 mg Tablet 400 mg Tablet 200 mg Tablet 400 mg

Bernofarm Dexa Medica Landson Indofarma Sanbe

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08.07

Golongan Tetrasiklin

Doxycyclin

Doxycyclin Siclidon

Kapsul 100 mg

Kimia Farma Sanbe

Tetracycline HCl Tetracycline HCl 08.08 Golongan Antifungi Fluconazole Griseofulvin Itraconazole Ketoconazole

Tetra Sanbe Tetrasiklin 250 mg Diflucan Griseofulvin 125 mg Sporacid Ketokonazole Mycoral Formyco

Kapsul 500 mg Kapsul 250 mg Kapsul 150 mg Tablet 125 mg Kapsul 100 mg Tablet 200 mg

Sanbe Kimia Farma Pfizer Indofarma Ferron Kimia Farma Kalbe Sanbe

Ketoconazole 2% Nystatin Per ml: Nystatin 100,000 iu 08.09 Antibakteri Kombinasi Per tablet: Sulfamethoxazole 400 mg, Trimethoprim 80 mg Kaplet Forte Trimethroprim mg, Sulfamethoxazole 800 mg Per ml syr: Trimethroprim mg, Sulfamethoxazole 200 mg 08.10 Golongan Antibiotika Lain Clindamycin Clindamycin 40 160

Ketoconazole Mycostatin Kandistatin Nymico Cotrimoxazole Sanprima Primadex

Cream 10 gram Tablet 500,000 u Drops 12 ml Tablet

Kimia Farma BristolMyers Squibb Metiska sanbe Indofarma Sanbe Dexa

Sanprima Forte Primadex Forte

Tablet Forte

Sanbe Dexa

Cotrimoxazole Sanprima Primadex

Syrup 60 ml

Indofarma Sanbe Dexa

Clindamycin Prolic

Kapsul 150 mg Kapsul 300 mg Kapsul 150 mg Kapsul 300 mg

Indofarma Sanbe

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Lincomycin Lincomycin HCl Per 5 ml syrup: Lincomycin HCl 250 mg Metronidazole Per 100 ml lar. Infus: Metronidazole 500 mg Metronidazole

Linco MPL Lincomycin Biolincom

Kapsul 500 mg Tablet 500 mg Syrup 60 ml

Medikon Indofarma Otto

Metronidazole Metronidazole

Tablet 500 mg Lar. Infus 100 ml

Kimia Farma Dexa Medica Sanovi Aventis

Flagyl

Forte tablet 500 mg